EQUIVALENTS OF WEIGHTS AND MEASURES, 
CUSTOMARY AND METRIC. 





Metric 




Troy Weight. 


Weight 

and M 
Measure. 


Fluid 
easure. 


Grains. 


Gr.] [Cc. ; N 


linims. 


7p 


.OOOI 




.0002 








1W5 


.0003 








t|o" 


.0004 








T?s 


.0005 








Ttftf 


.0006 








** 


.OOI Mg. 








1 
"5~0" 


.OOI3 








¥ 


.OOI6 








3*0 


.002 








1 
TO 


.003 








_1_ 
T , 6 


.OO4 








A 


.005 








tV 


.OO6 








i 


.OO8 








i 

6 


.OIO 








1 
4 


• Ol6 








1 
3 


.020 








I 


.032 








1 


.O4O 








1 


.O49 








| 


.050 








9 

TO 


.060 








•95 


.062 






i 


.065 




•05 


i-5 


.O97 




•7 


2 


•I30 


2.1 


2.9 


.185 


3 


3 


.194 


3-2 


3-3 


.246 


4 


4 


•259 


4-2 


4.8 


.300 


5 


5 


.324 


5-3 


5-7 


.370 


6 


6 


.389 


6-3 


6-7 


•431 


7 


7 


•454 


7-4 


7-7 


.500 


8.1 


8 


.518 


8-4 


8.6 


•554 


9 


9 


.583 


9-5 


9-5 


.616 


10 


IO 


.648 


10.5 


ii 


•713 


11. 6 


12 


•775 


12.6 


12.4 


.801 


13 


13 


.842 


13-7 


14 


.907 


14.7 


14-3 


.924 


15 


15 


•972 


15.9 


15-432 


1. 


16.23 


19 


1.232 


20 


20 


1.296 


21 


23.8 


1.540 


25 


28.5 


1.848 


30 [i 3 


30 [hZ 


1.944 


3i-6 


3°-9 


2. 


32-5 


38 


2.464 


40 


40 


2.592 


42.1 


42.8 


2.772 


45 


46.3 


3- 


48.7 


47-5 


3.080 


5o 


5o 


3.240 


52.6 


54.69 [*S 


3-544 


57-5 


57 


3-696 


60 [15 





Metric 




Troy Weight. 


Weight 

and 
Measure. 


Fluid 
Measure. 


Oz. Grains. 


Gr.] [Cc. 


Oz. Minims. 


60 [13 


3.888 


63.I 


61.7 


4- 


64.9 


77.2 


5- 


81.I 


80 


5-184 


84.I 


92.6 


6. 


97-4 


95-i 


6.161 


100 


100 


6.480 


105.2 


108 


7- 


H3-6 


109.37 LiS: 


7.088 


1159 


1 14. 1 


7-393 


120 [23 


120 [25 


7-775 


126.2 


123.5 


8. 


129.8 


138.9 


9- 


146. 1 


142.6 


9.241 


150 


150 


9.719 


157.8 


154.3 


10. 


162.3 


170 


11. 


178.5 


171.1 


11.090 


180 [33 


180 [33 


11.663 


189.3 


185.2 


12. 


194.8 


200.6 


13. 


211 


210 


13.607 


220.9 


216.1 


14. 


227.2 


2i8.75Q- a oI: 


H-I75 


230.1 


228.2 


14.786 


240 [45 


231-5 


15- 


243-4 


240 [45 


15.551 


252.4 


246.9 


16. 


259-7 


262.3 


17- 


275-9 


277.8 


18. 


292.1 


285.2 


18.483 


300 [53 


293.2 


19. 


308.4 


300 [53 


ig.440 


315-5 


308.6 


20. 


324.6 


324.1 


SI. 


340.8 


339-5 


22. 


357-1 


342-3 


22.180 


360 [63 


354-9 


23- 


373-3 


360 [63 


23.327 


378.6 


37o.4 


24. 


389-5 


380.3 


24.644 


400 


385.8 


25. 


405-7 


39o 


25.271 


410.2 


399-3 


25.876 


420 [73 


401.2 


26. 


422 


416.7 


27. 


438.2 


420 [7 3 


27.214 


441.7 


43 2 -i 


28. 


454-4 


437-5 [iS 


28.350 


460.1 


447-5 


29. 


470.7 


456.4 


29-574 


1 . [ij 


463 


30. 


1 6.9 


478.4 


31- 


1 23.I 


1 . . . [13 


31-103 


1 24.8 


1 137-3 


40. 


1 169.2 


1 291.6 


50. 


1 331-5 


1 432.8 


59-147 


2 ... 


1 445-9 


60. 


2 13-8 


2 . . . 


62.207 


2 49-7 


2 409. 2 


88.721 


3 • • • 


3 • • • 


93-3io 


3 74-5 


3 103.2 


100. 


3 183. 1 


4 362 


147.869 


5 • - • 


5 • • • 


I55-5I7 


5 124. 1 


32 72-4 


1000. 


33 390-6 



POTTER'S 

THERAPEUTICS, MATERIA MED1CA 

AND PHARMACY 



FUNK 



NOTICES OF THE MEDICAL PRESS 

OF PREVIOUS EDITIONS OF 

POTTER'S THERAPEUTICS, MATERIA MEDICA, 
AND PHARMACY. 



From the Medical Record: 

"This is an old and valued friend which needs no commendation, much less an intro- 
duction. It ought to be in the library of every physician and student. It is the most con- 
venient and most concise work on therapeutics and materia medica in the English language, 
and is at the same time thoroughly reliable. Though necessarily largely a compilation, 
nevertheless there is much that is original, the author being one of the most prominent of 
American therapeutists." 

From the American Journal of the Medical Sciences: 

"The author has very skilfully steered his course between the pessimism that marks 
a system of therapeutics based solely on the results given by experiments and observations 
in the chemical and physiological laboratories, and the optimism of hasty empirical general - 
zations upon meagre clinical data, and upon this we consider that the greatest claim can 
be made, that this book is a safe one for the junior practitioner. . . . The author, then, 
has fully attained the purpose which he set before him at the commencement." 

From the Lancet, London, England: 

"The third part is entitled 'Special Therapeutics,' and in its compilation a very large 
number of the works of accepted authorities have been laid under contribution. It forms a 
very complete and reliable index of treatment which will be a godsend to many a busy practi- 
tioner who has no time to wade through the copious literature that accompanies each new 
drug into the market." 

From the Australasian Medical Gazette: 

" It is a monument of persistent industry. There is no better book in the English language 
for the student and practitioner. . . . Dr. Potter's book is thoroughly practical, and Part 
III contains an enormous amount of information, for which the student ought to be grateful. 
. . . The chapter on prescriptions is especially well done, in fact the best we have 
seen." 

From the Journal of the American Medical Association: 

"Dr. Potter has embodied many original ideas in the preparation of this work, some, if 
not all of which will prove of very great value to the reader." 

From the Therapeutic Gazette: 

"The author has aimed to embrace in a single volume the essentials of practical materia 
medica and therapeutics, and has produced a book small enough for easy carriage and easy 
reference, large enough to contain a carefully-digested, but full, clear, and well-arranged mass 
If information. No new remedy of any acknowledged value is omitted from this list. Under 
each the section on physiological action and therapeutics has been written with care. . . . 
on the enumeration of drugs suited to different disorders a very successful effort at discrimina- 
tion has been made, both in the stage of disease and in the cases peculiarly suited to the remedy. 
It is no mere list of diseases followed by a catalogue of drugs, but is a digest of modern thera- 
peutics, and as such will prove of immense use to its possessor." 

From the New York Medical Journal: 

"Dr. Potter's Handbook will find a place, and a very important one, in our colleges 
and the libraries of our practitioners. It contains almost everything that can be found in 
the larger works in a more concise form and brought up to a rather more recent date. . . . 
Under the head of prescription writing considerable attention is paid to the subject of incom- 
patibilities, and the student will here find many valuable hints for his guidance in this difficult 
subject. Besides this, there are, under the head of special therapeutics, very many formulas 
for the treatment of particular diseases and abnormal conditions, arranged alphabetically for 
easy reference. This will be especially valuable to young practitioners, and will frequently 
save the trouble of looking through large works and monographs for suitable formulae in the 
treatment of special cases. This department is fuller in this book than in any with which we 
are acquainted." 



THERAPEUTICS 
MATERIA MEDICA AND PHARMACY 



THE SPECIAL THERAPEUTICS OF DISEASES AND SYMPTOMS, 
THE PHYSIOLOGICAL AND THERAPEUTICAL ACTIONS OF 
DRUGS, THE MODERN MATERIA MEDICA, OFFICIAL AND PRAC- 
TICAL PHARMACY, PRESCRIPTION WRITING, AND ANTIDOTAL 
AND ANTAGONISTIC TREATMENT OF POISONING 



BY 

SAM'L O. L. POTTER, A.M., M.D.,M.R.C. P. Lond. 

FORMERLY PROFESSOR OF THE PRINCIPLES AND PRACTICE OF MEDICINE IN THE COOPER MEDICAL 

COLLEGE OF SAN FRANCISCO; AUTHOR OF THE " QUIZ-COMPENDS OF ANATOMY AND 

MATERIA MEDICA," " AN INDEX OF COMPARATIVE THERAPEUTICS," SEVERAL 

ARTICLES IN FOSTER'S " PRACTICAL THERAPEUTICS," AND " SPEECH 

AND ITS DEFECTS"; LATE MAJOR AND SURGEON OF 

VOLUNTEERS, U. S. ARMV. 



THIRTEENTH EDITION 
REVISED AND ENLARGED 

BY 
ELMER H. FUNK, M. D. 

ASSOCIATE IN MEDICINE, JEFFERSON MEDICAL COLLEGE, PHILADELPHIA; MEDICAL 
DIRECTOR AND PHYSICIAN IN CHARGE OF THE DEPARTMENT FOR DISEASES 
OF THE CHEST OF THE JEFFERSON HOSPITAL; VISITING PHYSICIAN 
TO THE WHITE HAVEN SANATORIUM; ASSISTANT PHYSI- 
CIAN TO THE PHILADELPHIA HOSPITAL; FELLOW OF 
THE COLLEGE OF PHYSICIANS OF PHILADELPHIA. 



PHILADELPHIA 

P. BLAKISTON'S SON & CO 

1012 WALNUT STREET 



~RM 



% 



T2 



Copyright, 191 7, by P. Blakiston's Son & Co. 



" The use in this volume of certain portions of the text of the United 
States Pharmacopoeia is by virtue of permission received from the Board 
of Trustees of the United States Pharmacopoeial Convention. The said 
Board of Trustees is not responsible for any inaccuracy of quotation nor 
for any errors in the statement of quantities or percentage strengths." 




.JUL 20 1917 



THE MAPLE PRESS YORK PA 



CU 170330 



TO MY WIFE 

SARAH EVANS POTTER 

WHOSE DEVOTED CARE AND ENCOURAGEMENT 

SUPPORTED THE AUTHOR IN EVERY EXIGENCY 

OF HIS PROFESSIONAL LIFE 



PREFACE TO THE THIRTEENTH EDITION 



The editor has endeavored in this edition to bring the subject matter of 
Potter's book up to date and make the official preparations of the materia 
medica conform with the Ninth Revision of the United States Pharmaco- 
poeia. The task of revision has revealed the tremendous advances that 
have been made in pharmacology and therapeutics since the last edition. It 
has been necessary in many instances to rewrite the subject matter, for 
example, the articles on Digitalis and Diabetes Mellitus. A large amount of 
new material has been added and that which has become obsolete has been 
deleted. The task of deletion has been much more difficult than might at 
first be supposed. It must be borne in mind that many drugs of little prac- 
tical value are either contained in the Pharmacopoeia of the United States 
or have a certain vogue among practitioners. They have been included as a 
matter of reference rather than as a recommendation for their use. Further- 
more, the current medical literature frequently contains reference to remedies 
unknown to many doctors, who by consulting Potter's book will probably find 
some mention of them, with a brief statement of their therapeutic uses. The 
less important drugs are placed in small print and are to be omitted in the 
ordinary study of useful drugs. The editor wishes to state that he is in 
hearty accord with the tendency toward the simplification of modern thera- 
peutics. One of the most notable efforts in this direction was started by the 
Council on Medical Education, and subsequently pursued by the Council on 
Pharmacy and Chemistry of the American Medical Association. A list of 
useful drugs was submitted to the Confederation of State Licensing and 
Examining Boards and to the teachers of pharmacology and therapeutics and 
others interested in the subject. The ultimate result was a book based upon 
the information, advice and suggestions so obtained entitled " A Handbook of 
Useful Drugs," published by the American Medical Association, which has 
been consulted in the preparation of the present edition. The editor has also 
received most valuable aid, from "New and Nonofficial Remedies," a volume 
which contains a description of the medicinal substances that have been 
examined by the Council on Pharmacy and Chemistry of the American 
Medical Association and which appeared to comply with the rules of the 
Council. Every practising physician will do well to refuse to use any other 
nonofficial preparation. 

The Ninth Revision of the United States Pharmacopoeia contains a num- 
ber of new features. Many compound preparations have been deleted, 



V1U PREFACE 

because of their inclusion in the National Formulary, which has now become a 
legal standard for drugs (along with the Pharmacopoeia) as a result of the 
National Food and Drug Act that was passed by Congress June 30, 1906. Of 
those articles official in the U. S. P. VIII, 243 have been omitted from, while 
67 new ones have been included in the U. S. P. IX. There have been 30 
changes in official Latin titles, for example, Alcohol Absolutum has been 
changed to Alcohol Dehydratum; Aqua Hydrogenii Dioxidi to Liquor Hydro- 
genii Dioxidi, etc., etc. The class of preparations known as "Wines" 
has been dropped, owing to the fact that wine as a menstruum or solvent can 
with advantage be replaced by alcohol of various strengths. One of the most 
notable changes in the Pharmacopoeia is the use of the term mil, instead of 
cubic centimeter. The United States Bureau of Standards declared that the 
term cubic centimeter was a misnomer, there being a slight difference be- 
tween the thousandth part of a liter and the cubic centimeter, as one liter was 
determined to be equivalent to 1.000027 cubic decimeters. The Committee 
of Revision decided that the time had come to adopt the word mil, the first 
three letters of the whole word milliliter. In addition, the change promotes 
international uniformity in the two Pharmacopoeias published in the English 
language. Other innovations in the Pharmacopoeia are, the appending, after 
each article in the text, of a list of the official preparations in which it has 
been used; a chapter on sterilization for the production of preparations free 
from microorganisms; a chapter on diagnostical reagents for use in clinical 
tests; and the introduction of biological tests for the assay of certain drugs, 
such as digitalis, aconite, pituitary solution and cannabis. 

Among the notable therapeutic advances that have been included in the 
following pages are: the Serum Treatment of Pneumonia; the Starvation 
Treatment of Diabetes; the Intraspinal Therapy of Neurosyphilis; the Carrel- 
Dakin Treatment of Wounds; the Paraffin Film Treatment of Burns; the 
use of Emetine in Dysentery; the newer methods in bichloride of mercury 
poisoning and many others too numerous to mention in an isolated way. The 
sections on Digitalis and the Treatment of the Cardiac Affections have been 
entirely rewritten to conform with the latest knowledge. An introductory 
paragraph on Prophylaxis has been inserted in those sections dealing with the 
infectious diseases and those of a tropical nature. The text contains new 
articles on Radium and Radiotherapy and upon Electrotherapeutics. The 
rapidly progressing advances in the treatment of disease by biological prod- 
ucts has been noted in various sections throughout the book. 

In conclusion the editor wishes to express his deep appreciation to a num- 
ber of his friends for aid in the revision of certain sections of the book. Dr. 
Henry K. Gaskill, Assistant Professor of Dermatology of the Jefferson Med- 
ical College, has rewritten the sections on the Treatment of Diseases of the 
Skin. Dr. J. Scott Fritch, Instructor in Ophthalmology of the Jefferson 
Medical College, has rewritten the sections on Diseases of the Eye. Dr. W. S. 



PREFACE IX 

Newcomet, Roentgenologist to the Jefferson Hospital, has contributed the 
new paragraphs on Radium and Radiotherapy. Dr. William W. Clark, 
Lecturer on Electrotherapeutics in the Jefferson Medical College, the new 
section on Electrotherapeutics. Dr. Henry K. Mohler, Medical Director of 
the Jefferson Hospital, has revised the sections on Pharmacy and Poisonings, 
Dr. Erwin D. Funk, of the Laboratory of Clinical Medicine in Jefferson 
College, the section on Urine Examination and Dr. Robert M. Lukens, of 
the Tuberculosis Department, the sections on Diseases of the Larynx. Dr. 
W. J. Coley, of New York, has rewritten the section on the Treatment of 
Sarcoma by Mixed Toxins, with which his name is so prominently identified. 
To these gentlemen, whose contributions materially enhance the value of 
the book, the editor wishes to express his deep appreciation for their skilled 
aid so generously given. The Publishers have in every way endeavored 
to lighten the task of revision and it is a pleasure to record their uniform 
courtesy. Finally, the editor is indebted to his secretary, Miss Sarah S. 
Lingamfelter, for untiring aid in many ways while the manuscript was in 
press. 

It is hoped that Potter's book in its newest form may continue to meet the 
demands of students and practitioners of medicine. 

E. H. F. 

13 18 Spruce Street, Philadelphia. 



PREFACE TO THE TWELFTH EDITION 



The additions to the text in this edition number five hundred and thirty, 
making the book eighteen pages larger than before, and including new articles 
on Acidum Nitrosum, Alypin, Arteriosclerosis, Arseno-benzol, Aspirin, 
Chromic Sulphate, Digitalone and other preparations of Digitalis, Enesol, 
Eugenol-acetamide, Fibrolysin, Guaiacose, Hydrargyrum Succinimide, Lacto- 
bacilline, Laxaphen, Laryngitis Edematous, Libradol, Medinal, Novaspirin, 
Novocaine, Pellagra, Pertussin, Phenol-phthalein, Sodium Nucleinate, Tryp- 
sogen, Uriform, Valyl, and Veracolate. The section on Serums and Vaccines 
has been re- written and enlarged, and some obsolete material has been deleted. 

In preparing this edition the author has striven to merit the continued 
favor which has been so constantly shown to this book during the past twenty- 
six years by teachers, students, and practitioners of medicine. 

Samuel O. L. Potter. 

San Francisco, California. 



PREFACE TO THE FIRST EDITION 



The author's intention has been to produce a book which would embrace 
in a single volume the Essentials of practical Materia Medica and Therapeu- 
tics, treating of each subject in as concise phraseology as possible consistent 
with the delineation of every important feature. He has also endeavored to 
formulate such minute and definite directions for the framing of Prescrip- 
tions as might elucidate what to many is a very difficult problem. Further- 
more, he has tried to present as much information upon the subject of Phar- 
macy as every physician should possess, in order to handle the implements of 
his profession with confidence and to direct their use by others with pharma- 
ceutical accuracy. 

The complete fulfilment of these aims would be realized if the book should 
take rank as a working companion to the advanced student and the junior 
practitioner, and be deemed by them a reliable guide through the forest of 
observations and experiments on drug actions and uses, which make progress 



PREFACE XI 

slow for the already over-burdened mind, when ploughing through the more 
exhaustive and exhausting text-books. 

Although this book is essentially a compilation, as all books of its class must 
be, there will be found in its pages much original matter derived from the writer's 
own experience in professional life. The arrangement of the matter will be 
found to be in some respects unique. After full consideration of the many 
arrangements of the Materia Medica in vogue, a modified alphabetical plan 
was adopted, by which the advantages of the alphabetical order might be re- 
tained, while permitting the grouping together of agents which are closely re- 
lated, physiologically and therapeutically, under the title of the principal mem- 
ber of the class — the chief, as it were, of that particular clan. Thus, under 
the title Amylis Nitris will be found mention also of the Ethyl, Sodium and 
Potassium Nitrites, and their congener Nitroglycerin, all of which are closely 
allied to the first-named and to each other, in respect of their actions and uses. 
A very elaborate section on Drug Classification is placed before the Materia 
Medica, in order to supplement such deficiencies in grouping as are inevitable 
in an alphabetical arrangement. 

In detailing the characteristics of an important drug, its physical properties 
and chemical constituents are first briefly enumerated, then its preparations 
are described in the official language of the pharmacopoeia, usually somewhat 
abbreviated; any important unofficial preparations are also noted, and the com- 
pounds into which it enters are enumerated. Next the physiological action is 
taken up, its characteristic features being first described; then the actions 
resulting from an ordinary medicinal dose, next those produced by small doses 
continued, and finally those from a toxic dose. A concise summary of its thera- 
peutical applications closes the article — the whole presenting, it is hoped, a 
clearly defined word-picture of the drug under consideration. Every article 
and preparation comprised in the last edition of the U. S. Pharmacopoeia is 
fully noticed, while all the prominent unofficial agents receive such mention 
as their respective importance seems to demand. 

The second part of the book is devoted to Pharmacy, and has been written 
from the standpoint of a conviction that many young practitioners would 
gladly dispense their own medicines, if provided with a few practical directions on 
the subject; thereby saving many a dollar from the drug store, preventing in 
their own practices at least the "renewals" which constitute so bad a feature 
of modern pharmaceutics, and gaining for themselves a practical acquaintance 
with their professional weapons which cannot but make them better physicians 
and more accurate prescribers. In this section of the book Prescription Writ- 
ing receives full consideration, and many standard formulae are given as samples 
of prescriptions of each kind in extemporaneous use. 

In the third part the subject of Special Therapeutics is treated of elaborately, 
in the form of an alphabetically arranged Index to the treatment of diseases, 
as laid down by the accepted authorities. Every indication for the use of a 



XU PREFACE 

drug is referred to its author by his name or initial, and to the most prominent 
articles are appended a few selected formulae, to serve as guides to the neo- 
phyte in prescribing. 

The Appendix contains numerous Tables, comprising diagnostic hints, Latin 
terms and phrases, formulae for hypodermic use, and metric equivalents. 

The Index has received special attention, from a conviction that, if well 
made, it is the best part of a good book. Every title, synonym and other refer- 
ence of importance is included therein, double and treble entries being made 
in every instance which seemed to require such repetition. 

Cooper Medical College, San Francisco. 



TABLE OF CONTENTS 



PAGE 

INTRODUCTION, i 

Pharmacy i 

Materia Medica, i 

Therapeutics, i 

Empirical Therapeutics, 2 

Rational Therapeutics, 2 

Constituents of Organic Drugs, 4 

Active Principles, 5 

Carbohydrates, 5 

Alkaloids, 5 

Glucosides, 7 

Neutral Principles, 8 

Organic Acids, 8 

Coloring Matters, 8 

Resins, 9 

Fixed Oils and Fats, 9 

Waxes, 10 

Volatile or Essential Oils, 10 

Camphors, 10 

Miscellaneous Compounds, n 

Albuminoids or Protein Bodies, n 

Ferments, 12 

Classification of Medicines (alphabetically arranged), 1 2-46 

Administration of Medicines, 46 

The Hypodermic Method, 48 

The Intraspinal Method 51 

Dosage of Medicines 51 

PART I.— MATERIA MEDICA AND THERAPEUTICS, 53 

Abrus to Zingiber (alphabetically arranged) , 53-492 

PART H.— PHARMACY AND PRESCRIPTION WRITING, 493 

Pharmacopceias and Dispensatories, 493 

Weights and Measures, 494 

Metric System, 496 

Approximate or Domestic Measures, 497 

Specific Gravity and Specific Volume, 498 

Prescriptions, 498 

Procedure in Writing a Prescription, 499 

Analysis of a Prescription, 500 



XIV TABLE OF CONTENTS 

Prescriptions, continued. page 

Use of Latin in Prescriptions, 502 

Principles of Combination, 504 

Metric Prescriptions, 505 

Abbreviations, 506 

Renewals of Prescriptions, 507 

Federal Anti-Narcotic Law, 607 

Prescription Blanks, 507 

Incompatibility, 508 

Chemical Incompatibility, 508 

Pharmaceutical Incompatibility, 510 

Therapeutical Incompatibility, : 511 

Rules for Avoidance of the Dangers of Incompatibility, 511 

Extemporaneous Pharmacy, 513 

Filling a Prescription, 513 

Stock Solutions, 514 

Rules for the Pharmaceutical Student, 515 

Official Pharmacy, 515 

Official Operations, 515 

Pharmaceutical Operations, 515 

Preparations, 523 

Official Preparations, 523 

Pharmaceutical Preparations, 523 

Aceta to Vina, in alphabetical order, 523-556 

Excipients for Emulsions, 528 

Excipients for Mixtures, 538 

Excipients for Pills, 542 

Electrotherapeutics, 556 

PART III.— SPECIAL THERAPEUTICS, 565 

References and Bibliography, 565 

Applied Therapeutics, 573 

Abortion to Xanthoma Palpebrarum, in alphabetical order, 566-895 

Poisoning, v 784 

General Principles of Treatment, 784 

Antagonists and Antidotes, 785 

Poisons, their Antidotes and Antagonists, 789 

Temperature in Disease, 845 

Average Normal Temperature, 845 

Clinical Thermometry, 845 

Abnormal Temperature, 846 

Temperature in Phthisis, 847 

Temperature in Typhoid Fever, 847 

Temperature in Scarlatina, 847 

Temperature in Measles, 847 

Temperature in Diphtheria, 847 

Co-relation of Pulse and Temperature, 847 

Clinical Examination of the Urine, 867 

Composition of the Urine, 868 

Odor, Specific Gravity, etc., 869 



TABLE OF CONTENTS XV 

Clinical Examination of the Urine, continued. page 

Tests for Acetone, Albumin, Bile, etc., 870 

Deposits in Urine, 874 

APPENDIX, 897 

Contractions and Latin Phrases used in Prescriptions, 897 

Latin Numerals, 909 

Genitive Case-endings, ' 910 

Latin Verbs, Participles, Prepositions, etc. , 910 

Hypodermic Formula, 911 

Tables of Differential Diagnosis, 911 

Forms of Renal Disease, 911 

Spinal Diseases and Hip Diseases, 912 

Carditis, (Endocarditis and Pericarditis), 91 2 

Cerebral Concussion and Compression, 912 

Chancre and Chancroid, 913 

Cholera, 913 

Croup and Diphtheria, 913 

Epilepsy and Hysteria, 913 

Iritis, Conjunctivitis and Glaucoma, 914 

Pleurisy and Pneumonia, Intercostal Neuralgia, etc 914 

Pneumonia, Lobular and Lobar, 915 

Scarlet Fever, Measles and Smallpox, 915 

Typhus and Typhoid Fevers, 916 

Varicella and Varioloid 916 

Blackwater, Yellow and Bilious Remittent Fevers, 917 

Tables: 

Table of Drops in and Weights of a Fluidrachm, 918 

Table of Weights and Measures, 918 

Table for Metric Conversions, 919 

Table of Percentage Solutions, 920 

Federal Anti-Narcotic Law, 921 

Table of Equivalent Weights and Measures, Inside of Front Cover. 

Table of Prescription Doses and Quantities, Inside of Back Cover. 

INDEX, 9 2 5 



EXPLANATION 



For Signs and Abbreviations used, see pages 493 to 506, and page 565. 

Average Adult Doses of the U. S. Pharmacopoeia, for each drug and preparation, are given 

in brackets, thus — [av. gr. x.]. 
Unofficial Synonyms are placed in parentheses after the official synonyms. 
Numerals unqualified, under the subtitles Preparations, in Part I, denote grammes for 

solids and mils for liquids. 



xvi 



INTRODUCTION. 



Drugs (drugan, to dry),— is a term which was formerly applied to dried 
medicinal plants, and is still employed by writers and others in that sense. By 
extension, however, it has been made to cover all material substances used for 
the treatment of disease, including remedial agents from the animal and min- 
eral kingdoms as well as those belonging to the vegetable kingdom. 

Pharmacology ((fdp/xaKov, a drug, Aoyos, a discourse) , — is the science which 
treats of drugs and therefore properly embraces in its scope all of materia medica 
and therapeutics relating to drugs. By some writers this term is employed in a 
more restricted sense, including only the physiological action of drugs, a sub- 
ject which is more correctly designated by the word Pharmacodynamics (see 
below). 

Pharmacy is the name of the art which supplements the science of phar- 
macology, namely — the art of preparing drugs according to the requirements 
of the pharmacologist and of dispensing them on the prescriptions of the ther- 
apeutist. It includes a thorough knowledge of the materia medica, an acquaint- 
ance with the theories and manipulations of chemistry and an intimate prac- 
tical experience in many operations peculiar to itself. 

Materia Medica is the branch of Pharmacology which treats of the sub- 
stances used as medicines and describes their origin, composition, physical 
characteristics, chemical properties, modes of preparation and administration, 
also their physiological and toxicological actions. Two of its divisions are — 

Pharmacodynamics ((pdp/xaKov, a drug, dtivapus, power), means the discussion of the 
physiological action of drugs, which is their modifying power upon the normal physiological 
activity of the human organism. 

Toxicology (to^lkSv, a poison, \6yos, a discourse), describes the effects of drugs admin- 
istered in poisonous doses, and treats of the antagonists and antidotes by which their effects 
may be neutralized or the poisons themselves rendered innocuous and removed from the 
organism. 

Therapeutics (Oepcnrevav, to attend upon), comprises all the science and 
art of healing, and includes the use of medicines and all other agents and meas- 
ures which are known to alleviate or cure disease. The operations of Nature 
herself are properly embraced in the general term Therapeutics, which may 
be subdivided as follows: — 

Natural Therapeutics, includes the operations of the Vis Medicatrix 
Naturce, the healing power of Nature, — those modes and processes of heal- 



2 INTRODUCTION. 

ing which occur independently of art and tend to the spontaneous decline and 
cure of disease. There is no scientific dogma better established than this, 
that the living organism is in itself adequate to the cure of all its curable disorders. 
This natural law sustains the medical skeptic in his infidelity as to the value of 
medicines, and helps all physicians out of more close places in practice than 
they are generally willing to acknowledge. This part of the subject is taught 
only casually in the schools, in connection with pathology and the other sub- 
jects embraced in the chair of Principles and Practice of Medicine, but it 
deserves a special chair and more systematic treatment than it receives. 

Applied Therapeutics embraces the application by Art of agents foreign 
to the living organism, for the purpose of aiding Nature to restore the body to a 
healthy condition. This division is the portion of the subject which is taught 
separately and systematically in the schools, and therefore is alone considered 
in the following pages. 

Other divisions of the general subject employed in professional literature 
and conversation are those entitled Empirical Therapeutics and Rational Ther- 
apeutics. 

Empirical Therapeutics is a term applied to the use of medicinal or other 
therapeutical agents for the sole reason that they have been tried previously 
with successful results in cases apparently identical with the one under treat- 
ment. By those who advocate this method it is styled the Therapeutics of 
Experience, and is claimed to be an accumulation of means of combating dis- 
ease simply by observation and experiment independently of physio-pathological 
reasoning (Hartshorne) . It was necessarily the original method in therapeutics, 
has conferred many rich gifts upon medical science, and was advocated by 
many great physicians, notably the eminent and lamented Niemeyer. 

The use of Opium to relieve pain, of Cinchona for malarial fevers, of Colchicum in 
gout, of Potassium Iodide in syphilis, of the Bromides in epilepsy, and of Cod-liver Oil in 
phthisis, are examples of the empirical use of remedies. But, after all has been said for 
it that can be said, the fact remains that it is essentially an unscientific method, a mere ela- 
boration of the prevailing popular habit of recommending Mrs. A. to use pepper tea, because 
it cured Mrs. B. of "the very same trouble." Permitted to reign supreme, it would be de- 
structive to all exactness in therapeutical progress. The so-called "experience" of one ob- 
server is too often overbalanced by the experience of another equally competent and trust- 
worthy; and as few are encouraged to record their failures with remedies, there can be no 
scientific comparison of the failures with the reported successes. For this reason empirical 
methods would tend to a minimum degree of accuracy in a science which, in the very nature 
of things, can never be an exact one; — though undoubtedly such methods will always prevail 
to some extent. 

Rational Therapeutics means the use of remedies for reasons based on a 
knowledge of the pathological, conditions present in the subject and the phy- 
siological action of the agent employed. This method is the very antithesis of 
empiricism, and has been the leading idea in every revolt against empirical 
therapeutics in the past. Humoralism, Chemicism, Solidisrn, Stimulism, Galen- 



INTRODUCTION. 3 

ism in the 2d century, Paracelcism in the 16th, and Hahnemannism in the 19th, 
all originated in efforts to find a more rational system of administering 
medicines than the prevailing empiricism of the day. 

The illustrious Albrecht von Haller, the father of Physiology and the author 
of the doctrine of Irritability, was the real originator of modern physiological 
therapeutics. In the preface to his Swiss Pharmacopoeia {circa A.D. 1755), 
occur the following remarkable directions, — the first recorded of their kind: — 

"Nempe primum in corpore sano medela tentanda est, sine peregrina ulla miscella; 
odoreque et sapore ejus exploratis, exigua illius dosis ingerenda et ad omnes quae inde con- 
tingunt affectiones, quis pulsus, quis calor, quae respiratio, quaenam excretiones attendendum. 
Inde adductum phaenominorum in sano obviorum, transeas ad experiments, in corpore aegroto." 

"In the "first place the remedy is to be tried on the healthy body, without any foreign substance 
mixed with it; having been examined as to its odor and taste, a small dose is to be taken, and the 
attention directed to all effects which thereupon occur; such as upon the pulse, the temperature, the 
respiration, the excretions. Having thereby adduced their obvious phenomena in health, you 
may pass on to experiment upon the sick body." 

Forty or more years after these rules were laid down ex cathedra by Haller, 
the central idea therein was incorporated as one of the main pillars into a med- 
ical edifice then being erected in Germany. In the course of construction this 
pillar became so hidden beneath a superstructure of palpable absurdities, that 
the medical profession, in its anxiety to steer clear of the whole mass, almost 
forgot the corner-stone of truth appropriated from the teachings of one of its own 
greatest teachers. While, however, the mass of the medical profession, blinded 
by prejudice, turned away from everything which savored of drug-experiment, 
a few physicians were quietly working on the lines of Haller's dogma that drug- 
proving is the only true basis of drug-using. As a result of their labors the pres- 
ent generation sees the development of an idea, announced over 150 years ago, 
but now inspiring the minds of teachers and students all over the civilized world. 
Medical colleges are recognizing physiological drug-experimentation as a part 
of their regular curricula; laboratories are fitted up in many of the schools with 
costly instruments of precision, for the more exact prosecution of this study; and 
under the direction of able men, systematic researches are being conducted 
upon animals to ascertain the physiological action of every agent hitherto used 
in medicine. The alkaloids and other active principles of vegetable drugs, 
together with the numerous synthetic compounds which chemistry is giving to 
medicine, are subjected to the same rigid experimentation. The medical 
press of every civilized country is filled with the results of these labors, and no 
medical student is permitted to pass the graduating ordeal until he has mastered 
the essential characteristics of the physiological action of the important medica- 
ments so far as established. What has hitherto been the conviction of but a 
few, is daily growing into a fixed canon of professional belief, that physiological 
experimentation with drugs must be the basis of their therapeutical employ- 
ment, and that all real advance towards the establishment of therapeutics as 



4 CONSTITUENTS OF ORGANIC DRUGS. 

a science must be made upon the lines laid down by Haller, namely, drug- 
proving upon the healthy human organism. Still, in the words of Brown- 
Sequard, " Therapeutics will cease to be empirical, only when this last kind 
of knowledge shall be fully obtained;" but its fulness will never be fully 
realized unless the results have been thoroughly considered with regard to the 
differences due to the action of drugs in different doses on the human organism in 
health and disease. 

A thoroughly-prepared materia medica of half-a-dozen standard drugs, 
such as Aconite, Arsenic, Belladonna, Mercury, Opium and Quinine, based 
upon their actions and uses in different doses and under different states of the or- 
ganism, would be of more real value to the physician who wishes to do his work 
accurately and with his eyes open, than all the contents of the dispensatories, 
plus the entire literature of the "new remedies," and every symptom in the ten 
quarto volumes of the largely discredited and partly repudiated homeopathic 
materia medica. If medical students would devote but one month of their 
annual college vacation to the personal investigation of some one feature of the 
action of some one drug, under such safe-guards against error as would secure 
the acceptance of the resulting observations, a mine of therapeutic gold would 
soon yield its solid truth to eager eyes. Formally laid down by Haller in 1755, 
cultivated to some extent by Alexander in 1768, Crumpe in 1793, Thommassini, 
Curtis, etc., urged by John Hunter, Sir Thomas Watson, Dr. King Chambers, 
and many other luminaries of the medical profession, the scientifically guarded 
proving of drugs on the human organism has lain, like the similar work of Jenner, 
neglected these many years, waiting for another Koch to re-inaugurate the work. 



CONSTITUENTS OF ORGANIC DRUGS. 



Drugs are derived from all the three kingdoms of nature. Those which be- 
long to the mineral kingdom may be termed inorganic drugs and are resolved 
by chemical analysis directly into their ultimate principles, the elementary bod- 
ies of which they are composed. Organic drugs are those which are taken from 
the animal and vegetable kingdoms. They are to some extent composed of 
inorganic materials (water, gases, salts, etc.), but chiefly consist of organic com- 
pounds (proximate principles) obtained by a proximate analysis. The further 
reduction of these proximate principles to their elementary constituents shows 
that Carbon plays the leading role therein, associated with Hydrogen, Oxygen, 
Nitrogen and other elements. The proximate principles of vegetable drugs 
may be divided into insoluble and soluble groups; the first containing those 



CONSTITUENTS OF ORGANIC DRUGS. 5 

which resist the action of ordinary solvents, the second including those which 
may be dissolved in suitable menstrua and thereby separated from those which 
are not soluble in a particular menstruum. 

The Insoluble Constituents are substances which make up the cell-walls of vegetable 
drugs, namely — Cellulin (Cellulose), Lignin and Sclerogen. They are extremely intract- 
able to the action of solvents and yet find places in the materia medica under various forms. 
Cellulin in the form of Cotton is used extensively by both the surgeon and the pharmacist, 
and by the action of strong acids or alkalies thereon, there is obtained Pyroxylin (Gun-cot- 
ton), which dissolved in ether makes Collodion. By the destructive distillation of cellulin 
and lignin a large number of solid, liquid and gaseous products are obtained, including acetic 
acid, methylic alcohol, phenol, creosote and tar. From their natural decomposition result 
amber, coal, coal-tar and the many derivatives of the latter substance. The Soluble Con- 
stituents include some principles which are medicinally inert and also many active principles. 

The Active Principles include carbohydrates, alkaloids, glucosides, neutral 
principles, organic acids, resins, fixed oils and fats, waxes, volatile oils, camphors, 
miscellaneous principles (phenols, ketones, etc.), protein bodies (albuminoids) 
and ferments. Some of these are not proximate principles from the strict chem- 
ical point of view, as they are not simple bodies (e. g., fixed oils, fats, waxes, and 
many of the volatile oils), but for the purposes of the materia medica it is con- 
venient to so classify them. Others are active chiefly as foods, though in 
some cases they are employed as medicinal agents. For the methods of ex- 
tracting the soluble principles from drugs see the articles entitled Maceration 
and Percolation, in Part II of this book. 

Carbohydrates are properly regarded as foods rather than as medicines, 
yet many of them possess remedial qualities due to their neutral, bland, demul- 
cent, lubricant, protective or soothing action. They include the Amyloids, 
cellulose, starch, dextrin, inulin, etc., the Sugars, as glucose, levulose, lactose 
(milk sugar), maltose (malt sugar), saccharose (cane sugar), etc., and the Gums 
and Pectin Bodies, as arabin, pectin, bassorin, cerasin, etc. 

Gums are not proximate principles but amorphous, transparent substances which are 
widely disseminated in plants and yield Mucic Acid when treated with nitric acid. They 
form sticky preparations with water and are precipitated by alcohol. Arabin is the main 
constituent of soluble gums. Bassorin, which swells up in water, is one of the constituents 
of gum tragacanth, also of cherry and plum gums. [Compare the articles entitled Acacia 
and Tragacantha, in Part I.] 

Alkaloids {alkali, elSos, resemblance) — are organic basic substances exist- 
ing in many plants, usually in combination with organic acids. They readily 
combine with acids to form crystalline salts which are soluble in water, the al- 
kaloids themselves being almost insoluble therein though dissolving in alcohol. 
They are odorless, of more or less bitter taste, and generally possess powerful 
physiological actions. They are easily decomposed by alkalies or alkaline 
carbonates, and are precipitated from their solutions by several reagents, in- 
cluding iodine in a solution of potassium iodide, potassio-mercuric iodide, 
auric chloride, also picric, tannic, phospho-molybdic and phospho-tungstic 
acids. Their Latin names terminate in -ina, their English names in -ine, as 
Morphina, Morphine. 



6 CONSTITUENTS OF ORGANIC DRUGS. 

Alkaloids are sometimes called organic or vegetable alkalies, to distinguish 
them from the inorganic or mineral alkalies, which they resemble in little ex- 
cept their reaction and basic qualities. The term artificial alkaloid is applied 
to secondary alkaloids derived from natural ones, as Apomorphine. The term 
tetic alkaloid should be restricted to those which occur in nature but have 
been prepared synthetically, and should never be applied to bases which 
are only obtained by synthesis and do not occur naturally, as Antipyrine, 
Thallin, etc. 

Chemically the alkaloids may be regarded as derivatives of Ammonia (NH 3 ) or ammo- 
nias in which one or more atoms of H are replaced by various radicles. They are believed 
to be decomposition products of vegetable albumin occurring in the plant-cells during the 
process of growth. They all contain the elements C, H and N; most of them also contain 
O (amides), and usually occur as crystalline solids which (except Berberine) are colorless. 
A few containing O occur as liquids, namely — Lobeline, Lupuline, Muscarine, Pelletierine 
and Pilocarpine. Some are devoid of O (amines) and occur as volatile, oily liquids, namely — 
Coniine, Nicotine, Piperidine, Pyridine, Sparteine and Trimethylamine. In their chemical 
composition the latter are closely related to Pyridine, C 5 H 5 N, an alkaloid which seems to 
underlie the molecular structure of many others. Some of them may be synthetically pre- 
pared from the pyridine bases (picoline, collidine, etc.). By changing the chemical constitu- 
tion of an alkaloid its physiological action can be completely altered. 

Allied to the alkaloids are the organic products termed Leucomaines and Ptomaines, the 
former being alkaloidal substances produced by the decomposition of albuminous matter in 
the living animal tissues during the normal destructive metamorphosis, the latter being similar 
substances produced by the process of putrefaction. Many of the ptomaines are identical 
with certain vegetable alkaloids. 

Many so-called alkaloids are in reality mixtures of different alkaloids, e. g., Veratrine. 
Some plants contain more alkaloids than one, including a second which may be similar in 
action to the first but weaker (as Brucine) or antagonistic in action to the principal one (as 
Calabarine). 

The first alkaloid discovered was Morphine, isolated and described by the apothecary 
Serturner in 1816. Within sixteen years after that date Strychnine, Brucine, Quinine, Cin- 
chonine, Narcotine, Codeine, Veratrine, Coniine, Atropine, Nicotine, Aconitine and Hyos- 
cyamine were discovered by different chemists. 

Incompatible with the alkaloids are: Alkalies, Alkali Carbonates and Bicarbonates, 
Benzoates, Bichromates, Bromides of the alkalies, Borax, Cyanides, Gold Chloride, Ichthyol, 
Iodides, Mercuric Chloride, Oxalic Acid, Picric Acid, Piperazin, Potassio-mercuric Iodide 
(when acacia is absent), Oxidizers, Salicylates, Sodium Phosphate, Tannic Acid. Many 
alkaloids are physiologically incompatible with others. 

Twenty-four alkaloids are official, under either their own names or those 
of their salts, including Pelletierine and Veratrine, which are described as mix- 
tures of alkaloids. They are as follows: — 

Aconitina, Aconitine, — from Aconirum Napellus. 

Apomorphina, Apomorphine, — a derivative of the alkaloid Morphine. 

Atrophia, Atropine, — from Belladonna and some allied plants. 

Caffeina, Caffeine, — the active principle of Caffea, the coffee plant. 

Cinchonina, Cinchonine, — a minor alkaloid from Cinchona (Peruvian Bark). 

Cinchonidina, Cinchonidine, — another alkaloid from Cinchona. 

Cocaina, Cocaine, — from the plant Erythroxylon Coca. 

Codeina, Codeine, — the second in rank of the Opium alkaloids. 

Colchicina, Colchicine, — the active principle of Colchicum. 

Diacetylmorphina, Diacetylmorphine, — an alkaloid prepared from Morphine. 

Emetina, Emetine, — the hydrochloride of the alkaloid Emetine from Ipecac. 

Homatropina, Homatropine, — a derivative of the alkaloid Atropine. 

Hydrastina, Hydrastine, — from Hydrastis canadensis. 

Hydrastinina, Hydrastinine, — a derivative of Hydrastine. 

Hyoscyamina, Hyoscyamine, — an alkaloid from Hyoscyamus. 

Morphina, Morphine, — the principal alkaloid of Opium." 



CONSTITUENTS OF ORGANIC DRUGS. 7 

Pelletierina, Pelletierine, — a mixture of alkaloids obtained from Granatum. 
Physostigmina, Physostigmine, — also called Eserine, — from Physostigma. 
Pilocarpina, Pilocarpine, — the principal alkaloid of Pilocarpus (Jaborandi). 
Quinina, Quinine, — the principal alkaloid of Cinchona (Peruvian Bark). 
Scopolamina, Scopolamine, — from plants of the Solanacece; identical with Hyoscine. 
Sparteina, Sparteine, — a volatile alkaloid from Scoparius. 
Strychnina, Strychnine, — the principal alkaloid of Nux Vomica. 
Veratrina, Veratrine, — a mixture of alkaloids from Asagraea officinalis. 

Unofficial but Important Alkaloids are the following: — 

Berberina, Berberine, — from Berberis, Hydrastis, Calumba, and other plants. 
Brucina, Brucine, — the second alkaloid of Nux Vomica. 
Coniiina, Coniine, — the principal alkaloid of Conium (Hemlock). 
Curarina, Curarine, — the active ingredient of Curare (Woorara). 
Duboisina, Duboisine, — from Duboisia ; identical with Hyoscyamine. 
Emetina, Emetine, — the alkaloid of Ipecacuanha. 
Gelsemina, Gelsemine, — the active principle of Gelsemium. 
Hyoscina, Hyoscine, — an alkaloid from Hyoscyamus. 
Muscarina, Muscarine, — from the Fly-agaric, a poisonous mushroom. 
: Piperina, Piperine, — a feeble base obtained from Pepper. 
Quinidina, Quinidine, — a powerful but scanty ingredient of Cinchona. 

Glucosides (ykvKvs, sweet), — form a group of organic principles, existing 
in plants and generally neutral in character. They may be resolved by boiling 
with dilute acids or alkalies, or by the action of ferments, into glucoses (chiefly 
dextrose) or other bodies (mannite, phloroglucin) which themselves yield glu- 
coses, also one or more other bodies (alcohols, aldehydes, phenols, etc.) which 
are different in each case. Thus, Salicin, C 13 H 18 7 , which is a glucoside, by 
the action of a dilute acid is split up into glucose and saligenin, according to 
the following reaction, C 13 H 18 7 + H 2 = C 6 H 12 6 (glucose) + C 7 H 2 2 (sali- 
genin). Under the supposition that glucose and its congeners are alcohols it 
is probable that glucosides are the corresponding ethers. Few of them, if any, 
contain N, but they all contain C, H and O. They are often the most active 
of the principles in the plants containing them, but they are more frequently 
associated with other active principles, as alkaloids, oils, resins, etc. Like other 
neutral principles, the glucosides have Latin names which end in -inum, and 
English names ending in -in. The official glucosides or preparations 
thereof are: — 

Glycyrrhizinum Ammoniatum, Ammoniated Glycyrrhizin, — from Licorice-root. 
Salic inum, Salicin, — obtained from Salix and Populus barks. 

Strophanthinum, Strophanthin, — from Strophantus, and one of the most powerful 
poisons known. 

Unofficial but important Glucosides are the following-named: — 

Adonidinum, Adonidin, — from Adonis vernalis. 

Arbutinum, Arbutin, — from Bearberry leaves. 

Cathartic Acid, — one of three glucosides in Senna leaves. 

Colocynthinum, Colocynthin, — the active principle of Colocynth. 

Convallamarinum, Convallamarin, — from Convallaria majalis. 

Convolvulinum, Convolvulin, — the active principle of Jalap. 

Digitoxin, Digitalin, Digitalein, and Digitonin, — active principles contained in Digitalis, 

the last-named one antagonizing the others. 
Ipecacuanhic Acid, — existing in Ipecacuanha. 



S CONSTITUENTS OF ORGANIC DRUGS. 

Jalapinum, Jalapin, — the active principle of Scammony, found also in Jalap. 
Saponinu . — obtained from Quillaja, the Soap-bark. 

Tannins, except Tannic Acid, which is an organic acid, are considered to be glucosides; 
the chief ones being Caffetannic Acid, Chinotannic Acid and Quercitannic Acid. 

Incompatible with the glucosides are: Acids, Alkalies, Ferments, Lead Acetate and Sub- 
acetate. Tannic Acid, Water (hot). 

Neutral Principles, — are all neutral in character, of various composition 
and powers, and characterized by the absence of basic or other properties which 
would place them in the other groups. Many have a very bitter taste and have 
been therefore called Amaroids or Bitter Principles. Like the glucosides their 
Latin names end in -inum, their English names in -in. Those which are 
official are the following-named: — 

Aloinum, Aloin, — from various species of Aloes. 

Chrysarobinum, Chrysarobin, — obtained from Goa-powder.. 

Elaterinum, Elaterin, — extracted from Elaterium. 

Santoninum, Santonin, — the active principle of Santonica (Wormseed). 

Unofficial, but important Neutral Principles are — 

Anemoninum, Anemonin, — a camphoraceous principle from Pulsatilla. 
Cantharidinum, Cantharidin, — the active principle of Spanish Flies. 
Cotoinum, Cotoin, — an acrid principle in Coto Bark. 
Quassinum, Quassin, — a bitter principle in Quassia-wood. 

Besides the above-mentioned principles, there are several other medicinal 
substances bearing names ending in -inum or -in, which have no relation- 
ship to either of the groups previously described. Among them are — 

Chinoidinum, Chinoidin, — an unofficial mixture of alkaloids from Cinchona. 

Gelatinum, Gelatin, — a product from certain animal tissues. 

Glycerinum, Glycerin, — a triatomic alcohol from fats and fixed oils. 

Kaolinum, Kaolin, — a native aluminum silicate. 

Lupulinum, Lupulin, — a glandular powder from Hops. 

Parafnnum, Paraffin, — a mixture of hydrocarbons from Petroleum. 

Vanillinum, Vanillin, — an aldehyde occurring in Vanilla. 

Also Abrin, a toxic albumose in Jequirity-seeds ; Ricin, a poisonous ferment in Castor- 
oil seeds; and Benzin, Chinolin, Kairin, Lactophenin, Pancreatin, Pepsin, Phenacetin, Piper- 
azin, Pyroxylin, Thallin, and other organic compounds not derived from either the animal 
or vegetable kingdoms but manufactured in the chemical laboratory. 

Organic Acids or Carbon-acids, contain the univalent group C0 2 H (car- 
boxyl) linked with a hydrocarbon residue. They contain no N, but have acid 
properties, forming salts with bases. The principal organic acids are — 
Official. Unofficial. 

Acetic Acid. Oleic Acid. Aconitic Acid. Formic acid. 

Benzoic Acid. Salicylic Acid. Agaricic Acid. Malic Acid. 

Citric Acid. Stearic Acid. Angelic Acid. Mandelic Acid. 

Gallic Acid. Tannic Acid. Butyric Acid. Meconic Acid. 

Lactic Acid. Tartaric Acid. Cerotic Acid. Oxalic Acid. 

Trichloracetic Acid. Cinnamic Acid. Succinic Acid. 

Coloring Matters form a group of bodies having very different properties, 
the nature of many being not yet understood. Among them are — Carminic 
Acid, in the cochineal insect, also in some plants; Carthamin, from the safflower; 



CONSTITUENTS OF ORGANIC DRUGS. Q 

Chlorophyll, in all green parts of plants; Curcumin, the coloring matter of tur- 
meric; and Hematoxylin, from logwood. 

Resins. The proximate principles called by this name are neither the 
commercial resins nor the resins of pharmacy (see under Resin^e in Part II), 
all of which are complex bodies, but include only the chemical individuals of 
resinous character existing in nature, as those in Copaiba, Cannabis, Gamboge, 
Guaiac, Gurgun, etc. Even these, in their commercial form, are accompanied 
by other principles. It is difficult to define the resins correctly, but they are 
generally considered to be oxidation products of hydrocarbons, such asterpenes. 
They are mostly brittle, amorphous, uncrystallizable solids, insoluble in water 
but soluble in alcohol, ether, chloroform, benzin, etc. Most of them are of 
acid character, combining with alkalies to form a kind of soap, these " resin- 
soaps" being soluble in water and giving up their resins again to the action of 
acids. They soften or melt when heated and solidify again on cooling. They 
may be obtained from oleo-resins, as turpentine, by simple distillation, the vol- 
atile oil passing over and the resin remaining behind; or by heating the part 
of the plant in which they are contained, as in the case of guaiacum resin. 

The substances ordinarily called Resins are usually classified as follows: — 

True Resins are hard, compact products of oxidation, and are made up chiefly of resin 
acids. Such are Copal, Damar, Mastic, Sandarach, Dragon's blood, Gum-lac and Amber. 

Gum-resins are natural mixtures of gum and resin. When they are rubbed up with 
water the gummy matter dissolves and the resin is suspended in the form of an emulsion. 
[Compare the title Emulsa, in Part II, also the subtitle Gums, p. 5. Such are Olibanum 
(frankincense), Myrrh, Ammoniac, Asafetida, Galbanum and Tragacanth.] 

Oleo-resins include all mixtures of volatile oils and resins of whatever consistency, 
also the Balsams or mixtures of resins with benzoic and cinnamic acids. Such are Copaiba, 
crude Turpentine, Storax, and the true balsams — Benzoin, Balsam of Peru and Balsam of 
Tolu. There are six official oleo-resins, which are described under the title Oleoreslnle in 
Part II. 

Pharmaceutical Resins are solid preparations obtained by precipitating the resinous 
. principles of plants from their alcoholic solutions by the agency of water. Three such prepa-, 
rations are official in the U. S. Pharmacopoeia, and are described under the title Resins in 
Part II. 

Fixed Oils and Fats, though usually placed among the constituents of 
animal and vegetable drugs, are not proximate principles, being compound 
bodies containing the radicle Glyceryl, C 3 H 5 , in combination with anhydrides 
of the various fatty acids. The decomposition of these bodies by heating with 
water and an alkali yields the triatomic alcohol Glycerin, C 3 H 5 (OH) 3 , and one 
or more fatty acids (stearic, palmitic, oleic, etc.). The latter combine with the 
alkali, forming soaps, and the glyceryl is converted into glycerin, a portion of 
the water being consumed in the reaction. An exception to this rule is the 
case of Cod-liver Oil, which does not yield glycerin when saponified but oxide 
of propyl. The following-named fixed oils and fats are those which are chiefly 
employed in medicine, viz. — 

Adeps, Lard, — the abdominal fat of the hog. 

Adeps Lanse, Wool Fat, — the purified fat of the sheep's wool. 

Sevum, Suet, — the abdominal fat of the sheep. 



IO CONSTITUENTS OF ORGANIC DRUGS. 

Cetaceum, Spermaceti, — obtained from the sperm whale. 

Oleum Amygdalae Expressum, Almond Oil, — expressed from almonds. 

Oleum GossypiiSeminis, Cottonseed Oil, — from cottonseed. 

Oleum Lini, Linseed Oil, — expressed from flaxseed. 

Oleum Morrhuae, Cod-liver Oil, — from the liver of the cod-fish. 

Oleum Olivae, Olive Oil, — expressed from ripe olives. 

Oleum Ricini, Castor Oil, — from the seed of the castor-oil plant. 

Oleum Theobromatis, Oil of Theobroma, Cacao-butter, — expressed from the seed of the 

Chocolate-tree. 
Oleum Tiglii, Croton Oil, — expressed from the seed of Croton Tiglium. 

Waxes are compound bodies, closely allied to fats but containing no gly- 
ceryl, and are usually placed among the proximate principles for sake of con- 
venience. The official wax (Cera) is prepared by the honey-bee. Chinese 
insect wax is the secretion of a coccus upon a variety of ash. Japanese wax is 
obtained from the fruits of several varieties of Rhus. Myrtle wax is obtained 
from the fruits of various species of Myrica. Wax is used in pharmacy; inter- 
nally it is practically inert and harmless. 

Volatile or Essential Oils form a large group of organic bodies existing 
in plants, from which they are usually extracted by distillation with water, 
being volatilizable at the temperature of boiling water. They are generally 
liquid at ordinary temperatures, and when exposed to cold many of them sepa- 
rate into a solid, crystalline portion, called stearopten, and a liquid portion, 
called elcBopten. They are highly odorous, oily, sparingly soluble in water, more 
or less soluble in alcohol and in ether, colorless or yellowish, inflammable, and 
prone to become resinous on exposure to the air. Most of them are complex 
bodies, consisting of two or more principles which can be separated from each 
other. The list of the volatile oils is quite an extensive one, 25 being official 
in the U. S. Pharmacopoeia and described in Part I of this book under the 
titles of their respective sources. The group may be subdivided into the 
following classes, viz. ■ — 

Hydrocarbon Oils (or Terpenes), — consist of C and H, most of them having the formula 
C 10 H 16 and being therefore isomeric with rectified Oil of Turpentine, which is the type of this 
class. 

Oxygenated Oils, — contain C, H and O, are highly aromatic and usually consist of a 
terpene mixed with an oxygenated principle (an acid, an aldehyde, etc.). The oils of Cin- 
namon and Peppermint are examples of this class. 

Sulphuretted Oils, — contain Sulphur in addition to their other elementary constituents, 
and are pungent and disagreeable in odor and taste; as the oils of Garlic and Mustard. In 
the latter case the oil is formed by the reaction of the constituent principles in the presence 
of water and does not preexist in die plant. 

Nitrogenous Oils, — contain N, as the compound Cyanogen, CN, in the form of Hydro- 
cyanic Acid, which is formed only after maceration with water. Examples are the oils of 
Bitter Almond, Peach-kernels, etc. 

Camphors are volatile, aromatic principles, composed of ten atoms of C 
with various proportions of H and O. They are solid and crystalline at ordi- 
nary temperatures, and are closely related to the terpenes, with which they are 
associated in plants and by the oxidation of which they seem to be formed. The 
principal member of the group is the official Camphora, C 10 H 16 O, which is 



CONSTITUENTS OF ORGANIC DRUGS. II 

described under its own title in Part I. Stearoptens obtained from various 
essential oils are often, though incorrectly, called camphors, as Borneol, Men- 
thol, Eucalyptol, etc. 

Borneol, or Borneo-camphor, C 10 Hi 8 O, — is a secondary alcohol occurring in a tree 
which grows in Borneo and Sumatra. It may be formed artificially by heating common 
camphor with alcoholic potash or by treating it with sodium. 

Menthol, or Mint-camphor, C 10 H 20 O, occurs in Oil of Peppermint together with a ter- 
pene and separates in crystals on cooling the oil. It is a secondary alcohol, is official, and 
is described under the title Mentha Piperita, in Part I. 

Miscellaneous Compounds include several organic bodies (phenols, ke- 
tones, etc.) which occur as proximate principles in plants but are not referable 
to the other groups. Among them are — 

Anethol, C 10 H 12 O, — from the oils of Anise and Fennel. 

Apiol, C 12 Hi 4 4 , — from the Oil of Parsley. 

Carvol, C 10 HnO, — from the Oil of Caraway. 

Cineol, Cajuputol or Eucalyptol, C 10 H 18 O, — a liquid obtained from the volatile oils of 

several species of Eucalyptus, also from the oils of Cajuput, Myrtle, Rosemary, Sage 

and Wormseed. 
Eugenol, C 10 H 12 O, — from the Oil of Cloves and other volatile oils. 
Guaiacol, C 7 H 8 2 , — the essential constituent of Creosote. 
Safrol, C 10 H 10 O 2 , — obtained from the oils of Sassafras and Camphor and the bark of 

several plants. 
Thymol, C 10 H u O, — a phenol from Oil of Thyme and other volatile oils. 

Albuminoids or Protein Bodies all contain N, as well as C, O, H and 
Sulphur. They are formed exclusively in plants, in every part of which they 
occur in small amounts but in larger quantities in the seeds. When consumed 
and assimilated by animals they undergo alteration and enter into the ani- 
mal tissues and form the chief part of the solid constituents of the blood, muscles, 
nerves, glands and other organs. They are chiefly valuable as foods, and may 
be conveniently divided into the following classes: — 

Native Albumins, are soluble in water; as Serum-albumin, Egg-albumin, Plant 
albumin (in the juices of plants). 

Derived Albumins or Albuminates, are insoluble in water but soluble in very dilute 
acids or alkalies; as Syntonin (acid-albumin), Alkali-albumin, Casein, the chief proteid in 
milk, Legumin or plant-casein. Gluten, the chief nitrogenous constituent of the seeds of 
cereals (wheat, rye, etc.), is believed to be a combination of four albuminoids, gluten-fibrin, 
gluten-casein, gliadin and mucedin. 

Globulins, are insoluble in water but soluble in dilute saline solutions and in very dilute 
acids or alkalies, and include — Globulin (Crystallin), Myosin, Fibrinogen, Vitellin Para- 
globulin and Globin (residue of Hemoglobin, which forms the chief part of the red blood- 
corpuscles; contains Iron and is closely related to the proteins). 

Fibrin (Animal Gluten), is insoluble in water and sparingly soluble in neutral saline 
solutions and in dilute acids and alkalies. It has a filamentous structure and possesses 
remarkable elasticity. 

Coagulated Protein, is formed from albumin, fibrin, etc., by the action of heat or alcohol, 
and is insoluble in water or alcohol but soluble in strong hydrochloric acid and gradually in 
acetic acid. 

Peptones, are formed from albumins by the action of the acid gastric juice. They are 
highly diffusible and readily soluble in water, but are insoluble in alcohol or ether. 

Amyloid Substances, include Ichthin, Ichthidin, Ichthulin and Emydin, which occur 
in the eggs of fishes and amphibii also Lardacein or Amyloid Substance, a pathological 
infiltration into various organs. 



CLASSIFICATION OF MEDICINES. 

Collagenes and Mucilaginous Bodies, include Ossein, Collagen (and their derivative 
Gela;. astin, Chondrin, Keratin and Mucin. 

Ferments are known only by their power of effecting peculiar changes 
in other organic bodies. The true ferment-substances have not yet been iso- 
lated, but they are present in certain preparations obtained from animals and 
plants, the most important of which are named in the following list, viz. — 

Pepsin, — contained in the gastric juice of animals. 
Pancreaiiti, — obtained from the pancreas of animals. 
Papayotin (Papain), — from the sap of Carica papaya c 
Bromclin, — contained in the juice of the Pineapple. 
Ptvalin, — the peculiar ferment of animal saliva. 
Diastase, — formed during the germination of seeds. 
Emulsin, — the ferment occurring in almonds. 
Mvrosin, — the ferment contained in mustard-seeds. 

The first four above-named are described under the title Pepsinum, Diastase under 
Axiylum, Emulsin under Amygdala, and Myrosin under Sinapis, in Part I of this book. 



> 



CLASSIFICATION OF MEDICINES. 



In the present state of knowledge respecting the actions and uses of medic- 
inal agents, no really scientific classification of these substances is possible. 
Some writers have adopted a system based on the natural relations of the various 
articles to each other, while many classify them according to their effects on the 
human system, and others make no attempt at arrangement but treat of them 
in alphabetical order. The latter method has been chiefly followed in this 
work, from a conviction that every medicine should first be studied as an in- 
dividual, both with respect to its physiological actions and its therapeutical 
applications. When the student has thus made himself familiar with the char- 
acteristic features of each article of the materia medica, he may begin, by com- 
paring one with another, to seek acquaintance with their more delicate lights 
and shades. Some system of classification then becomes imperative as an- aid 
to the memory, and as the titles of the groups to which the various agents belong 
in any physiological classification are also used to express their actions and 
uses, the following synopsis is inserted as an appropriate introduction to the 
section on Materia Medica and Therapeutics. 

Acids are compounds containing the electro-positive element Hydrogen 
united directly to strongly negative elements, or as the negative radicle Hydroxyl 
(HO) united to positive elements. The terminal syllables of their names indi- 



CLASSIFICATION OF MEDICINES. 1 3 

cate the comparative amount of oxygen or other electro-negative constituent 
present, those terminating in -ic having the greater quantity, those ending 
in -ous having the lesser quantity. When there are more than two such com- 
binations the prefix hyper- is affixed to the highest, and hypo- to the lowest. 
Many strong acids (as hydrochloric) contain no oxygen, but all contain hydro- 
gen. They change the color of litmus from blue to red, and unite with bases 
to form salts. Their physiological actions are chiefly due to their powers of 
neutralizing alkalies, withdrawing water from the tissues, and precipitating 
the globulins and some other proteids. They are poisonous to protoplasm, 
somewhat antiseptic, and many of them are powerfully corrosive to the tissues. 
Taken internally in dilute solution they have a sour taste, and cause an astrin- 
gent sensation in the mouth and throat, induce a reflex flow of saliva, and in 
the stomach displace weaker acids from their combinations. Applied to the 
mouths of ducts from glands having an alkaline secretion they stimulate the 
latter, but check the secretion of glands producing acid secretions. This doc- 
trine has but a limited application, as they do not pass beyond the stomach 
in their own form, though they increase the flow of the alkaline pancreatic juice 
by reflex action. In the blood and tissues they exist as salts by combination 
with the alkalies of the body, and if administered in sufficient quantity to 
neutralize the latter the animal dies, its blood being unable to carry carbon 
dioxide from the tissues to the lungs. They are rapidly excreted by the kidneys 
as acid salts, increasing the acidity of the urine. Therapeutically they are em- 
ployed locally as caustics, styptics and anhidrotics, and internally in very dilute 
form as refrigerants, stomachics, astringents, hemostatics, and antidotes 
in poisoning by alkalies. 

Incompatible with Acids generally are: Alcohol with strong acids; Alkalies, Alkaloids; 
Benzoates and Borates with strong acids; Bismuth and Ammonium Citrate, Bicarbonates, 
Bromides of weak bases, Carbonates, Chlorides of weak bases, Glucosides, Iodides of weak 
bases, Metallic Salts with organic acids, Pancreatin, Potassium and Sodium Tartrate, Potas- 
sium Tartrate, Salicylates, Silicates. [See also the particular Acids in Part I.] 

Alkalies are compounds possessing certain properties in common, viz. — 
solubility in water, neutralizing acids and with them forming salts, saponify- 
ing fats, changing reddened litmus back to its original blue color, and altering 
the color of turmeric from yellow to brown. The alkalies proper are the five 
fixed alkalies, Potassa, Soda, Lithia, Csesia, and Rubidia, which are hydrated 
oxides of the corresponding alkali metals, and the volatile alkali Ammonia, a 
gaseous compound of N and H 3 . They are strong, electro-positive bases, unit- 
ing with acids to form salts. The oxides of calcium, barium, strontium and 
magnesium are called alkaline earths, are but slightly soluble in water, and 
much less corrosive than the alkalies proper. In medicine the term alkali 
includes also such salts as have an alkaline reaction, as carbonates, bicarbonates, 
and borates. 

The physiological action of the hydrates and carbonates of the alkali metals 



> 



14 CLASSIFICATION OF MEDICINES. 

is due entirely to their powerful hydroxyl constituent, and depends chiefly on 
their powers of neutralizing acids, dissolving proteins, saponifying fats, and 
abstracting water from the tissues. In solid form or concentrated solutions 
they are energetic corrosives, destroying all living tissues with which they come 
in contact, the hydrates being the most powerful in this respect. In weak 
solutions locally they stimulate the cells of the skin and soften the epidermis. 
Taken internally in dilute solution they have a characteristic taste, and dissolve 
the superficial layers of the mucous membrane of the mouth and the mucus 
of the secretions. Small quantities are neutralized in the stomach by the hydro- 
chloric acid of the gastric juice, larger ones neutralize or alkalinize the stomach 
contents and stop the gastric digestion, slightly irritate the walls of that viscus, 
improve its circulation, and dissolve its mucus. Applied to the mouths of ducts 
of glands they are said to stimulate acid secretions and check alkaline secre- 
tions, but this is denied by experimental physiologists for the gastric juice, and 
is shown to be true for the pancreatic secretion only indirectly by diminishing 
the acidity of the fluid passing through the pylorus. The prolonged admin- 
istration of large doses of the alkaline carbonates and bicarbonates causes chronic 
gastro-enteritis in animals. Concentrated solutions of alkalies corrode the walls 
of the esophagus and stomach, and may prove fatal by causing perforation into 
the peritoneal cavity. Alkalies have but little influence on metabolism and 
uric acid excretion, other than that due to their action on digestion. They are 
rapidly excreted by the kidneys as bicarbonates, rendering the urine less acid 
or even alkaline in reaction. 

Incompatibles. Alkalies are incompatible with many substances. They neutralize free 
acids, and precipitate alkaloids and soluble non-alkaline metallic salts. Caustic alkalies 
decompose Bromoform, Chloroform, Chloral, Copaiba, Glucosides, and Resin. Strong 
alkalies decompose salts in solution which have weak or volatile bases. [See also the individual 
alkalies, Potassium Hydroxide, etc., in Part I.] 

Alkalies may be subdivided into two groups, named, from their physiological 
actions, Direct Antacids, those which lessen acidity in the stomach, and Indirect 
or Remote Antacids, which have no power over acidity in the stomach, but are 
oxidized in the blood, and excreted as carbonates in the urine, decreasing its 
acidity. The following List of Alkalies comprises the chief members of both 
groups, and also some which have the actions of both. They should all be 
largely diluted before administration. 

Direct Antacids. Remote Antacids. 

(Lessen Acidity in the Stomach.) {Lessen Acidity of the Urine.) 

Liquor Potassii Hydroxidi. Liquor Potassii Hydroxidi. 

Liquor Sodii Hydroxidi. Liquor Sodii Hydroxidi. 

Carbonates and Bicarbonates of Potas- Carbonates and Bicarbonates of K, Na 
sium, Sodium, Lithium, Magnesium Li, Mg and NH 4 . 

and Ammonium. Potassium Acetate and Citrate. 

Lime-water. Chalk. Magnesia. Sodium Acetate and Citrate. 

Aromatic Spirit of Ammonia. Sodium Phosphate. Lithium Citrate. 



CLASSIFICATION OF MEDICINES. 1 5 

Alteratives are remedies which alter the course of morbid conditions in 
some way not yet understood, perhaps by promoting metabolism. They cer- 
tainly modify the nutritive processes and thereby cure many diseases of chronic 
type. Mercury and Iodine are the most prominent agents of this class, the 
former being endowed with the power of breaking up newly deposited fibrin 
and disorganizing syphilitic deposits, while the latter acts energetically upon 
the lymphatic system and promotes absorption. Arsenic also is almost specific 
in many chronic skin affections, and has remarkable power over chronic 
pulmonary consolidations, probably producing fatty degeneration and soften- 
ing of the effusion, so that it may be absorbed or expectorated. The principal 
alteratives are — 



Arsenic. 


Mercury. 


Iodine. 


Antimony. 


Colchicum. 


Iodides. 


Aurum. 


Guaiacum. 


Stillingia. 


Mezereum. 


Sanguinaria. 


Sarsaparilla. 


Sulphur. 


Xanthoxylum. 


Cod-liver Oil. 


Sulphides. 


Calcium Chloride. 


Phosphorus. 



Analgesics or Anodynes (ay, without, aXyos, pain, odvvq, pain), — are rem- 
edies which relieve pain either by direct depression of the centres of perception 
and sensation in the cerebrum, or by impairing the conductivity of the sensory 
nerve fibres. Opium is the most efficient of all analgesics, because it arrests 
the afferent impressions at every step of their track — at their formation, along 
the course of their conduction, and at the point where they impinge on the sen- 
sorium. The Local Anodynes are described under Anesthetics; the list of 
General Anodynes includes the following-named agents: — 

Opium, Morphine. Gelsemium. Aconite. 

Belladonna, Atropine. Antipyrine. Chloroform, Ether, etc. 

Cannabis. Acetanilid. Conium. 

Stramonium. Phenacetin. Hydrated Chloral. 

Hyoscyamus. Phenocoll. Croton-chloral. 

Anaphrodisiacs (dv, without, A<ppoStT7), Venus), — are those medicines and 
measures which lower the sexual function and diminish the sexual appetite. 
They act by lessening the excitability of the nerves of the genital organs, by 
depressing the genital centres in the brain and cord, or by decreasing the local 
circulation. The principal anaphrodisiacs are named in the following list. 
[Compare Aphrodisiacs.] 



Bromides. 


Digitalis. 


Purgation. 


Potassium Iodide. 


Conium. 


Venesection. 


Camphor (at last). 


Belladonna. 


Ice, locally. 


Opium (at last). 


Stramonium. 


Cold Baths. 


Cocaine. 


Gelsemium. 


Vegetable Diet. 


Tobacco. 


Nauseants. 





A few drops of a 4 per cent, solution of Cocaine upon the glans penis will destroy all 
erection-power for a quarter to half an hour. 



I 



1 6 CLASSIFICATION OF MEDICINES. 

Anesthetics (dr, without, cuadrjai^ perception), — are agents which tem- 
porarily destroy sensation. The Local Anesthetics are described below. The 
General Anesthetics include certain volatile substances, mostly belonging to the 
chemical groups named alcohols and ethers, which when inhaled sufficiently 
produce complete unconsciousness and loss of sensation (anesthesia), also less- 
ened motor power. Narcotics also produce more or less anesthesia, but this 
term is usually restricted to the effects of the volatile agents referred to above. 
The principal members of this group are — 

Ether (Ethyl Oxide). Chloroform. 

Methylene Bichloride. Ethyl Chloride. 

Ethylene Bichloride. Ethyl Bromide. 

Nitrous Oxide. Pental (Tri-methyl-ethylene). 

The list of General Anesthetics also includes Alcohol and many substitution products 

derived from alcohols and ethers. [Compare the articles entitled Alcohol, ^Ether and 
Chloroform in Part I.] 

Local Anesthetics and Anodynes (dv, without, oBvvrj, pain) . — reduce the 
functions of the sensory nerves until they lose the power of receiving or con- 
ducting sensations. Some act by direct depression of the end-organs in the skin, 
etc., others by impairing the conductivity of the sensory nerves, while some act 
indirectly by reducing the local circulation. The Anodynes diminish, and the 
Anesthetics destroy, for a time, the sensibility of the skin and mucous mem- 
branes to which they are applied. The chief members of this class are named 
in the following list: — 

Local Anesthetics. Local Anodynes. 

Extreme Cold, Ice. Aconite, Aconitine. 

Ether Spray. Belladonna, Atropine. 

Ethyl Chloride. Opium, Morphine. 

Cocaine, Eucaine. Veratrine. 

Tropacocaine. Menthol. 

Chloretone. Hydrocyanic Acid. 

Ouabain. Phenol. 

Antipyiine, Acetanilid. Chloroform, Ether, Alcohol. 

Hydrocyanic Acid. Hydra ted Chloral. 

Creosote, Guaiacol. Sodium Bicarbonate. 

Iodoform. Zinc Oxide. 

Orthoform. Oil of Turpentine. 

Phenol. Volatile Oils. 

Galvanism. 

Anhidrotics (dv, without, ifyxos, sweat), — are agents which check perspira- 
tion, and are the opposites of the Diaphoretics, which promote this secretion. 
TVipv nsiiflllv art eifhpr — 



They usually act either — 



i. By depressing the action of the sweat-glands. 

2. By depressing the excitability of the'sweat-centres. 

3. By reducing the circulation in the skin. 

The most important agents of this class are those named in the following 
list:— 



CLASSIFICATION OF MEDICINES. 1 7 

Belladonna. Acids, locally. Chloralformamide. 

Atropine. Pilocarpus. Quinine (?). 

Hyoscyamus. Pilocarpine. Picro toxin. 

Stramonium. Nux Vomica. Camphoric Acid. 

Muscarine. Strychnine. Opium 2 (small doses). 

Agaracin. Ergot. Zinc Salts. 

Salvia (Sage). Sulphuric Acid. Local Cold. 

Strychnine, Atropine, Pilocarpine, Picrotoxin and Zinc Salts are all respiratory stimu- 
lants, and very efficient against the sweating of phthisis, though most of them are classed 
as diaphoretics. This is explained by the theory of accumulation of carbonic acid in the 
blood by depressed respiration caused by severe coughing, thus stimulating the sweat-centres, 
and being opposed by agents which stimulate the respiratory centre. 

Antagonists are agents which directly oppose each other in some or all 
of their physiological actions, and may be used against each other to counter- 
act their effects upon the organism. Antagonistic action takes place in the 
blood and tissues, after the absorption of both the poison and the antagonist ; 
it is available against poisons administered hypodermically as well as by other 
channels, and so far as drugs are concerned it is applicable chiefly to vegetable 
poisons or to those which produce their toxic effects after absorption. In most 
cases of poisoning by vegetable principles absorption has proceeded so far 
before professional assistance is obtained that the time for antidotes has passed, 
and reliance can be placed only upon the physiological antagonists and such 
antagonistic measures as may support vitality until the poison can be eliminated 
by the excretory organs of the body. There may be an exception to this rule 
in the case of Morphine, which, after making the round of the circulation, con- 
stantly returns in part to the stomach until finally eliminated, so that repeated 
washing of that organ with a solution of potassium permanganate, or the 
ingestion thereof from time to time, may have a continuous antidotal action on 
such portion of the poison as may have been absorbed. [Compare Antidotes.] 

Antagonistic Measures include all such procedures as may tend to antag- 
onize any remote effects of poisons, as artificial respiration, faradization of the 
respiratory muscles, constant motion or absolute repose, application of heat 
or cold, douching, etc. 

Thus, in the case of poisoning by Digitalis the antagonists which will counteract the 
effects of such portion of the drug which has been absorbed are the following: Aconite or 
Morphine against the cardiac action, the former for the effects of large doses, the latter for 
those of the long-continued use of the drug. Atropine may be used to check the excessive 
vagus action. Absolute Rest in the recumbent posture is an antagonistic measure of prime 
importance, by reason of the liability to sudden cessation of the lowered cardiac action on 
the assumption of the erect posture by the patient. 

In Part I of this book, under the several titles of the poisonous drugs, their most effi- 
cient Antidotes and Antagonists are not mentioned; but these are fully described and arranged 
in a form suitable for reference under the caption Poisoning in Part III. 

Physiological Antagonism means a balance of opposed actions on particular 
organs or tissues, excited by medicinal agents and measures or by disease. It 
may extend throughout the whole or the greater part of the range of action of 



> 



IS CLASSIFI CATION OF MEDICINES. 

the opposing agents, or, as is usually the case, may be limited to a few points 
thereof. There is no instance in which the antagonism of two drugs is 
absolutely complete along their whole line of action. In a few cases it 
is nearlv so; as with Morphine and Atropine (except as to narcotism), 
and Atropine and Muscarine, the latter being considered the most com- 
plete instance known. In most cases the antagonism extends only to cer- 
tain definite spheres of action, and the antagonists therein may be synergists 
to each other in other spheres, as the narcosis produced by both Morphine and 
Atropine. It may be local, affecting a single organ or function, or it may extend 
to a group of organs, to several associated functions, or over the distribution 
of the nerves proceeding from a single nerve-trunk (as the vagus) or con- 
trolled by a single nerve-centre. Antagonism implies a balance of functional 
disturbance, not an alteration of structure. 

Drugs are rarely antagonistic to each other in the same degree, but, by 
reason of differences in their mode and time of action, the action of one pre- 
ponderates over that of the other, so that the latter will not counteract the former 
to the extent of averting a fatal result, though in the reverse order their counter- 
action may be most satisfactory. For example, while Chloral is the antagonist 
to Strychnine, opposing as it does the spinal action of the latter drug, the reverse 
is true to a very limited extent; and, while Atropine may prevent death from 
a lethal dose of Aconitine, Morphine or Bromal Hydrate, no one of these three 
will do so in atropine poisoning. 

Two mutually antagonistic principles may exist in the same plant, as the 
alkaloids Pilocarpine and Jaborine in pilocarpus, and the glucoside constituents 
of digitalis (see article on Digitalis). 

Toxicological Antagonism is a very ancient idea in medicine. Mithridates of Pontus 
(b. c. 164-124) and other monarchs of the heathen world occupied themselves with the study 
of poisons and their antidotes and antagonists, established botanical gardens for the purpose 
of their investigation, and gave their names to what were supposed to be universal preventives 
against the results of poisoning. In the 16th century Prosper held that theriaca (opium) 
was an antagonist to all poisons. From 1570 to 1677 many observations were made and 
published on the treatment of belladonna poisoning by opium, and in 18 10 the same matter 
was made the subject of an inaugural thesis by Lipp. The scientific investigation of drug 
action and antagonism was not possible until the discovery and isolation of the alkaloids, but 
followed immediately thereafter, and was begun in 1809 by Magendie upon the upas poison 
(nux vomica) and its newly discovered alkaloid, strychnine. In 1869 Schmiedeberg and 
Koppe made their researches on muscarine and atropine, and Liebrich discovered chloral 
and proved the antagonism of strychnine to it action, the converse of which was shown by 
Bennett in 1875. In 1870 Fraser published his investigations upon atropine and physostigma, 
and Preyer his on the antagonistic influence of atropine and hydrocyanic acid on respiration. 
In 1875 a committee of the British Medical Association made an extended investigation and 
report on the antagonisms of several drugs, which was supplemented by the work of Vulpian 
on atropine and pilocarpine in the same year, that of Fothergill in 1877 on aconite, atropine 
and digitalis, and that of Huseman on the antagonisms of chloral. Much good work has 
also been done in England by Brunton and Ringer, and in the United States by Wood and 
Bartholow, on the same lines. The name of Brunton is unalterably associated with the 
antagonism between amyl nitrite and the spasmodic paroxysm of angina pectoris, a discovery 
in therapeutic antagonism which was made by him through the exercise of purely scientific 
reasoning and which has since been applied to the similar paroxysm induced in poisoning 
by certain drugs, as cocaine. 



CLASSIFICATION OF MEDICINES. 



*9 



The following table, modified from Brunton, gives the antagonistic poisons, also their 
mutual antagonistic and lethal doses in each case in which they have been determined. The 
doses are expressed in grains or fractions of a grain per pound weight of the animal. 

Table of Antagonistic Poisons. 



ANTAGONISTS. 



II. 



Aconitine and Atropine, . . 

" Digitalin,.. 

" " Strychnine, 

Alcohol and Strychnine, . . 

Atropine and Aconitine, . . 

" Chloral, . . . 



" Hydrocyanic Acid, 

" " Muscarine, 

" " Morphine, 

" " Pilocarpine, 

" " Phytolaccine, 

" Physostigmine, . . . . 

" Quinine, 

Bromal Hydrate and Atropine, . . 

Chloral and Atropine, 

" " Picrotoxin, 

" " Physostigmine, 

" Strychnine, 

Chloroform and Amyl Nitrite, . . . 

Digitalin and Aconitine, . # 

" " Muscarine, 

" " Saponin, 

Gelsemium and Opium, 

" " Atropine, 

Morphine and Caffeine, 

" " Chloroform, 

Muscarine and Atropine, 

Opium and Atropine, 

" " Gelsemium, 

" " Veratrum Viride, 



ANTAGONIS- 
TIC DOSE. 



LETHAL 
DOSE. 



II. 



Til 



If 

2. 
5 

125 



§0U 
1_ 

900 



II. 



7 

i 

sis 



7 
7 



288 
900 



7 
if 



Anthelmintics (dvn, against, ca/uvs, a worm), — are agents which destroy 
(vermicides) or expel (vermifuges) worms inhabiting the intestinal canal. 
The principal vermifuges are the purgatives Castor Oil, Jalap and Scammony; 
while the vermicides are classed according to the worm they are each most 
efficient against, thus, — 



Thread Worms 
(Oxyuris Vermicular is). 
Alum. 

Sulphate of Iron. 
Lime Water. 
Quassia. 
Eucalyptol. 
Sodium Chloride. 
Tannin. 

Veg. Astringents. 
Naphthalene. 



Round Worms 
(Ascaris Lumbricoides) . 
Santonica. 

Santonin. 
Spigelia. 
Chenopodium. 
Senna \ with the 
Calomel / above. 
Naphthalene. 
Papain. 



Tape Worms 
(Tenia, etc.). 

Aspidium. 

Kamala. 

Kousso. 

Granatum. 

Pelletierine. 

Pepo. 

Turpentine. 

Chloroform. 

Naphthalene. 



> 



20 CLASSIFICATION OF MEDICINES. 

The substances enumerated in the first column are all used locally by enema. Adjuncts 
to* these remedies are such agents as prevent the excessive secretion of intestinal mucus, which 
affords a nidus for the worms. Such are Bitter Tonics and preparations of Iron, also 
Ammonium Chloride and Sodium Chloride. Thymol and Chenopodium are specifics 
against the hook-worm (ankylostomum duodenale). 

Antidotes (avn, against, oY6w/ai, I give), — are agents which affect a poison 
either physically or chemically, or both, so as to remove it from the body or 
alter its character by forming with it an insoluble or inert compound before 
its absorption, with the object of preventing its toxic action upon the organism. 
Antidotes do their work in the alimentary canal or in the respiratory passages, 
and are applicable to vegetable as well as mineral poisons, but are not avail- 
able against poisons administered hypodermically. They include sundry chem- 
ical substances, also measures of various kinds, and may be divided into two 
classes: (i) Chemical or True Antidotes, which unite chemically with the poison, 
converting a soluble and absorbable substance into a compound which is more 
or less insoluble and non-absorbable, or harmless though soluble; (2) Mechan- 
ical Antidotes or Antidotal Measures, which include such medicinal or mechan- 
ical processes as tend to remove a poison from the body, either before or after 
the use of an antidote; and include emesis, the use of the stomach-pump, pur- 
gation, etc. The term Antidotal Treatment covers the employment of both 
antidotes and antidotal measures, and is often used in a still wider sense, namely, 
to mean all the treatment of a case of poisoning, including the use of Antagonists 
as well as that of Antidotes. [Compare Antagonists, ante p. 17, also the List 
of Antidotes under the caption Poisoning in Part III.] 

Thus, Tannic Acid is the antidote for poisoning by Digitalis, as it forms with the active 
toxic principles of the drug chemical compounds (tannates) which are almost insoluble and 
therefore comparatively harmless. But as these tannates are not entirely inert, an antidotal 
measure, evacuation of the stomach, must also be employed, by the administration of Zinc 
Sulphate or any other emetic, or by the use of a stomach-pump. 

Antiperiodics are remedies which affect certain periodical febrile diseases, 
lessening the severity of their paroxysms or preventing their return. They act 
probably by arresting the development in the blood of successive crops of patho- 
genic organisms, upon which the disorders are supposed to depend. The prin- 
cipal antiperiodics are — 

Cinchona Bark and its alkaloids, especially Quinine. Arsenic. 

Salicin, Salicylic Acid, Salicylates. Eucalyptol. 

Opium and its alkaloid, Narcotine. Iodine. 

Quinine is the most powerful antiperiodic and Arsenic ranks next in order of efficiency. 

Antiphlogistics (ovtl, against, (pXoyi^oi, I burn), — are measures and medi- 
cines which are supposed to have some specific power in reducing inflamma- 
tion. The term is becoming obsolete, but frequent references are still seen to 
the influence of Mercury and Opium in inflammations of serous membranes, 
Antimony and Aconite in inflammations of the respiratory tract and organs, 



CLASSIFICATION OF MEDICINES. 21 

and to the power of Veratrum Viride over puerperal metritis. The chief anti- 
phlogistics are — 

Aconite. Opium. Digitalis. Venesection. 

Veratrum Viride. Ergot. Local Depletion. 

Tartar Emetic. Ipecacuanha. Purgation. 

Mercury. Potassium Nitrate. Counter-irritation. 

Gelsemium. Rest (recumbent position). Cold (locally). 

Antipyretics (dvri, against, irvpcrhcr, fever), — are agents or measures which 
reduce the body-temperature when abnormally high. This may be done by 
two principal methods, and the agents doing either accomplish the result by 
five different actions, as follows, viz. — 

(a) Lessening the Production of Heat, by..{ T - ^f^^I ^e-^g 6 - 
v ' 6 J ' J 1 2. Reducing the circulation. 

3. Dilating the cutaneous vessels, and pro- 
ducing increased radiation. 
(6) Promoting the Loss of Heat, by -j 4. Producing perspiration, and its evapo- 
ration. 
. 5. Abstracting heat from the body. 

The following list contains nearly all the antipyretics: — 



Quinine. 


Camphor. 


Blistering. 


Quinidine. 


Salicylic Acid. 


Poulticing. 


Cinchonine. 


Sodium Salicylate. 


Acetphenetidin. 


Cinchonidine. 


Quinine Salicylate. 


Resorcinol. 


Berberine. 


Methyl Salicylate. 


Thallin. 


Benzoic Acid. 


(Oil of Gaultheria.) 


Pyrocatechin. 


Phenol. 


Salol. 


Pheno-resorcin. 


Picric Acid. 


Acetanilid. 


Nitrous Ether. 


Salicin. 


Antipyrine. 


Dover's Powder. 


Eucalyptol. 


Antimonials. 


Cold Bath. 


Thymol. 


Vera trine. 


Cold Drinks. 


Alcohol. 


Colchicum. 


Ice to Surface. 


Digitalis. 


Leeching. 


Cold Sponging. 


Aconite. 


Cupping. 


Wet Packing. 



Purgation and Venesection produce antipyretic results, but their mode of action is doubt- 
ful (Brunton). The Body- temperature is raised by Belladonna (or Atropine) and by Cocaine, 
but not to such a degree as to constitute fever or enable them to be classed as pyretics. Tuber- 
culin, various albumoses, and certain animal poisons, as that of shell fish, will also produce a 
rise of temperature. 

Antiseptics and Disinfectants. Antiseptics, (dm', against, o-rjif/Ls, putre- 
faction), are agents which arrest the development of the micro-organisms which 
produce decomposition. In stronger solutions than those required for their 
antiseptic action, most of the antiseptics are germicidal and are therefore dis- 
infectants; while all disinfectants are antiseptics. The chief antiseptics are 
named in the following list, the figures giving the minimum strength of their 
effective solutions, though these figures cannot be applied to all bacteria and 
their spores indiscriminately: — 

Mercuric Chloride, 1 : 50,000 Zinc Chloride, 1 : 500 

Mercuric Iodide, 1 : 40,000 Phenol, 1 : 333 

Formaldehyde, 1 : 25,000 Alcohol (absolute), 1 : 333 

Silver Nitrate, 1 : 12,500 Potassium Permanganate, 1 : 300 

Aluminum Acetate, 1 : 6,000 Acetic Acid, 1 : 250 

Creolin, 1 : 5,000 Alum, 1 : 222 



22 



CLASSIFICATION OF MEDICINES. 



Chlorine, i : 4.000 
Creosote, 1 : 3,000 

'. : ;.cvo 
BT Sulphate. 1 : -.000 
Pyoktanin, 1 : 2,000 
Bromine. 1 : 1,666 
Thymol. 1 : 1,500 
Salicylic Acid, 1 : 1.500 
Eucalyptol, 1 : 1000 
Hydrogen Dioxide, 1 : 1,000 
Calcium Hypochlorite, 1 : 1,000 
Trikresol, 1 : 1,000 
Benzoic Acid, 1 : 900 
Sulphuric Acid, 1 : 800 
Quinine Sulphate, 1 : 800 



Ferrous Sulphate, 1 : 200 
Coffee (freshly roasted), 1 
Arsenic Trioxide, 1 : 166 
Boric Acid, 1 : 143 
Hydrated Chloral, 1 
Resorcinol, 1 : 100 
Antipyrine, 1 : 25 
Calcium Chloride, 1 
Zinc Sulphate, 1 : 20 
Sodium Borate, 1 : 14 
Potassium Bromide, 1 : 10 
Potassium Iodide, 1 : 10 
Ammonium Chloride, 1 : 9 
Sodium Chloride, 1 : 6 
Glycerin, 1 : 4 



107 



: 5 



The best antiseptics for surgical use are those which act sufficiently on micro-organisms 
without injuring or irritating the tissues. The Mercuric Salts are very poisonous. Chlorine 
and Bromine are too irritant. Salol is of little value itself, but the products of its decompo- 
sition in the intestines are active germicides, and it is one of the best intestinal antiseptics 
(Wood). Benzoic Acid and Naphthol are good intestinal antiseptics, but complete asepsis 
in this situation is impossible. 



Disinfectants are agents which destroy the specific germs of infectious dis- 
eases. Many antiseptics do not possess germicidal power, and therefore are 
not disinfectants; but all disinfectants are antiseptics. Disinfectants act in 
several ways, some as oxidizants, others by combining with albumin, others by 
chemical combination forming substitution-compounds, others by arresting 
molecular changes, and still others by altering the reaction of the media con- 
taining the germs. The principal disinfectants are named in the following 
list, the figures following each giving the strength of its aqueous or aerial solu- 
tion necessary for rapid and certain action: — 



Fire, the most efficient. 
Heat, moist, at 212 F. 
Heat, dry, at 302 F. 
Mercuric Chloride, 1 : 1,000 
Iodine, 1 : 500 
Bromine, 1 : 500 
Benzoic Acid, 1 : 250 
Salicylic Acid, 1 : 200 
Formaldehyde, 1 : 100 
Hydrogen Dioxide, 1 : 100 
Potassium Permanganate, 1 
Chlorine, 1 : 100 
Chloretone, 1 : 100 



Calcium Hypochlorite, 1 : 100 
Eucalyptol, 1 : 100 
Creolin, 1 : 100 
Lysol, 1 : 100 
Trikresol, 1 : 50 
Phenol, 1 : 33 
Sulphurous Acid, 1 : 25 
Liq. Sodae Chlorinatas, 1 : 20 
Ferrous Sulphate, 1 : 20 
Acetic Acid, 1 : 14 
Lime, fresh, 1 : 4 
Zinc Chloride, 1 : 2 



Many good disinfectants are not available by reason of cost or some side action, as 
Hydrogen Dioxide, Bromine, Iodine, Potassium Permanganate, though the Tincture of 
Iodine is an excellent disinfectant for the skin, hands, and lacerated wounds. Formaldehyde 
is the best surface disinfectant, but has slight penetrating power. It has the advantage of 
not being retarded in action by albuminoid matter. Sulphurous Acid is of very doubtful 
value, even when present to the extent of 10 per cent, in moist air (Koch). Chlorine is used 
rather as a deodorant than a disinfectant, its germicidal power being uncertain (Munson). 
Burnett's Fluid is a 50 per cent, solution of Zinc Chloride. Labarraque's Solution is the same 
as the official Liquor Sodse Chlorinatae. Both these preparations depend for their efficacy 
upon the amount of free chlorine which they give out. Condy's Fluid is a 2 per cent, aque- 
ous solution of Potassium Permanganate; and though a good antiseptic and deodorant, it is 



CLASSIFICATION OF MEDICINES. 



23 



practically useless as a disinfectant, being constantly expended in oxidizing the organic matter 
of the infective substance, and would be required in enormous and impracticable quantities 
(Davies). Dakin's Solution is described at length under the Treatment of Wounds. 
The use of this solution, according to the technic of Carrel, represents perhaps the most 
recent noteworthy advance in the domain of antiseptics, and one which has already saved 
a great many lives in the present war. Flavine, Diamino-tnethyl-acridinum Chloride and 
Brilliant Green have recently been brought forward in the treatment of infected wounds in 
which they act as powerful antiseptics with low toxicity to the tissues. Flavine was origi- 
nally prepared for Ehrlich and found to have a marked therapeutic effect in trypanosome 
affections. At the present time these substances are being subjected to experimental and 
clinical studies (British Medical Journal, January 16, 19 17), and so far it would seem that 
they are destined for a wide field of usefulness. 

The popular idea of disinfecting the air of a room by burning sulphur, etc., is an absurdity 
because foul air is easily removed by simple ventilation. In disinfecting a room in which 
there has been a case of contagious or infectious disease, the true aim is to kill the germs 
contained in the dust on ledges, in the crevices between the boards, or adhering to the walls, 
and a dry gas is powerless for this purpose, which is best accomplished by using a Corrosive 
Sublimate Solution of the strength of 1 in 1000; or by Lime washing, provided that the lime 
be freshly burnt, and caustic; or by spraying with Formalin, or by dropping the latter on hot 
plates or sheets of hot metal. 

Antispasmodics (avrt, against, (nraa^os, a spasm), — are agents.which pre- 
vent or allay spasm of voluntary or involuntary muscles in any portion of the 
organism. Some of the agents belonging to this class act by tonic stimulation 
of the higher nervous centres, the coordinating power, and the circulation; 
as Ether in small doses, Camphor, Musk, Valerian: others by a depressant 
influence on the motor centres, as the Bromides; and still others by paralysis of 
the vaso-motor nerves, as Amyl Nitrite. A few depress all the vital functions, 
as Aconite, Tobacco, Lobelia, Hellebore, and Prussic Acid; and a number 
stimulate the muscular fibres of the intestines to expel gaseous accumulations, 
namely — Asafetida, Cajuput, Valerian, Musk, Aromatic Oils, etc. They are 
used in convulsive affections, especially asthma and other spasmodic diseases 
of the respiratory organs, hysteria, chorea, angina pectoris, epilepsy, etc. The 
principal antispasmodics are named in the following list: — 



Alcohol. Ether. 


Valerian. 


Hyoscyamus. 


Ipecacuanha. 


Paraldehyde. 


Conium. 


Hydrocyanic Acid. 


Senega. 


Chloroform. 


Aconite. 


Physostigma. 


Silver Salts. 


Amyl Nitrite. 


Lobelia. 


Curare. 


Zinc Salts. 


Nitrites. 


Tobacco. 


Ammoniac. 


Copper Salts, 


Bromides. 


Hellebore. 


Castor. 


Asafetida. 


Potassium Iodide. 


Opium. 


Musk. 




Potassium Nitrate. 


Belladonna. 


Galbanum. 




Arsenic. 


Stramonium. 


Sumbul. 





Antizymotics (dvn', against, £v/xwo-i'?, fermentation), — are agents which 
arrest the fermentative processes, the action of these depending on unorganized 
ferments (enzymes), as diastase, ptyalin, pepsin, etc., or upon that of organized 
ferments, as the yeast-plant, bacteria, etc. The Antizymotics are usually sub- 
divided into two groups, respectively entitled Antiseptics and Disinfectants 
(which see). 

Fermentation is a general name for those processes of decomposition, during which 
certain carbon compounds called Ferments act upon other carbon compounds, as on their 
food, — splitting these latter up, setting free their elementary constituents, and thereby lead- 



1 4 CLASSIFICATION OF MEDICINES. 

the formation of still other carbon compounds, by the rearrangement of the freed 
molecules. These processes are of two kinds, viz.: — 

(i)— Those in which water is taken up, (hydration),— chiefly carried on by enzymes. 
(2)— Those in which O is transferred from the H to the C association, as in lactic and 
alcoholic fermentation, and the putrefactive processes, which are chiefly carried on 
by the agency of organized ferments. 
The Ferments producing these fermentative changes are also carbon compounds, and 
are divisible into two groups, viz.: — 

Enzymes, or Organic Ferments, — have no definite structures and are unorganized, i. e., 

not living, — as Diastase, Ptyalin, Pepsin, etc. 
Organized Ferments, — are minute, living organisms, as the moulds, yeast-plant, bacteria, 
and other members of the Protophytes, the lowermost class of plants, which, in the 
course of their life history, split up the carbon compounds in which they live, appro- 
priating some part of their elements. 
Antizymotic Drugs are drugs which arrest or inhibit these fermentative processes either 
by destroying or by rendering inactive the causative ferments. 

Aphrodisiacs (AcrpooYr?;, Venus), — are medicines which, stimulate the sex- 
ual appetite and power. They act by reflex or by direct action upon either the 
cerebral or the spinal genital centre. Tonics are indirectly aphrodisiac, as are 
all measures which promote the general bodily nutrition. The chief agents 
used as direct aphrodisiacs are named in the following list. [Compare An- 

APHRODISLA.CS.] 

Strychnine. 

Cannabis. 

Cantharis. 

Phosphorus. 

Aurum. 

Yohimbine. 

Strychnine acts by increasing general nutrition and exalting the reflex excitability of 
the genital centres. Hemp probably only causes a mild delirium which may or may not 
take a sexual direction. Cantharides acts by direct irritation of the mucous lining of the 
urethra, and is dangerous in aphrodisiac doses. Alcohol in small doses excites; so also 
Opium and Camphor, the latter being decidedly anaphrodisiac after a time. Urtication .and 
Flagellation of the nates produce priapism by irritation of the genital centre in the cord 
through the sensory nerves of the part. Ergot is considered useful by contracting the dorsal 
vein of the penis, preventing its emptying too rapidly. 

Astringents (ad, to, stringo, I bind), — are agents which produce contrac- 
tion of muscular fibre and condensation of other tissues, the first probably by 
direct irritation, the second by precipitating their albumin and gelatin. They 
also lessen secretion from mucous membranes. The principal astringents are-^- 

Acids. Tannic Acid. Bismuth Subnitrate, etc. 

Alcohol. Gallic Acid. Cadmium Sulphate. 

Alum. Catechu. Gambir. Copper Sulphate. 

Chalk. Galls. Ferric Chloride. 

Lime. Kino. Lead Acetate. 

Creosote. Oak-bark. Silver Nitrate. 

Phenol. Uva-Ursi. Zinc Sulphate. 

Sulphuric Acid, Gallic Acid, and Lead Acetate are examples of Remote Astringents, acting 
on internal organs through the blood. Those which affect the part to which they are applied 
are Local Astringents, and include the others named above. 

Cardiac Sedatives lessen the force and the frequency of the heart's action. 
They are used to control palpitation and overaction of tnat organ, and to slow 



Cimicifuga. 


Iron. 


Serpentaria. 


Alcohol. 


Sanguinaria. 


Bitter Tonics. 


Opium (at first). 


Meat Diet. 


Camphor (at first). 




Ergot. 





CLASSIFICATION OF MEDICINES. 25 

the pulse in febrile conditions in sthenic subjects, especially when local inflam- 
mation is the exciting cause of the fever. The chief cardiac sedatives are — 

Hydrocyanic Acid. 
Potassium Salts. 
Cofd. 



Aconite. 


Pilocarpine. 


Antimony. 


Digitalis. 


Veratrum (?). 


Emetine. 


Muscarine. 


Chloral. 


Quinine in full doses. 


Senega. 



Cardiac Stimulants rapidly increase the force and frequency of the pulse 
in depressed conditions of the cardiac apparatus. One of the most useful agents 
of this class is Alcohol in some form, its action being largely due to a reflex 
influence excited through the nerves of the mouth and stomach. It should 
therefore be given in but slightly diluted form, and in small quantities fre- 
quently. Ether is next in value and still more rapid in action, and the local 
application of Heat is one of the most powerful and available. Ammonia has an 
energetic action as a stimulant to the vaso-motor centre, as well as a reflex one 
upon the heart similar to that of Alcohol. The chief cardiac stimulants are — 

Adrenalin. Cocaine. Sparteine. 

Alcohol. Ether. Camphor. 

Ammonia. Heat (locally). Aromatic Oils. 

Atropine. Continuous Galvanic Cur- Turpentine. 

Nitroglycerin. rent. Opium and Morphine, in 

Hydrastinine. Counter-irritation. small doses. 

Cardiac Tonics, when given in moderate doses, stimulate the cardiac 
muscle, slowing and strengthening its contractions. In large doses they are 
apt to produce irregular action of the heart, and some of them have more or less 
of a tendency to cause sudden death by syncope if pushed to any great extent. 
The most important of these agents are — 



Digitalis. Veratrum. 


Squill. 


Strychnine. 


Convallaria. 


Oubain. 


Helleboreln. 


Cimicifuga. 


Caffeine. 


Adonidin. 


Sparteine. 


Strophanthus. 





Carminatives (carmino, I soothe), — promote the expulsion of gas from 
the stomach and intestines by increasing peristalsis, stimulating the circulation, 
and relaxing the cardiac and pyloric orifices of the stomach. They also act as 
diffusible stimulants, both of the bodily and mental faculties. The principal 
carminatives belong to the aromatic oils, alcohols or ethers, and are named in 
the following list: — • 



Asafetida. 


Mace. 


Oil of Cloves. 


Camphor. 


Mustard. 


Oil of Coriander. 


Capsicum. 


Pepper. 


Oil of Eucalyptus. 


Cardamom. 


Serpentaria. 


Oil of Fennel. 


Chloroform. 


Spirits. 


Oil of Peppermint. 


Ether. 


Oil of Anise. 


Oil of Spearmint. 


Fennel. 


Oil of Cajuput. 


Oil of Nutmeg. 


Ginger. 


Oil of Caraway. 


Oil of Pimento. 


Horse-radish 


Oil of Cinnamon. 


Oil of Valerian. 



26 CLASSIFICATION OF MEDICINES. 

Cathartics or Purgatives (xada\oto, pur go, I cleanse), — are agents which 
increase or hasten the intestinal evacuations. According to their respective 
degrees and direction of action they are subdivided into several groups, as 
follows: — 

Laxatives (laxo, I loose), or Aperients (aperio, I open), — include those which 
excite moderate peristalsis, and produce softened motions without irritation. 
Sulphur is the typical laxative. 

Simple Purgatives, — cause active peristalsis, and stimulate the secretions 
of the intestinal glands, producing one or more copious and semifluid motions 
with some irritation and griping. Senna is the type of this group, which also 
includes Aloes, Rhubarb, Castor Oil, etc. 

Drastic Purgatives (Spaeiv, to draw), — act still more intensely, producing 
violent peristalsis and watery stools, with much griping pain, tenesmus, and 
borborygmi. They irritate the intestinal mucous membrane, cause exosmosis 
of serum from its vessels, and in large dose set up inflammation and symptoms 
of irritant poisoning. Jalap is a typical drastic. 

Saline Purgatives. — This group includes the neutral salts of metals of the 
alkalies or alkaline earths. They stimulate the intestinal glands to increased 
secretion, and by their low difTusibility impede reabsorption, causing an accu- 
mulation of fluid in the intestinal tract, which, partly from the effect of gravity 
and partly by gentle stimulation of peristalsis excited by distention, reaches 
the rectum and produces a copious evacuation. Magnesium Sulphate and 
Sodium Sulphate are the typical salines. They should be given in plenty of 
water and during active movement (as in walking) in order to produce their 
best effects. 

§ Hydragogue Purgatives (y&wp, water, &y<*>, I bring away), — include the most 
active of the drastic and saline groups, especially those which remove a large 
quantity of water from the vessels. Elaterium is a typical hydragogue cath- 
artic. 

Cholagogue Purgatives (x°^y, bile, ayw, I bring away), — are those agents 
which produce free purgation, the stools being green-colored ("bilious") and 
liquid. Podophyllin is the type of this group. 

The principal Cathartics are the following-named: — ■ 

Laxatives. Simple Purgatives. Drastics. 

Sulphur. Senna. Jalap. Gamboge. 

Magnesia. Aloes. Colocynth. 

Cassia. Rhubarb. Elaterium. 

Manna. Castor Oil. Scammony. 

Figs. Prunes. Rhamnus Frangula. Croton Oil. 

Tamarinds. Ox-gall. Cathartic Acid, hypoder- 

Honey. Calomel. mically. 

Cascara Sagrada. Small doses of drastics, 

Physostigma. salines or cholagogues. Hydragogues. 
Phenolphthalein . 

Ergot. Elaterium. 

Belladonna. Gamboge. 

Stramonium. Potassium Bitartrate. 



CLASSIFICATION OF MEDICINES. 27 

Laxatives. Saline Purgatives. Hydragogues. 

Hyoscyamus. Magnesium Sulphate. Croton Oil. 

Almond Oil. Magnesium Citrate. Salines in large doses. 

Olive Oil. Potassium Sulphate. 

Soap. Potassium Tartrate. 

Taraxacum. Potassium Bitartrate. Cholagogues. 

Glycerin. Sodium Sulphate. Podophyllin. 

Oatmeal. Sodium Phosphate. Mercurials. 

Bran Biscuit. Sodium Chloride. Aloes. Rhubarb. 

Brown Bread. Pot. and Sodium Tartrate. Euonymin. 

Manganese Sulphate. Nitrohydrochloric acid. 

Cerebral Depressants lower or suspend the functions of the higher cere- 
brum after a preliminary stage of excitement. Under this head may be 
included the Hypnotics, Narcotics, General Anesthetics, and several of the Anti- 
spasmodics, all acting on the cells of the convolutions; at first stimulating the 
brain-functions, they produce after a time stupor, coma and insensibility. 

The most useful of this class are the Bromides as they also diminish reflex excitability 
and thus secure rest of the nervous system. Some cerebral depressants are decidedly dan- 
gerous, as they may paralyze the heart of the medulla and its centres of organic life before the 
consciousness is much disturbed ; such being Chloroform, Chloral, Phenol, Aconite, Opium, and 
the irritant poisons. 

Cerebral Excitants are remedies which increase the functional activity 
of the brain, without producing any subsequent depression, or any suspension 
of the cerebral functions. They act partly by increasing the action of the heart 
and consequently the rapidity of the circulation, partly by a direct action upon 
the gray matter of the brain. The chief members of this group are — 

Acetic Acid (inhaled). Cannabis. Camphor. Ether. 

Alcohol (at first). Coffee, Caffeine. Quinine. 

Ammonia (inhaled). Tea, Theine. Tobacco. 

Ammoniac. . Guarana, Guaranine. Strychnine. 

Asafetida. Coca, Cocaine. Valerian. 

The Cerebellum is markedly disturbed by the few drugs which affect it specifically, their 
action upon its different lobes producing various disturbances of coordination and equilibrium. 
Alcohol in considerable dose causes a staggering gait, and a tendency to fall; and different 
preparations thereof seem to affect different portions of the cerebellum. Intoxication by 
wine or beer is said to be accompanied by a tendency to fall sideways, — that, by whiskey, 
especially Irish whiskey, an inclination to fall on the face, — and that by cider a backward 
tendency; and these disturbances correspond exactly with those caused by injury to different 
lobes of the cerebellum (Brunton). Apomorphine in large doses seems to act upon the cere- 
bellum or corpora quadrigemina, as the animal poisoned by it does not vomit, but moves 
round and round in a circle. 

► Ciliary Excitants are substances which, when dissolved in the mouth, 
promote the expectoration of bronchial mucus by their reflex excitation of the 
tracheal and bronchial cilia. This group includes such agents as the Chlorides 
of Ammonium and Sodium, Potassium Chlorate and Gum Acacia. 

Deliriants excite the functions of the higher brain to such a degree as to 
disorder the mental faculties, producing intellectual confusion, loss of will- 
power, delirium and even convulsions. They are all narcotics (though all nar- 
cotics are not deliriants), and the most important may be listed as follows: — 

Belladonna. Alcohol. Cannabis. 

Stramonium. Chloral. Lupulus (at first). 

Hyoscyamus.. Ether. Opium (at first). 

Turpentine. Chloroform. Nitrous Oxide Gas. 



2S CLASSIFICATION OF MEDICINES. 

Demulcents (demulceo, I soothe), — are substances usually of oleaginous 
or mucilaginous nature, which soothe and protect the parts to which they are 
applied. This term is generally used for substances employed for mucous 
membranes, and the term Emollients for similar agents used on the skin. The 
chief agents belonging to this class are: — 



Acacia. 


Starch. 


Honey. 


Olive Oil. 


Cetraria. 


Glycerin. 


Marsh-mallow. 


Isinglass. 


Barley. 


Flaxseed. 


White of Egg. 


Tragacanth. 


Licorice. 


Gelatin. 


Almond. 


Bland Oils. 



> 



Dental Anodynes are substances employed locally in toothache due to 
caries exposing a nerve filament. Such are Aconite, Opium and Cocaine salts, — 
also Creosote, Chloral, Phenol, and Potassium Chlorate. A solution, contain- 
ing the three first named, applied on a pledget of cotton, will promptly relieve 
whenever the nerve is accessible. Chloral should never be employed for this 
purpose, as in solution sufiiciently strong to be of any service it is very apt to 
cause sloughing of the gum, especially if injected thereinto by a hypodermic 
syringe, as is frequently done by ignorant dentists, who advertise the "extrac- 
tion of teeth without pain." 

Dentifrices (dens, a tooth, frico, I rub), — are medicated powders or pastes 
applied with a stiff brush to cleanse the teeth and gums. Chalk is the basis 
generally used, for its mechanical action and its alkaline quality. Antiseptics, 
as Borax, Quinine, Phenol, etc., should also be employed, so as to prevent the 
acid fermentation of food products between the teeth and the consequent decay 
of the dentine. Tincture of Myrrh is an excellent ingredient, being an aromatic 
local stimulant and disinfectant. 

Many drugs affect the teeth injuriously, such being the Mineral Acids, Persalts of Iron 
and Alum. The first two should be taken through a glass tube, and the mouth should be 
rinsed afterwards with a weak alkaline solution. 

Deodorants are agents which destroy foul odors. The Volatile Deodorants 
are chiefly oxidizing and deoxidizing substances, acting chemically on the ob- 
noxious gases; while the Non-volatile ones are mainly absorbents, which con- 
dense and decompose the effluvia. The deodorants in general use are the fol- 
lowing-named: — 

Formaldehyde. Hydrogen Dioxide. Charcoal. 

Chlorine Gas. Potassium Permanganate. Earth. Lime. 

Sulphurous Acid Gas. Coffee, freshly roasted. Ferrous Sulphate. 

For removing the fetid exhalations emitted by the feces, the following powder is a very 
efficient and cheap deodorizing and disinfecting agent. Zinc Sulphate, lbs. ij, Sulphuric Acid, 
3 jss to 5ijss, Essence of Mirbane, 3 j, Indigo Blue, gr. ij. About a dessert-spoonful of this is 
placed in the bed-pan or chamber utensil before it is used. Contact with urine or a liquid 
stool causes its prompt solution, deodorization is instantaneous, the liquid excreta are at once 
sterilized, and the fetor is changed to a rather agreeable odor. Oil of Eucalyptus has the prop- 
erty of spreading rapidly over .water in a thin film, and if a few drops are sprinkled over the 
water in the pan of a water closet before using the latter, no fecal odor will arise therefrom. 



CLASSIFICATION OF MEDICINES. 2Q 

Destructive Metamorphosis of the tissues is promoted by a number of 
agents, most of which are classed as Alteratives or as Astringents, the most 
important of which are the following-named: — 

Alkalies. Sulphides and Iodides. 

Vegetable Acids. Sarsaparilla. 

Metals and their salts. Stillingia. 

Colchicum. Xanthoxylum. 

Tannic and Gallic Acids, and substances containing them. 

Destructive Metamorphosis may be diminished by many substances, the 

following-named being the chief ones: — 

Alcohol. Salicin. Resorcinol. 

Glycerin. Salicylates. Cocaine. 

Oils and Fats. Quinine. 

Diaphoretics and Sudorifics (dteupoptco, I carry through, sudor, sweat, 
facio, I make), — are remedies which increase the action of the skin and pro- 
mote the secretion of sweat. When they act energetically, so that the perspira- 
tion stands in beads upon the surface, they are known as Sudorifics. They 
may be subdivided into the following groups, viz. — 

(1) Simple Diaphoretics, which enter the circulation and are eliminated by the sudor- 
iferous glands, which they stimulate to increased action. 

(2) Nauseating Diaphoretics, which produce relaxation and dilatation of the superficial 
capillaries. 

(3) Refrigerant Diaphoretics, which reduce the circulation, at the same time acting directly 
on the sweat-centres in the spinal cord and medulla. 

The principal diaphoretics are the following-named: 

Aconite. Ipecacuanha. Mezereon. 

Veratrum. Opium (large doses). Sarsaparilla. 

Tobacco. Dover's Powder. Guaiacum. 

Lobelia. Tartar Emetic. Serpentaria. 

Alcohol. Sulphur. Sassafras. 

Ether. Camphor. Senega. 

Nitrous Ether. Cocaine. Vapor Bath. 

Salicylates. Ammonium Acetate. Turkish Bath. 

Pilocarpus. Ammonium Citrate. Wet Pack. 

Pilocarpine. Potassium Salts. Warm Drinks. 

Diluents (diluo, I dilute), — are indifferent substances which, after their 
absorption, dilute the excretory fluids and enable the latter to hold more solid 
material in suspension. Water is the one true diluent, whatever form it may 
be disguised in, as teas, weak fluid foods, acid drinks, etc. 

Discutients or Sorbefacients (discutio, I dissipate, sorbere, to suck), — 
are agents which promote absorption, and may be divided into two classes; 
(1) those which stimulate the lymphatics to the removal of morbid or inflam- 
matory deposits, (2) those which promote the imbibition of nutritive or medic- 
inal material into the system. [Compare Alteratives.] These agents include 
the following-named: — 

Arsenic. Ichthyol. Vapor Bath. 

Mercury. Lanolin. Hot Water Bath. 

Iodine. Oleic Acid. Poultices. 

Iodides. Cacao Butter. Counterirritation. 

Cadmium. Massage. Galvanism. 



30 CLASSIFICATION OF MEDICINES. 

Lanolin and Oleic Add have remarkable power of penetration through the skin and are 
used as excipients for drugs which are to be administered by cutaneous absorption. Cacao 
Butler possesses the same penetrative property, and is usually employed in making medicated 
suppositories. 

Diuretics (du>vpi)<ns, urination), — are agents which promote the secretion 
of urine, either by raising the local or general blood-pressure and so increasing 
the renal circulation, by stimulating the secreting cells or nerves of the kidneys, 
or by flushing the kidneys with water. Diuretics may be classified according 
to their physiological action or according to the different purposes for which 
they are employed. Refrigerant Diuretics, especially the salines, excite the renal 
epithelium, induce a hyperemic condition of the kidneys and increase the water 
of the urine. They possess a sedative action upon the heart and the general 
circulation, but used to excess they depress the heart and impoverish the blood. 
Potassium Chlorate is a decided renal irritant, and should never be used as a 
diuretic. Hydragogue Diuretics increase the water of the urine largely, and 
in general act by raising arterial pressure, either — (a) throughout the body, or 
(b) locally in the kidneys. This they accomplish in various ways, direct and 
indirect, — increasing the action of the heart, contracting the efferent vessels 
or dilating the afferent vessels, so as to raise the blood-pressure in the glomeruli, 
etc. The action of the Stimulant Diuretics is directly upon the renal tissue, 
by which they are largely eliminated from the body. In small or moderate 
doses they dilate the renal arterioles, increase the renal blood-supply, and so 
induce diuresis, but in large doses they irritate the renal epithelium, contract 
the renal arterioles, diminish the renal blood-supply, excite renal inflammation, 
render the urine albuminous and bloody, and may even induce suppression of 
the urine. All the members of this division should be used with caution. 

Individual members of the diuretic class act in various modes, some of them 
in more than one manner, and probably as follows, viz. — 

i. By increasing the action of the heart (Digitalis, etc.) or by contracting the intestinal 
and other vessels, thus raising the general blood-pressure. 

2. By dilating the afferent renal vessels, thereby increasing the renal blood -supply and 
raising the pressure in the glomeruli. 

3. By contracting the efferent vessels, raising the pressure in the glomeruli and lessen- 
ing absorption in the tubules, or both. 

4. By stimulating the secreting cells or nerves of the kidneys. 

5. By flushing the kidneys, as by the ingestion of Water in large quantity. 

The following list contains the most important agents of this group, which 
are usually subdivided into the three classes indicated by the subtitles. 



Refrigerant Diuretics. 


Hydragogue Diuretics. 


Stimulant Diuretics 


Potassium Acetate. 


Digitalis. 


Alcohol. 


Potassium Bitartrate. 


Strophanthus. 


Blatta orien talis. 


Potassium Citrate. 


Con valla ria. 


Cantharides. 


Potassium Chlorate. 


Cimicifuga. 


Turpentine. 


Potassium Nitrate. 


Adonis vernalis. 


Juniper. 


Sodium Acetate. 


Erythrophlceum. 


Savin. 


Sodium Chlorate. 


Squill. 


Copaiba. 


Sodium Chloride. 


Broom. Sparteine. 


Cubeb. 


Ammonium Acetate. 


Calomel. 


Cannabis. 



CLASSIFICATION OF MEDICINES. 3 1 



Refrigerant Diuretics. 


Hydragogue Diuretics. 


Stimulant Diuretics, 


Calcium Chloride. 


Caffeine. Theocin. 


Capsicum. 


Lithium Carbonate. 


Theobromine. 


Buchu. 


Lithium Citrate. 


Apocynum. 


Asparagus. 


Magnesium Citrate. 


Nitrous Ether. Nitrites. 


Guaiac. 


Magnesium Sulphate. 


Strychnine. 


Fennel. 


Water. Milk. 


Colchicum. 


Urea . 


Carbonic Acid. 


Tobacco. 


Uva Ursi. 


Cold to surface. 


Sugar of Milk. 


Zea. 



Diuretics are employed in medicine for certain definite purposes, as fol- 
lows: — to remove fluid from the tissues and cavities of the body in cases of 
dropsy; to promote the elimination of waste-products and other poisons from 
the blood; to maintain the action of the kidneys; to dilute the urine, and to 
alter morbid conditions of that excretion. 

In Dropsies from Cardiac Disease, or other dropsies due to venous congestion, the most 
efficient diuretics are those which act on the general vascular system, as Digitalis, Strophan- 
thus, Squill, etc. Calomel is often very efficient in this form of dropsy, also Theobromine 
Sodio-Salicylate (Diuretin). 

In Dropsy from Renal Disease, Diuretin, Broom-tops, Nitrous Ether, Oil of Juniper, 
Digitalis and Squill are the most reliable diuretics. 

In Ascites from Hepatic Cirrhosis, Copaiba is the best diuretic when the kidneys are healthy. 
In this form and the previous ones a little Pil. Hydrargyri given occasionally will often aid 
the diuretic action of the other agents. 

To eliminate Waste-products from the Blood, Potassium Nitrate and Bitartrate, Turpentine, 
Juniper, Caffeine, and Water in large quantity. 

To Dilute the Urine ,Water is the best agent, its most efficient form being Distilled Water 
charged with Carbonic Acid gas. 

As Adjuvants to Diuretics, when pressure on the uriniferous tubules or venous congestion 
prevent their action, — paracentesis abdominis, purgation, cupping over the loins, and even 
venesection, are often necessary to start the diuretic action. 

The activity of the renal cells is directly depressed by the Renal Depressants, 
which thereby lessen or suspend the secretion of urine. Morphine, Quinine 
and Ergot act in this manner through their influence on the circulation. 

Emetics (c/^ew, I vomit), — are agents which produce vomiting. They may 
be subdivided into two groups, Local Emetics, or those which act by irritating 
the end-organs of the gastric, pharyngeal or esophageal nerves, and General 
or Systemic Emetics, which act through the medium of the circulation. The 
members of both these groups produce emetic action by irritation of the vomit- 
ing centre in the medulla, the first by reflex, the second by direct stimulation. 
The principal emetics are the following named: — 

Local Emetics. General Emetics. 

Alum, Mustard, Salt. Ipecacuanha. Emetine. 

Ammonium Carbonate. Apomorphine. 

Zinc and Copper Sulphates. Tartar Emetic. 

Subsulphate of Mercury. Senega. 

Tepid Water, in quantity. Squill. 

Vegetable Bitters, as Quassia, Ouabain, 

in strong infusions. 

Tartar Emetic, Ipecacuanha and probably Apomorphine, act locally as well as systemically, 
for if injected subcutaneously they are excreted by the stomach in part, thus irritating the 
gastric nerves as well as the vomiting centre. Pilocarpus is a local emetic, and Digitalis and 
its congeners, also Muscarine, are systemic emetics, but none of these agents are used medicin- 
ally for that purpose. Opium, Morphine, and Codeine usually produce emesis as one of their 
after effects. 



32 CLASSIFICATION OF MEDICINES. 

Vomiting is an evacuant act which consists in compression of the stomach by the simul- 
taneous spasmodic contraction of the diaphragm and abdominal muscles; also in relaxation of 
its cardiac orifice by contraction of the radiating muscular fibres in the gastric wall. If both 
acts occur at the same time, the contents of the stomach are expelled and vomiting occurs; if, 
however, the two acts do not take place simultaneously, the contents of the stomach are re- 
tained, and the abortive efforts are called retching. These acts are controlled and regulated by 
a nerve-centre in the medulla oblongata, which is closely connected with the respiratory centre, 
the muscular movements of vomiting being merely modified respiratory movements. This 
vomiting centre is ordinarily excited in two ways, — (i) by the peripheral stimulation of afferent 
nerves going to it from other parts of the body, (2) by impulses sent down to it from the brain 
(Brunton). 

Nausea and vomiting are diminished by agents termed Anti-emetics, includ- 
ing gastric sedatives and general sedatives; some of which act by means of a 
local sedative influence upon the end-organs of the gastric nerves, others by 
reducing the irritability of the vomiting centre in the medulla. The act of 
vomiting being occasioned by irritation of afferent nerves from many regions 
of the body or impulses from the brain excited by impressions on the nerves 
of special sense, the measures and agents by which it may be combated are 
very diversified. [Compare the article entitled Vomiting, in Part III.] The 
most important anti-emetics are named in the following lists: — 

Local Gastric Sedatives. General Sedatives. 

Alcohol. Creosote. Opium. 

Alum. Ether. Morphine. 

Arsenic. Ice. Codeine. 

Belladonna. Opium. Hydrocyanic Acid. 

Bismuth. Hydrocyanic Acid. Bromides. 

Carbonic Acid. Silver Nitrate. Chloral. 

Cerium Oxalate. Calomel 1 small Nitro-glycerin. 

Chloroform. Ipecac J doses. Alcohol. 

Phenol. Hot water. Amyl Nitrite. 

Potassium Nitrate. Cocaine. Food. 

Ice, swallowed in small pieces, is probably the most efficient of the local sedatives. Phe- 
nol and Cocaine are also effective anti-emetics, given in small doses by the mouth at short 
intervals. Astringents are very useful where there is congestion of the gastric mucous mem- 
brane, as in the vomiting of alcoholism and phthisis, when Silver Nitrate and Alum are espe- 
cially to be recommended. Opium and its principal alkaloid, Morphine, will produce nausea 
and vomiting in many persons, even when given in very small doses. 

Emmenagogues (l/x^vta, the menses, ayw, I move), — are remedies which 
restore the menstrual function, either directly by stimulation of the uterine 
muscular fibre, or indirectly by improving the blood and toning up the nervous 
system. Some of the direct emmenagogues are oxytocic in large doses. The 
principal members of this class are named in the following list: — 

Direct Emmenagogues. Indirect Emmenagogues. 

Ergot. Iron. 

Savin. Manganese. 

Tansy. Rue. Cinnamon. 

Digitalis. Quinine. 

Cantharis. Strychnine. 

Asafetida. Aloetic Purgatives. 

Alcohol. Cod-liver Oil. 

Apiol. Hot Hip-baths. 

Guaiacum. Leeching the genitals. 

Cimicifuga. Rubefacients to thighs. 

Oxalic Acid. Tonic Remedies. 



CLASSIFICATION OF MEDICINES. 33 

Emollients (emollio, I soften), — are substances which soften and relax 
the tissues to which they are applied. They relieve tension, dilate vessels, 
diminish pressure on the nerves, and protect inflamed surfaces from the air and 
from friction. The principal articles which may be classed under this heading 
are the following: — 

Hot Fomentations. Linseed Oil. Petrolatum. 

Poultices. Olive Oil. Soap Liniment. 

Glycerin. Spermaceti. Starch. 

Lard. Almond Oil. Cacao Butter. 

Errhines and Sternutatories (h, in, piv, the nose; stemuto, I sneeze), — 
are agents which produce increased nasal secretion and sneezing, when locally 
applied to the mucous membrane of the nose. The first term is usually applied 
to substances which cause increase of the mucus without sneezing, the latter 
to those which invariably produce sneezing. The drugs should be applied 
in powder. The stimulus produced by these agents is transmitted by the 
nasal branches of the fifth nerve to the respiratory centre, exciting the sud- 
den and forcible expiratory effort called sneezing; also to the vaso-motor centre, 
contracting the smaller vessels throughout the body and producing a general 
rise in the blood-pressure. The principal agents of this class are — 

Tobacco, as snuff. Euphorbium. Capsicum. 

Ipecacuanha. Sassy Bark. Hellebore. 

Sanguinaria. Saponin. Ammonia. 

Veratrum Album. Ginger. Cubebs. 

The last two named may be used as simple Errhines, as the vapor of dilute Ammonia, 
water or the smoke of burning Cubebs do not excite sneezing generally. 

Escharotics or Caustics (iax^pcc a slough or scab; kolLcd, I burn), — are 
agents which destroy a tissue to which they are applied, and produce a slough. 
They may be divided into two classes, the actual, or those in which heat is the 
active agent, and the potential, by which a chemical process is called into play. 
Escharotics act usually in one of the following modes: — 

1 . By abstracting the water of the tissues. 

2. By combining with the albumin of the tissues. 

3. By corrosive deoxidation of the tissues. 

4. By conversion of the tissues into carbon or gaseous bodies. 

The principal escharotics are: — 

Mineral Acids. Caustic Potash. Mercuric Chloride. 

Glacial Acetic Acid. Caustic Soda. Mercuric Oxide. 

Phenol. Dried Alum. Mercuric Nitrate. 

Chromic Trioxide. Silver Nitrate. Bromine. 

Arsenic Trioxide. Copper Sulphate. f Cautery. 

Antimony Chloride. Zinc Sulphate. High Heat. \ Moxa. 

Lime. Zinc Chloride. { Boiling Water. 

Nitric Acid and Zinc Chloride are probably the safest and most generally useful of the 
potential caustics where any decided escharotic action is desired. Silver Nitrate is the best 
for superficial use, its action being limited to the part with which it comes in contact, and 
being stopped at once by the application of a solution of common salt. Chromic Trioxide is 
one of the most efficient escharotics, but it must be carefully used. 



Acids. 


Nux Vomica. 


Squill. 


Strychnine. 


Garlic. 


Senega. 


Onion. 


Saponin. 


Turpentine. 


Licorice. 


Sulphur. 


Saccharine Substances 



34 CLASSIFICATION OF MEDICINES. 

Expectorants (ex, out of, pectus, the breast), — are remedies which modify 
the secretion of the broncho-pulmonary mucous membrane, and promote its 
expulsion. They may be divided into the following groups: 

Nauseating Expectorants in large doses act mechanically by expelling the 
mucus in the act of vomiting, in small doses by increasing osmosis from the 
inflamed mucous membrane. The members of this subdivision generally 
increase secretion and tend to lower the blood-pressure. The chief ones are the 
following named: — 

Antimony, Tartar Emetic. Apomorphine. Alkalies. 

Ipecacuanha. Emetine. Pilocarpus (Jaborandi). Potassium Iodide. 

Stimulant Expectorants are largely eliminated by the bronchial mucous 
membrane, which they stimulate, altering the secretion and facilitating expec- 
toration. These remedies generally diminish secretion. This subdivision 
includes the following named: — 

Ammonium Chloride. 
Ammonium Carbonate. 
Benzoin and Benzoic Acid. 
Balsams of Peru and Tolu. 
Wood Tar, and Tar. 
Oleum Pini Sylvestris. 

Besides the above many other remedies may act as expectorants, some by relieving bron- 
chial spasm, as Opium, Stramonium, and Tobacco; others by soothing the irritable respiratory 
centre, as Opium and Chloral; and the ciliary excitants by reflex action through their impres- 
sion on the nerves of the mouth. 

Galactagogues (yaAa, milk, ayco 3 I bring away), — are agents which are 
supposed to increase the lacteal secretion. The value of most of them is very 
doubtful, probably the only efficient one being Pilocarpus (Jaborandi), but its 
influence is very transient and the excessive perspiration and salivation caused 
by it are objectionable. The leaves of Ricinus communis, the castor-oil plant, 
locally applied, have been highly recommended; but general measures are 
more trustworthy, such as the correction of anemia, attention to sore nipples, 
administration of tonics and good food. [Compare the article entitled Lac- 
tation in Part III.] 

Galactophyga (yaAa, milk, <t>evyu), I shun), — are agents and measures which 
diminish or arrest the secretion of milk. Belladonna or its alkaloid Atropine 
is the most efficient, acting whether applied locally or administered internally. 
Antipyrine has similar power, so also has Camphor applied locally and Potas- 
sium Iodide, Colchicum with Magnesium Sulphate, Tobacco, Sage, Quinine, 
Tannin, etc. Compression of the breasts, by bandaging or strapping with 
adhesive plaster, has positive antigalactic action. 

Hearing is affected by several drugs. Strychnine and Morphine increase 
the excitability of either the auditory nerve or the centre for hearing in the 
superior temporo-sphenoidal convolution, making that faculty much more 
acute. Quinine, Antipyrine and the Salicylates produce hyperemia of the 



CLASSIFICATION OF MEDICINES. 35 

auditory apparatus, causing subjective noises, as humming, buzzing, or ring- 
ing, which are very unpleasant. Hydrobromic Acid and the Bromides, also 
Ergot, will diminish the congestion and thus neutralize or prevent these noises 
to a great extent. 

Quinine in large doses is believed by some to have produced permanent injury of the sight 
and the hearing, but authentic cases of such action are extremely rare, if indeed they can be 
found at all. Temporary deafness is often caused by Quinine, but it usually disappears soon 
after the administration of the drug is stopped. 

Hepatic Stimulants and Cholagogues (zoArj, bile, aj-co, I bring away), — 
are two groups of agents acting upon the biliary secretion, the first-named 
increasing the functional activity of the liver-cells and the amount of bile formed, 
the second removing the bile from the duodenum and preventing its reabsorp- 
tion into the portal circulation. Some hepatic stimulants are also cholagogues, 
others are not, while cholagogues proper generally act indirectly as hepatic 
stimulants by carrying off the bile and thereby urging the liver to secrete more. 
The discovery of the enterohepatic circulation of bile has cleared up many of 
the discrepancies formerly existing with regard to the action of drugs upon this 
gland and its secretion, yet neither this subject nor hepatic chemistry has yet 
attained such results as would enable us to formulate positive doctrines thereon. 
Bile, Bile Salts and Sodium Salicylate are at present the only agents which 
have been experimentally proven to have the direct power of increasing the 
biliary secretion, though a number of drugs are believed to act in this manner 
upon clinical and other evidence. The following list includes the principal 
agents which are generally credited with the actions defined above: — 

Hepatic Stimulants. Cholagogues. 

Bile, Bile Salts. Ipecacuanha. Mercury with Chalk. 

Sodium Salicylate. Colocynth. Calomel. 

Nitro-hydrochloric Acid. Colchicum. Pil. Hydrargyri. 

Mercuric Chloride. Podophyllin. Sodium Phosphate. 

Mineral Acids. Arsenic. Euonymin. Sodium Sulphate. 

Sulphurated Antimony. Jalapin. Potassium Sulphate. 

Benzoic Acid. Scammony. Aloes. Rhubarb. 

Sodium Benzoate. Rhubarb. Podophyllin. 

Sodium Phosphate. Aloes. Colchicum. 

Sodium Sulphate. Sanguinarine. Colocynth. 

Sodium Phenolsulphonate. Hydrastin. Jalapin. 

To secure the best cholagogue effect it is advisable to combine an hepatic stimulant with 
an intestinal stimulant which shall produce increased secretion from the .intestinal mucous 
membrane and excite peristalsis. Hydrochloric Acid which has been kept long and has become 
a light or golden-yellow color, is relatively inert as an hepatic stimulant, but the freshly com- 
bined, deep red acid is active and valuable (Wood). 

Hypnotics (vttvos, sleep), — are remedies which produce sleep. In this wide 
sense the term includes the narcotics and the general anesthetics, but it is usually 
restricted to those agents which, in the doses necessary to cause sleep, do not 
disturb the normal relationship of the mental faculties to the external world 
(Brunton). Another definition of hypnotics is — that they produce sleep with- 
out suspending the consciousness of pain, narcotics doing both. Hypnotics 
may be subdivided into the following classes: — 



36 CLASSIFICATION OF MEDICINES. 

Pure Hypnotics, — which directly induce a sleep closely resembling the 
normal, without causing narcotic or other dangerous cerebral symptoms. The 
Bromides are the type of this subdivision, but the list is constantly growing 
smaller as experience reveals toxic powers in the action of its members. 

Xarco-hypnotics, — which induce sleep by direct depression of the cerebral 
functions and in larger doses are narcotic, suspending the consciousness of 
pain and producing coma. Opium is the type of this class. 

Indirect Hypnotics. — which induce sleep by removing or suppressing any 
cause (not mental) which interferes therewith. Such are the non-narcotic 
analgesics,* acting against pain; the respiratory stimulants, f relieving dyspnea; 
the pulmonary sedatives, J relieving cough; the motor depressants, § restrain- 
ing excessive motor activity; also the vascular and cardiac tonics,^ antagoniz- 
ing cerebral hyperemia and regulating the cardiac action. 

The principal members of each of the above subdivisions are named in the 
following lists: — 

Pure Hypnotics. Nar co-hypnotics. Indirect Hypnotics. 

Potassium Bromide. Hydrated Chloral. Chloretone. * Antipyrine. 

Sodium Bromide. Opium, Morphine, Apomorphine. * Acetanilid. 

Paraldehyde. Hyoscine. Duboisine. * Acetphenetidin. 

Sulphonmethane. Cannabis. t Strychnine. 

Sulphonethylmethane. Amylene Hydrate. j Hydrocyanic Acid. 

Veronal. Alcohol. § Conium. 

Ethyl Carbamate. § Gelesmium. 

Chloralformamide. 1[ Ergot. 

Hedonal. ^ Digitalis. 

Hydrated Chloral is undoubtedly the most efficient of all hypnotics. Paraldehyde is one 
of the most reliable and safe, but its sleep is transient, lasting only a few hours. Sulphon- 
methane and Sulphonethylmethane are very efficient in some cases, but often fail entirely. Ethyl 
Carbamate is feeble and uncertain, and the same may be said of Humulus and some other 
agents which are not mentioned above. 

Dr. Wilcox rejects the dangerous, unreliable and objectionable hypnotics, and retains 
four as amply sufficient for all ordinary cases of insomnia. These he classifies as follows: 

As to Potency: Paraldehyde, Chloralformamide, Pellotine, Sulphonethylmethane. 

As to Rapidity: Pellotine, Paraldehyde, Chloralformamide, Sulphonethylmethane. 

As to not causing Habituation: Pellotine, Sulphonethylmethane, Chloralformamide, 
Paraldehyde. 

As to Safety: Chloralformamide, Pellotine, Paraldehyde, Sulphonethylmethane. 

Intestinal Astringents contract the walls of the intestinal vessels, dimin- 
ishing the exudation therefrom, and lessening the fluidity of the fecal discharges. 
The more powerful members of this group have also a constringing action on 
the intestinal mucous membrane. The principal agents of this class are named 
in the following lists: — 

Astringents. Constringents. 

Phosphoric Acid. 1 Tannic Acid. 

Nitric Acid. r,.,,,, - Vegetable Astringents. 

Sulphuric Acid. r Dlluted - A1 2 m> 

Acetic Acid. J Zinc Oxide. 

Lead Acetate. Copper Sulphate. 

Silver Nitrate. Persalts of Iron. 



CLASSIFICATION OF MEDICINES. 37 

Irritants are substances which, when applied to the skin, produce a greater 
or less degree of vascular excitement. When used to produce a reflex influence 
on a part remote from their site, they are termed counter-irritants. They may 
be subdivided into the following groups: — 

Rubefacients, are those which produce temporary redness and congestion 
of the skin, unless left too long in contact with the surface, when they may 
cause exudation between the cuticle and the true skin (vesicants), or may de- 
stroy the tissue and form a slough (escharotics) . They may also induce mus- 
cular atrophy. 

Vesicants, Epispastics or Blisters, are those which cause decided inflam- 
mation of the skin and the outpouring of serum between the epidermis and 
the derma. Cantharides is the agent generally used for blistering purposes. 

Pustulants, affecting isolated parts of the skin, namely — the orifices of the 
sweat-glands, giving rise to pustules. 

The following list includes the principal agents and measures belonging to 
these three groups: — 



Rubefacients. 


Rubefacients 


Vesicants. 


Mustard. 


Oil of Cajuput. 


Cantharides. 


Capsicum. 


Oil of Turpentine. 


Euphorbium. 


Camphor. 


Volatile Oils. 


Mezereon. 


Ammonia. 


Pitch. Friction. 


Iodine. 


Mezereon. 


Hot Water. 


Rhus Toxicodendron. 


Arnica. 




Ammonia (the confined vapor). 


Alcohol. 


Pustulants. 


Glacial Acetic Acid. 


Ether. 


Croton Oil. 


Volatile Oil of Mustard. 


Chloroform. 


Tartar Emetic. 


Heat / Boilin g Water. 

\ Corrigan's Hammer. 


Iodine. 


Ipecacuanha. 


Menthol. 


Silver Nitrate. 





Mydriatics (/xvSpiWis, mydriasis), — are agents which cause dilatation of the 
pupil of the eye. They are used by ophthalmologists to prevent or break down 
adhesions of the iris, and to dilate the pupil for ophthalmoscopic and other 
examinations. Most of the mydriatics produce paralysis of the ciliary muscle 
(cycloplegia), resulting in temporary loss of accommodation, the eye remaining 
focused for distant objects only, and the intra-ocular tension being increased. 
The principal mydriatics are named in the following list: — 

Atropine. Duboisine. Cocaine. 

Homatropine. Hyoscyamine. Gelseminine. 

Daturine. Euphthalmin. 

Atropine and its congeners act as mydriatics by paralyzing the terminations of the 3rd 
nerve in the circular fibres of the iris and stimulating the sympathetic filaments which supply 
its radiating fibres. Atropine paralyzes the ciliary muscle completely, leaving the eye adjusted 
for the far point only. Its effects last from 10 to 14 days. Homatropine paralyzes the muscle 
less completely, its effects lasting only a day or two. Cocaine acts as a mydriatic by stimulat- 
ing the sympathetic filaments, and has very slight action on the ciliary muscle. Its effects 
last only a few hours. Euphthalmin is a rapid and safe mydriatic, neither impairing accommo- 
dation nor increasing intra-ocular tension. The General Anesthetics cause mydriasis by central 
action, both early and late in the course of their administration. [See under Myotics.] 

Myotics (/iv£tv, to close), — are agents which cause the contraction of the 
pupil. They act by stimulating the motor oculi nerves supplying the circular 



38 CLASSIFICATION OF MEDICINES. 

muscular fibres of the iris, and produce this effect when locally applied or in- 
ternally administered, except Morphine, which acts centrally, and does not 
affect the pupil when applied locally. Physostigmine (Eserine) is the chief 
myotic for local use, and the only one employed in ophthalmic practice. Others 
are Muscarine, Pilocarpine, and Nicotine. 

Physostigmine also contracts the ciliary muscle, leaving the eye accommodated for the 
near point only, and lessens intra-ocular tension, antagonizing exactly the eye-actions of Atro- 
pine. Morphine given internally produces myosis by stimulation of the oculo-motor centres 
probably, the dilatation which occurs as death approaches being due to final paralysis of the 
same (Wood). The General Anesthetics dilate the pupil in the first and last stages of their 
action, but contract it in the middle stage, that of complete anesthesia. When in this stage 
dilatation occurs, it is a dangerous sign of failing respiratory power, unless it is accompanied 
by symptoms of returning consciousness, as reflex movements and vomiting. 

Narcotics (vao/cr), stupor), are agents which lessen the relationship of the 
individual to the external world. At first more or less excitant to the higher 
brain and stimulant to the mind and to all the bodily functions, the next stage 
of their action is one of profound sleep characterized by increasing stupor, and 
this, if the dose has been sufficient, is followed by coma and insensibility (nar- 
cotism), and finally death occurs from paralysis of the medullary centres 
which govern respiration and the other functions of organic life. Nar- 
cotics, in proper medicinal doses, give us the power of lowering morbidly 
acute perception, of relieving pain and allaying irritation, nervous agitation and 
spasm, of inducing sleep, and of regulating the vital functions by rest — all of 
which are means of great therapeutical value. The chief narcotics are: — 

Opium, Morphine. Alcohol. Phenol. 

Belladonna, Atropine. Ether. Hydrocyanic Acid. 

Hyoscyamus. Chloroform. Oil of Turpentine. 

Stramonium. Hydrated Chloral. Other Essential Oils. 

Cannabis. Bromal Hydrate. Carbonic Acid Gas. 

Opium is the typical member of the group. Humulus (hops) and Lactucarinm (lettuce) 
are sometimes included among the narcotics, but their action is so feeble that they are sel- 
dom used for that purpose." 

Oxytocics or Ecbolics (b£vs, quick, tokos, childbirth, tnpoArj, abortion), 
— are agents which stimulate the muscular fibres of the gravid uterus to contrac- 
tion, and may therefore produce abortion. In small doses the same remedies 
are emmenagogue as a rule. Their mode of action has not been clearly made 
known, but it is generally believed to be due in some cases to direct stimula- 
tion of the uterine centre in the cord, in others to congestion of the uterus pro- 
ducing reflex stimulation. The principal oxytocics are those named in the fol- 
lowing list: — ■ 

Cotton-root Bark. 
Oil of Rue. 
Pilocarpine. 
Strong Purgatives. 

Any drastic purgative, or gastro-intestinal irritant, may produce abortion by reflex action. 
The Volatile Oils act in this manner, also Colocynth and many other agents used by women to 
produce abortion, as Tansy, Pennyroyal, etc., all of which are dangerous to life in doses suffi- 
cent to excite the action of the gravid uterus. 



Ergot. 


Savin. 


Epinephrine 


Potassium Permanganate 


Pituitrin 


Hydrastis. 


Cotarnine 


Borax. 



CLASSIFICATION OF MEDICINES. 39 

According to Boissard there are no abortifacient drugs in the strict sense of the term, 
though some drugs given in toxic doses may cause abortion and the death of the woman. Such 
drugs are therefore useless in any except the most reckless hands. The oxytocic and ecbolic 
drugs belong to another class, having the power of strengthening the intensity of the uterine 
contractions after they have been aroused (oxytocics), or of arousing and aiding uterine con- 
tractility (ecbolics). The action of the former is certain, that of the latter is very doubtful. 

Pancreatic Stimulation may result when the mucous membrane of the 
intestine, especially the duodenum, is excited by mustard, pepper and other 
pungent substances. Secretin is the name of the hormone which is secreted 
by the duodenal mucous membrane and normally stimulates the pancreatic 
flow. It is formed under the influence of the hydrochloric acid coming from 
the stomach. Alkalies inhibit the formation of Secretin. The vagus secre- 
tory nerve endings in the pancreas are excited by Pilocarpine and Choline and 
inhibited by Morphine and Atropine. Experimentally, in dogs, large doses of 
atropine caused a profuse secretion of pancreatic juice (Wertheimer- 
Lepage). No drugs are known to influence the internal secretion of the 
pancreas (Meyer and Gottlieb). 

Parasiticides {Tzapaaixos, a parasite, ccedo, I kill), — are agents which de- 
stroy the animal and vegetable parasites found upon the human body. They 
are generally applied in the form of lotions, ointments or oleates, and include the 
following-named substances: — 

Sulphur. Mercury. Phenol. 

Sulphides. Ammoniated Mercury. Petroleum. 

Sulphurous Acid. Mercuric Chloride. Storax. 

Sulphur Iodide. Mercuric Nitrate. Balsam of Peru. 

Iodine. Mercuric Oxide. 

Protectives are agents of a mechanical nature employed to cover and pro- 
tect an injured part from the air, water, friction, etc. Collodion and Gutta- 
percha are those in general use, but certain plasters, as the adhesive, the lead 
or the soap plaster, may be employed for this purpose, also cotton. 

Pulmonary Sedatives diminish cough and dyspnea by lessening the irrita- 
bility of the respiratory centre or that of the nerves of respiration. Some act 
by directly depressing the respiratory centre; others by removing some irritant 
from the passages, or by lessening local congestion, as the expectorant group ; 
and others by lowering the excitability of the vagus end-organs in the lungs and 
that of other afferent filaments throughout the respiratory tract. The principal 
pulmonary sedatives are named in the following list: — 

Opium. Hydrocyanic Acid. Ethyl Iodide. 

Morphine. Codeine. Potassium Cyanide. Conium. 

Belladonna. Amyl Nitrite. Tobacco. 

Stramonium. Cannabis. Lobelia. 

Hyoscyamus. Turpentine. 

Opium has the most powerful influence as a sedative to the respiratory centre, and mucil- 
aginous or saccharine substances soothe the local irritation, hence the latter are so frequently 
used as vehicles for the former in cough mixtures. Hydrocyanic Acid has a similar sedative 
action, hence the use of Prunus Virginiana and other substances containing it against cough. 
Belladonna stimulates the respiratory centre, but at the same time lessens the excitability of 
the vagus terminations in the lungs, and completely arrests secretion from the bronchial 
mucous membrane. Stramonium acts similarly. 



40 CLASSIFICATION OF MEDICINES. 

Refrigerants (rcfrigero, I cool), — are remedies which allay thirst and im- 
part a sensation of coolness. They include the Vegetable Acids, the Mineral 
Acids (greatly diluted), Ice, Water if cold, effervescing drinks, fruit juices, and 
many diaphoretics. 

Respiratory Depressants lower the activity of the respiratory centre, ren- 
dering the respirations slow and shallow. The chief agents of this class are: — 



Opium (large dose). 


Gelsemium. 


Ether. 


Colchicine. 


Physostigma. 


Aconite. 


Chloroform. 


Nicotine. 


Muscarine. 


Veratrine. 


Chloral. 


Quinine. 


Lobeline. 


Bromides of the Alkalies: 


Saponin. 


Hydrocyanic Acid 


Phenol. 


Alcohol. 


Conium. 





The ten last named first excite the centre for a brief period and then depress it. 

Respiratory Stimulants exalt the function of the respiratory centre, quick- 
ening and deepening the breathing. Such agents are: — 

Strychnine. Thebaine. Tobacco (briefly). 

Brucine. Caffeine. Alcohol (briefly). 

Atropine. Ammonia. Ether (briefly). 

Duboisine. Camphor. Cold Douche. 

Apomorphine Digitalis. 

Cocaine Quebracho. 

Strychnine also stimulates the vagus tract. Electricity, applied to the nerve-trunks or to 
the inspiratory muscles, is a direct respiratory stimulant. Veratrine, Physostigmine and 
Muscarine stimulate the vagus terminations, quickening the respiration, but afterwards slow 
it by depressing the respiratory centre. Aconite stimulates the end-organs of the vagus when 
given in small doses. 

The Respiratory Centre is situated in the medulla oblongata, close to the termination of 
the calamus scrip torius. It probably consists of thoracic and diaphragmatic Inspiratory 
Centres, the act of expiration being considered normally a passive one, due to the natural con- 
traction of the walls of the air vesicles, and the return of the diaphragm and thoracic walls to 
the position from which they were moved by the inspiratory effort. An Expiratory Centre must 
exist for the initiation of forced expiration, as in the production of voice, cough, sneezing, etc. 
The chief Inspiratory Nerves are the pulmonary branches of the vagus. The Expiratory 
Nerves are the nasal branches of the fifth, the superior and inferior laryngeal, and the cutaneous 
nerves of the chest and abdomen. 

Restoratives are agents which promote constructive metamorphosis, in- 
cluding the Foods, Hematics and Tonics, as well as many agents called Stimu- 
lants in other classifications. 

Foods, are substances which, when introduced into the body, supply ma- 
terial to renew some structure or to maintain some vital process; being distin- 
guished from medicines in that the latter modify some vital action but supply 
no material to sustain it. 

The food of man is derived from all three of the kingdoms of nature, the animal, vegetable, 
and mineral, and includes many substances treated of in the Materia Medica, as Oils and Fats, 
Sugar, Starch, Gum, Alcohol, Beverages like Coffee and Tea, Water, Calcium Phosphate, 
Sodium Chloride. 

Hematics (*Ciul } the blood), are medicines which augment the quantity 
of hematin in the blood, and thus restore the quality of that tissue by enrich- 
ing its red corpuscles. They consist chiefly of Iron and Manganese and their 
compounds. 



CLASSIFICATION OF MEDICINES. 41 

Tonics (rovos, tension), are agents which improve the tone of the tissues 
on which they have specific action, restoring energy and strength to debilitated 
subjects by a scarcely perceptible stimulation of all the vital functions, their 
effects being apparent in an increased vigor of the entire system. The chief 
tonics are enumerated in the foregoing lists under the heads of the organs or 
tissues particularly affected by them. [Compare Stimulants, Respiratory 
Stimulants, Cardiac Tonics, Vascular Tonics, Gastric Tonics, etc.] 

Salts are compound bodies formed: — (i) by the interaction of an acid and 
a base, which may be an element, an oxide, or a compound containing a weaker 
acid radicle than the acid employed; the base displacing some of the hydrogen 
from the acid, as HN0 3 and K, forming KN0 3 Potassium Nitrate: (2) by the 
interaction of two elements, as Na with CI, forming NaCl, Sodium Chloride or 
common salt: (3) by the union of two or more oxides of elements having oppo- 
site electrical states, as S0 3 and BaO, forming BaS0 4 , Barium Sulphate. Most 
salts contain three elements, one being Oxygen, and its comparative amount 
is shown by the terminal of the name of the salt; those ending in -ate being 
formed by an -ic acid and having the greater quantity of oxygen, those ending 
in -ite being formed by an -ous acid and having the lesser amount of oxygen. 
The prefixes hyper- (or per-) and hypo- indicate respectively a greater or lesser 
amount of oxygen than can be represented by the terminations -ate and -ite. 
Salts formed by the union of two elements and containing no oxygen have the 
termination -ide, which indicates that they contain nothing but the elements 
designated in their names. Salts may be divided into six classes, viz. — 

Normal Salts, — in which the Hydrogen of the acid is fully displaced by a 
single element, as KN0 3 Potassium Nitrate. 

Acid Salts, — in which some displaceable Hydrogen still remains, as KHC0 3 
Acid Potassium Carbonate. 

Mixed Salts, — in which two or more bases are present, as KNa (C 4 H 4 O fl ) 
Potassium Sodium Tartrate. 

Double Salts, — in which two complete salts unite to form a definite compound, 
generally crystalline, as K 2 S0 4 . A1 2 (S0 4 ) 3 Potassium Aluminum Sulphate. 

Oxy-salts, — also called subsalts or basic salts, in which oxygen takes the 
place of one or more of the acid radicles, as Bi N0 3 Bismuth Oxy-nitrate or 
Bismuth Subnitrate. 

Haloid Salts, — are salts formed by the Halogen (salt-forming) elements 
(Chlorine, Bromine, Iodine, Fluorine) and the compound radicle Cyanogen, 
uniting with other elements, without the aid of oxygen, as Na CI, Sodium 
Chloride, common salt. Their names have the termination -ide, indicating 
that they contain nothing but the elements respresented in their names. 

Sedatives (sedo, I allay), — are agents which exert a soothing influence 
on the system by lessening functional activity, depressing motility and dimin- 
ishing pain. 



4a CLASSIFICATION OF MEDICINES. 

General Sedatives include the narcotics and anesthetics. Local Sedatives include Aconite, 
Opium, Ice, etc. Pulmonary Sedatives, as Hydrocyanic Acid, Veratrine and the nauseants 
and emetics. Spinal Sedatives, as Gelsemium, Potassium Bromide. Stomachic Sedatives in- 
clude Arsenic, Bismuth, Silver Nitrate, Sodium Bicarbonate. Vascular Sedatives, as Digitalis, 
Tobacco, Aconite, Veratrum, and the emetics. Nervous Sedatives, among which are Potassium 
Bromide, Tobacco, Lobelia, and the group of spinal depressants. 

Sialogogues (atodov, saliva, ayco, I carry off), — are agents which increase 
the secretion and flow of saliva and buccal mucus, either by reflex action from 
the local irritation produced when anything is taken into the mouth, or by 
stimulating the glands during their elimination. The principal sialogogues 
are divided into two groups, the first or topical sialogogues acting by reflex 
stimulation ; the second general sialogogues, acting through their systemic influ- 
ence on the glands or their secretory nerves; and include the following-named 
substances: 

Topical Sialogogues. General Sialogogues. 

Acids and Alkalies. Pilocarpus (Jaborandi). 

Ether, Chloroform, etc. Muscarine. 

Mustard. Ginger. Physostigma. 

Pyrethrum. Mezereon. Mercurials. 

Tobacco. Cubebs. Iodine compounds. 

Capsicum. Rhubarb. Antimonials. 

Horse-radish. Tobacco. Ipecacuanha. 

Agents which diminish salivary secretion are termed Antisialics. The prin- 
cipal member of this group is Atropine, which paralyzes the terminals of the 
nerves of secretion. Physostigma counteracts this paralysis, but in large doses 
acts also as an antisialic by lessening the blood supply to the glands. Opium 
diminishes the reflex excitability of the reflex centre and also lessens the secre- 
tion directly. Others acting locally are — 

Borax. Soda. Lithia. 

Potassium Chlorate. Lime. Magnesia. 

Insipid or nauseous articles of food or medicine. 

Smell is one of the senses which is increased by Strychnine. It is decreased 
by all cerebral depressants and by those agents which produce changes in the 
nasal mucous membrane, as Potassium Iodide. 

Specifics, — are agents which have each a selective curative influence on a 
particular disease. Mercury is said to be specific to syphilis, Quinine to malaria, 
and other drugs are more or less specific to certain affections, but they have so 
many actions and uses that they are usually placed in other groups. The true 
specifics are the various Animal Extracts and Sera, though even these are being 
found remedial in other than their specific diseases. The most important of 
these agents are the Thyroid and Supra-renal Glands, and Anti-diphtheric Serum 
or Diphtheria Antitoxin, which are official, but many other Animal Extracts 
and Sera are used in medicine. 

Stimulants {stimulus, a goad), — is a term which is used in various senses 
when applied to medicinal agents. Alcoholic preparations, which are true 



CLASSIFICATION OF MEDICINES. 43 

narcotics, are commonly termed "stimulants," and the same expression is 
employed to designate any agent which excites even briefly the organic action of 
any part of the system. All excessive stimulation reacts into depression, and 
most of the agents which stimulate the nerve centres at first will soon depress 
and finally paralyze them. In many cases the action is one of progressive stimu- 
lation primarily and progressive paralysis afterwards, affecting the centres in 
the inverse order of their development, the highest or latest developed centres 
being affected first, the lowest or oldest ones last. These laws are well ex- 
emplified in the action of Alcohol upon the nervous system. [Compare the 
article entitled Alcohol in Part I.] 

Diffusible Stimulants are those which have a prompt but transient effect on the general 
system, such as Alcohol, Ammonia, Camphor. Spinal Stimulants exalt the functions of the 
cord, as Strychnine, Picrotoxin, Ergot, Atropine, Phosphorus. Cardiac Stimulants increase the 
action of the heart, as Alcohol, Adrenalin, Strychnine, Atropine, and Morphine in small doses; 
also Squill, Convallaria, Cimicifuga and Digitalis, which slow but strengthen the cardiac 
action. Respiratory Stimulants directly stimulate the respiratory centre, as Ammonia, Strych- 
nine, Apomorphine, Belladonna. Vascular Stimulants, as Alcohol, Chloroform, Ether (all 
three in very small quantities), Adrenalin, Ammonia, Strychnine, Digitalis, and Squill, acting 
on the vaso-motor centre; and the Nitrites, Belladonna, Electricity, Volatile Oils, acting as 
local dilators of the vascular system. Cerebral Stimulants, as Alcohol, Opium, Belladonna, 
Caffeine, Cocaine, Cannabis, Chloroform, Ether, Tobacco. Renal Stimulants, as the diuretic 
group. Stomachic Stimulants, as the Aromatics, Volatile Oils, Vegetable Bitters, Mineral 
Acids, Nux Vomica, Mustard, Capsicum. Hepatic Stimulants, as Nitro-muriatic and Nitric 
acids, and the cholagogue purgatives Podophyllum, Jalap, Leptandra, Euonymin, Iridin. 
Intestinal Stimulants, as Mercurials, Elaterium, Colocynth, Jalap, Scammony, Podophyllum, 
which affect the glandular apparatus, — and Belladonna, Physostigma, Nux Vomica, Rhubarb, 
Senna, Aloes, Frangula, Cascara, which chiefly affect the muscular fibres and the intestinal 
nerves. Cutaneous Stimulants, as the diaphoretic group, and the rubefacients, Mustard, 
Capsicum, Turpentine, Ammonia. 

Local Stimulants increase common sensibility to the extent of producing pain, chiefly by 
direct action upon the end-organs of the sensory nerves in the skin, though some act probably 
by stimulating the local circulation, as in inflammation. The principal members of this sub- 
division are: — Heat, Cold, Faradism, Alcohol, Ether Chloroform, Phenol, Creosote, Ammonia, 
Mineral Acids, Volatile Oils, Acrid Essential Oils, Metallic Salts, Veratrine (at first), Can- 
tharis (at first). 

Stomachics or Gastric Tonics are agents which increase the appetite and 

promote gastric digestion. They include a number of substances, dietetic and 

medicinal, some acting by stimulating the production of gastric juice, others 

by stimulating the local circulation, and several by exciting the activity of the 

nervo-muscular apparatus of the stomach. The first indication is met by the 

use of dilute alkaline solutions before meals, — the second by administering 

any of the pungent carminatives, as the Aromatic Oils, Pepper, Mustard, etc., 

or by Alcohol and Ether in small doses, or by the Aromatic Bitters, as Gentian, 

Orange, or the simple bitters, as Calumba; — while the third desideratum is 

secured by the use of such agents as Nux Vomica, Hydrastis, Arsenic, the 

dilute mineral acids and the volatile oils. 

Adjuvants to digestion are the digestion-ferments, Pepsin, Ingluvin, Papain, and also 
dilute HC1 acid; all of which may be used to supplement the gastric juice when insufficient in 
quantity or quality. The juice of the Pineapple contains a very active digestive principle, and 
may be employed as an aid to digestion with excellent results. Pepsin acts in acid media, and 
is only applicable to gastric indigestion; Pancreatin acts in alkaline media, is destroyed by acids, 
and is only applicable to intestinal indigestion; while Papain is said to exercise its proteo- 
lytic power in either acid, alkaline or neutral solutions. 



44 CLASSIFICATION OF MEDICINES. 

Styptics and Hemostatics (o-tv<£o), I contract, alfxa, blood, o-rao-is, a stand- 
ing^. — are agents which arrest bleeding; Styptics being those which are applied 
locally, and Hemostatics those which are administered internally. Some of the 
former act mechanically, by promoting the formation of a clot in the mouths 
of the bleeding vessels; others cause the vessels themselves to contract, thereby 
checking the flow of blood. The principal members of this class are the follow- 
ing named: — 

Styptics, — Acids, Alum, Antipyrine, Collodion, Gelatin, Adrenalin, Cotarnine, Hydras- 
tinine, Tannic Acid, Matico, Ferric Chloride, Ferric Sulphate, Lead Acetate, Silver Nitrate, 
Zinc Sulphate, Cold (locally), Cauterization. 

Hemostatics, — Adrenalin, Cotarnine, Hydrastinine, Ergot, Digitalis, Gallic Acid, Matico, 
Dilute Sulphuric Acid, Gelatin, Lead Acetate, Ipecacuanha, Hamamelis, Oil of Turpentine, 
Heat (locally). 

Synergists (<rvv, together, epyov, work), — are agents which cooperate 
in their action, for example, the various members of the digitalis group 
on the heart, bromides and chloral for sleep, calomel and jalap for catharsis. 

Taste is not much affected by drugs except as each drug makes its own 
peculiar impression on the nerves of taste, and may overcome that of another 
agent. Smell has much to do with taste in many instances, the expedient of 
holding the nose while swallowing castor oil being familiar to every one. 

The "after-taste" of drugs is often different to their original taste; thus Bitters are said to 
leave a sweet after-taste, and the same is claimed for Quinine if given in acid solution so as to 
be entirely dissolved, and if washed out of the mouth with water immediately after swallowing. 
Substances which are excreted from the system in the saliva (as Iodides) leave a very persistent 
after-taste. 

Urinary Acidifiers include the Acid Sodium Phosphate, Benzoic and 
Salicylic Acids and several of their salts, Vegetable Acids in excess, L T rotropin, 
and Salol; also excess of proteins, sugar and starch in the food, and certain 
wines and spirits. The mineral acids have little or no influence on the acidity 
of the urine, being excreted as neutral sulphates, chlorides, phosphates, etc. 

Benzoic Acid and its salts are among the very few agents by which morbid alkalinity of the 
urine can certainly be neutralized, though this is denied by some clinicians. Ashhurst main- 
tains that Sodium Benzoate acts indirectly by checking the ammoniacal fermentation which 
renders the urine alkaline. Salol is much quicker in its action on the urine than Ammonium 
Benzoate; ordinarily in a day or so, under its administration, the urine in chronic cystitis loses 
its alkalinity and foul odor, and becomes clear (Dr. Mansel Sympson). Potassium Bitartrate, 
being an acid salt, will in most cases acidify an alkaline urine. Acid Sodium Phosphate is one 
of the most efficient agents for this purpose (Hutchinson). 

Urinary Alkalinizers include the alkalies, particularly Potassium and 
Lithium Salts, but excepting Ammonia, which is broken up in the organism. 
Sodium salts, being partly excreted by the bile and the bronchial mucus, and 
partly locked up in the system as the neutral chloride, while sodium urate is 
insoluble, are not so efficient in this regard as are other alkalies. Fruits, milk 
and fish also act in the same manner by means of the salts which they convey 
into the economy, and a strictly vegetable diet plays an important part towards 
the same end. 



CLASSIFICATION OF MEDICINES. 45 

Urinary Sedatives and Astringents, when administered internally, act 
in a sedative manner upon the whole extent of the urinary tract through the 
medium of the urine, which, being charged with them, brings them into contact 
with the genito-urinary mucous membrane. Some of them may be applied 
locally as far as the urethral and vesical mucous surfaces, the portion above the 
latter being inaccessible to direct local medication. 

Instances of the application of these agents are the use of Potassium and Lithium Salts to 
diminish the acidity of the secretion, — Cubebs, Copaiba, and Santal Oil as antiseptics and 
astringents, — and urethral injections of Alum, Acetates of Zinc and Lead, Boric Acid, Chloral 
and Zinc Chloride, etc., for a similar purpose. Copaiba is one of the most efficient agents for 
rendering the urine antiseptic, and should be more employed in cystitis and urethritis than it is. 

Uterine Depressants lower the activity of the nervo-muscular apparatus 

which controls the uterine contractions. The most important of these agents 

are — 

Opium. Chloral. 

Bromides. Chloroform. 

Cannabis. Tartar Emetic. 
Viburnum Prunifolium. 

Uterine Stimulants — See Oxytocics. 

Vascular Contractors increase the contractile power of the vessels, lessen- 
ing the circulation therein and raising the blood-pressure; hence they are used 
to check hemorrhage and cut short inflammations. The principal agents 
included in this group are — 

Epinephrine. Opium (small doses). Sulphuric Acid. 

Antipyrine. Cocaine. Barium Salts. 

Cotarnine. Ergot. Lead Salts. 

Hydrastinine. Digitalis. Silver Salts. 

Strychnine. Squill. Zinc Salts. 

Hamamelis. Strophanthus. Cold (locally). 

Atropine (small doses). Iron. Camphor. 

These agents act upon the local vaso-motor mechanism in the walls of the vessels. Cold 
is one of the most powerful agents of this class, and is also a cardiac sedative. Epinephrine 
produces an enormous rise of the blood-pressure, due to its extraordinary contractile power 
over the muscular fibres in the walls of the arterioles. Digitalis, Squill, and Strophanthus, in 
small doses contract the vessels, but in large doses dilate them. 

Vascular Dilators produce dilatation of the peripheral vessels, and in- 
crease the rapidity of the circulation, thus equalizing the blood-pressure and 
relieving internal congestions. The most useful are Alcohol and Ether, as they 
stimulate the action of the heart simultaneously with the vascular relaxation. 
The chief members of this group are — 

Alcohol. Ether. Belladonna. Chloral. . 

Nitrous Ether. Stramonium. \ at last. Chloroform. 

Nitroglycerin. Hyoscyamus. J Ammonium Acetate. 

Amyl Nitrite. Opium (full doses). Tartar Emetic. 

Potassium Nitrite. Ipecacuanha. Hydrocyanic Acid. 

Sodium Nitrite. Dover's Powder. Aconite (?) 

Erythrol Tetranitrate. Thyroid Extract. Heat (at first). 

Vascular Dilators are often called Vascular Stimulants or stimulants of the circulation; 
but there is this difficulty of speaking of stimulants or sedatives of the circulation, that if 
both the heart and the vessels are stimulated at the same time, the action of the one tends to 
counteract that of the other. On the other hand, a drug which weakens the heart may increase 
the circulation by dilating the vessels, thus acting as a vascular stimulant (Brunton). 



46 ADMINISTRATION OF MEDICINES. 

Vesical Sedatives are substances which lessen irritability of the bladder, 
relieving pain and decreasing the desire to micturate. Opium, Belladonna, 
Hyoscyamus, Zea, Sabal, Cannabis, lessen the irritability of the nerves; mucil- 
aginous drinks, such as Barley-water or Linseed tea, also astringents like 
Buchu, Uva Ursi, Pareira, diminish the irritation due to chronic cystitis; and 
antiseptics, as Copaiba and Cubebs, act in like manner, being carried by the 
urine to the bladder. 

Vesical Tonics increase the contractile power of the muscular fibres in the 

wall of the bladder. By strengthening the detrusor they prevent retention of 

urine and by stimulating the sphincter they prevent incontinence. The most 

important members of this group are Cantharides, Belladonna, Strychnine 

and Potassium Bromide by internal administration, Silver Nitrate locally, and 

the use of a urethral bougie. 

Cantharides stimulates the sphincter vesicas by rendering the urine irritant thereto; Strych- 
nine, by increasing the irritability of the nerve-centre which governs it. Potassium Bromide 
lessens reflex susceptibility from the bladder, so that the detrusor is less frequently called into 
action. Belladonna probably decreases the sensibility of the bladder to changes of pressure 
within it. Silver Nitrate, locally applied to the neck, acts in the same manner as the passing 
of a urethral bougie, — by altering the direction of reflex action (Brunton). 

Vision is affected by several drugs. The Accommodation is impaired or 
paralyzed by Atropine and its congeners, Cocaine, Gelsemine, Physostigmine, 
and Pilocarpine, acting on the ciliary muscle. Ocular Sensibility is increased by 
Strychnine, the vision being thereby rendered more acute, and the field of vision 
being enlarged. This drug also increases the field of vision for blue colors, 
while Physostigmine diminishes it for red and green, and Santonin causes objects 
to appear of a violet color at first, and of a greenish-yellow color afterwards. 

Amblyopia, or impairment of vision due to nerve changes, is often produced temporarily 
by Quinine, and may be permanently induced by Alcohol and Tobacco, also by Lead and 
Arsenic poisoning. 

Intraocular Tension is increased by Atropine, Hyoscyamine, etc., and is decreased by 
Physostigmine. Gelsemine paralyzes the external ocular muscles, especially the levator pal- 
pebral and external rectus, by its action on the terminal nerve filaments. [Compare 
Mydriatics and Myotics.] 



ADMINISTRATION OF MEDICINES. 



Medicines may be introduced into the circulation by various routes, in- 
cluding the mouth, the stomach, the rectum, the respiratory tract, the veins 
and arteries, the subcutaneous cellular tissue, and the integument. 

The Mouth is the usual receptacle for medicines intended for the stomach, 
but may itself be employed for the introduction of minute quantities of power- 
ful agents. A drop of the tincture of Aconite placed on the tongue is quickly 
absorbed, and soon manifests that fact by its symptoms. Many of the small 
tablets used for hypodermic adminstration, if placed under the tongue, are 
readily conveyed into the system, and used in this way form a very convenient 
means of medication with alkaloids and other active principles. 



ADMINISTRATION OF MEDICINES. 47 

The Stomach is the most convenient organ for the absorption of medi- 
cines and the one most frequently employed. After being swallowed, the 
remedies find their way into the current of the circulation through the walls 
of the gastro-intestinal blood-vessels and the lacteals. When the stomach is 
empty and its mucous membrane healthy, crystalloidal substances in solution 
pass rapidly through the walls of its vessels. Colloidal Substances (fats, albumin, 
gum, gelatin, etc.) require to be digested and emulsified before they can be ab- 
sorbed. Iodine and Iodides should be given on an empty stomach, so that 
they may diffuse rapidly into the blood; if adminstered during digestion, the 
acid gastric juice and the starch of the food will alter their chemical consti- 
tution and weaken their action. Acids should be given, as a rule, on an empty 
stomach, especially when they are intended to check the secretion of the acid 
of the gastric juice. Alkalies, of which Sodium Bicarbonate may be taken as 
the type, are given after meals to neutralize excessive acidity, and before meals 
to stimulate the acid gastric secretions. Silver Oxide and Silver Nitrate should 
be administered after the digestive process is ended; if given during digestion, 
chemical reactions destroy or impair their special attributes and defeat the 
object for which they were prescribed. Metallic Salts (especially corrosive sub- 
limate), also Tannin and pure Alcohol, impair the digestive power of the active 
principle of the gastric juice, and should be given by the stomach only during 
its period of inactivity. Malt Extracts, Cod-liver Oil, Phosphates, etc., should 
be administered with or directly after food, so that they may enter the blood 
with the products of digestion. Bismuth should be given on an empty stomach, 
it being usually employed for its local sedative action on the gastric mucous 
membrane. Potassium Permanganate should be given after meals; on an empty 
stomach it would irritate the mucous membrane and might possibly produce 
ulceration thereof. Arsenic and other irritant and dangerous drugs (the salts 
of copper, zinc and iron), should be given directly after food, except where 
local conditions require their administration in very small doses on an empty 
stomach. Morphine should only be given by hypodermic injection when the 
patient is lying down, unless he is previously habituated to its use. Pilocarpine, 
administered to produce sweating, should be given when the patient is in bed 
in a warm room. Ammonium Acetate acts as a diaphoretic when the recipient 
is warm in bed, but as a diuretic when the patient is in a cold atmosphere. 
Sulphonal should be given two or three hours before its hypnotic action is de- 
sired, as it is very slowly absorbed. 

Under some circumstances it becomes necessary to introduce medicines directly into the 
stomach, as in cases of the patient's inability to swallow, through narcotic poisoning or other 
causes. The stomach-pump or the stomach-tube may then be employed to convey both food 
and medicine to that organ. In obstruction of the esophagus, as from stricture or malignant 
disease thereof, it may become necessary to make an opening through the abdominal wall and 
the wall of the stomach itself. Nasal feeding, by the use of a small catheter with a hard rubber 
funnel inserted into its end is a very efficient method of conveying liquids into the stomach. 
The eye end of the catheter is oiled and passed gently along the floor of the nose and down 
the pharynx; the fluid being then poured into the funnel. This method is particularly service- 
able in cases of acute tonsillitis or other painful affections of the mouth or palate, also after 



( 



(.8 ADMINISTRATION OF MEDICINES. 

excision of the tongue, when swallowing is to be avoided as much as possible. In many cases, 
especially insane ones, the patient will so constrict the muscles of the throat as to force the 
catheter into the mouth, but if it is withdrawn until nearly out of the pharynx, the presence of 
the fluid as it drops down will excite swallowing, and the patient may be fed as well as if the 
tube were in the esophagus. 

The Rectum will absorb many substances applied in the form of enemata 
or suppositories. Those most suited to this route are the salts of the alka- 
loids in solution, especially those of Morphine, Atropine and Strychnine, the 
latter being absorbed more rapidly by the rectum than by the stomach. Nu- 
tritive enemata must be small, not exceeding three or four fluid ounces, or 
they will not be retained. At the present time the value of nutritive ene- 
mata is questioned, but the importance of using this method to introduce 
fluids such as saline solution and water to counteract toxemia and flush 
the kidneys is emphasized. [Compare the articles entitled Injectiones and 
Suppositoria in Part II and Enemata in Part III.] 

The Respiratory Tract admits of the rapid absorption of medicinal sub- 
stances through its extensive blood-supply. The inhalation of vapors or atom- 
ized fluids, the insufflation of powders into the nares, fauces, larynx, etc., and 
the use of a medicated nasal douche, are methods whereby this channel may 
be utilized. [Compare the article entitled Inhalationes, in Part II.] 

The Veins are chiefly used as a route of medication in emergencies, when 
the other channels are not available, and where immediate action is necessary 
to the preservation of life, the operation being a highly dangerous one. The 
injection intravenously of Saline Solutions in the collapse of cholera, diabetic 
coma, etc., Blood as a last resort in excessive hemorrhage, pernicious anemia, 
the collapse of cholera, and a solution of Strophanthin in acute cardiac failure 
are instances admitted in practice. Shortly after the introduction of Sal- 
varsan in the therapy of syphilis the intravenous administration became and 
still is the method of choice. With the perfection of the remedy and the 
use of distilled water in its preparation the untoward reactions have been 
reduced to a minimum. 

The Hypodermic Method is the introduction of medicines into the or- 
ganism by injecting them into the subcutaneous areolar tissue, from which 
they are quickly absorbed by the lymphatic and capillary vessels. The great 
advantage of this method is the absolute certainty as to the quantity of drug 
actively affecting the organism, a very essential question when using small 
quantities, as when powerful alkaloids are employed. Another advantage is 
the avoidance of reaction between the drug and the contents of the stomach, 
which may destroy the activity of the former, or seriously change its character. 
In the presence of a chill or other condition of impaired peripheral circula- 
tion, hypodermic injections cannot be expected to act with any degree of speed 
or certainty, and in the presence of dropsy they are useless because the drug 
lies in the fluid contained in the subcutaneous tissues until, as the result of pur- 



ADMINISTRATION OF MEDICINES. 49 

gation, increased circulation, or diuresis, absorption of the dropsical fluid occurs. 
The medicine must be in solution, and the latter should be of neutral reac- 
tion and freshly prepared; the usual menstruum being distilled water, though 
filtered spring water will answer just as well, and much better than distilled 
water which has been standing several days and frequently exposed to the air. 
The solution is to be injected beneath the skin, not into it, by a hypodermic 
syringe, care being taken to avoid puncturing a vein. The most suitable locali- 
ties for the injection are the external aspect of the arms and thighs, the ab- 
domen, the back, and the calves of the legs. On the external aspect of the thigh, 
just in front of the great trochanter, there is an area of some two inches square, 
over which the insertion of a fine hypodermic needle is not felt, so barren is the 
skin of sensitive nerve filaments in that region. A few years ago the sight of a 
hypodermic syringe in a physician's hand suggested an injection of morphine 
to the patient and to the patient's friends, and many a physician has acquired 
the reputation of giving morphine on every possible occasion because he ad- 
ministered drugs by the hypodermic method. It is therefore well to inform 
the patient that another drug is being so administered when such is the fact. 
In this age of toxin and antitoxin treatment the hypodermic syringe has become 
a necessity, as many of these agents are inert when given by the stomach. When- 
ever such preparations are employed their injection must be administered under 
strict aseptic conditions, applied to the syringe and needle as well as to the site 
of the operation, and the contents of the syringe should be discharged very 
slowly into the tissues beneath the skin, giving time for the fluid to diffuse itself 
without rupturing the connective tissue. 

The classic practice of pinching up a fold of the integument before inserting the hypo- 
dermic needle is entirely wrong both in theory and in practice. It is never done by persons 
who habitually use this instrument on themselves, and they are admittedly the most expert 
of all operators in this line. It increases the liability to local soreness, and often produces 
bruises and ecchymoses which might be avoided by following the method described below. 

After nearly filling the syringe with the solution to be used, the needle, if separate, should 
be screwed on tightly; and with the instrument held in a vertical position, point uppermost, 
the excess of solution over the amount required should be ejected, thus expelling- air-bubbles 
and filling the needle itself. A site having been selected, where there is no danger of pene- 
trating a vein or artery, the needle should be quickly inserted at a right angle with the surface, 
and carried on for fully one-half its length into the subcutaneous tissue, except when a solu- 
tion of Cocaine is to be injected for the production of local cutaneous anesthesia, in which 
case it is injected into the skin itself. The syringe should be held steadily, not moved around, 
so as to avoid injuring the tissue. The piston should be pressed down slowly, and when the 
injection has been delivered the needle should be quickly withdrawn, and no attention paid 
to the few drops of solution which may follow it. The very finest needles should alone be used, 
except in cases where the patient is struggling and liable to break the needle off by his move- 
ments. The point of the needle should be perfect and its surface highly polished. It is far 
better to use a new needle every day than to risk one's reputation for skill on a blunt-pointed 
and rough-surfaced instrument. The writer buys the short and finest needles by the 
dozen and uses a new one on every patient. He has injected a strychnine solution in this 
manner on some 300 patients during three years, three or four times daily in the same upper 
arm for a month in each case, without having produced any more serious results than a hyper - 
emic zone around some punctures in a very few instances. If the solutions are freshly prepared 
with clean water, the needles sharp, clean and bright, and the injections delivered beneath 
the skin and not into it, there is no danger of producing abscesses or even indurations with the 
agents ordinarily employed in this manner. After using the syringe force out all liquid, and 
wipe the needle-point dry between the fingers, before returning it to the case; the sebaceous 



5<D ADMINISTRATION OF MEDICINES. 

matter on the fingers will keep it free from rust. Avoid puncturing a vein; if you do so, watch 
the patient and prepare an injection containing gr. T ^ of Atropine Sulphate, to administer 
it dangerous symptoms arise. Never, except under special circumstances, administer the 
Salts of Morphine or Atropine hypodermically to children less than 15 years of age. 

.4 cekmilid, in minute proportion, added to aqueous solutions for hypodermic use, is said 
to preserve them from decomposition more efficiently than any other agent hitherto employed 
for that purpose, but Phenol, a drop or two to the fluid ounce is generally effective in this 
respect. 

Compressed Tablets for hypodermic use are prepared by the prominent manufacturers, 
and are furnished in glass tubes containing from 20 to 25 tablets each. The writer prefers those 
which are very small, entirely free from foreign material, sufficiently soluble, and put up in 
short tubes which can be carried in cases to fit the vest pocket. The tablets may be readily 
dissolved in a teaspoon at the bedside, or in the syringe itself if the instrument has a screw- 
hole large enough to admit the tablet before screwing on the needle. A regular line of hypo- 
dermic Tablets includes many agents which are prepared by the manufacturing chemists. 

Parenchymatous Injection is the delivery of a medicine deeplv into the tissue, either 
to affect a muscle itself or to locally influence some important nerve-trunk. The principal 
agents used in this manner are Strychnine for palsied muscles, Chloroform for sciatic and 
other neuralgias, Salts of Cocaine for local anesthesia, and Phenol for deep-seated in- 
flammations. 

The Integument is an active absorbent of crystalloidal substances when 
its epidermis or cuticle is removed, and many substances may be made to pass 
through the latter and produce their characteristic effects on the system. By 
this route there are four methods of introducing medicaments into the circu- 
lation — the Endermic, Enepidermic and Epidermic Methods, and Inoculation. 

The Endermic Method obviates the difficulty of absorption through the cuticle 
by removing the latter with a blister, and then powdering the medicament over 
the surface of the denuded derma. Before the introduction of the hypodermic 
method this procedure was quite common, but it is rarely employed now, as 
it is both painful and unpopular. 

An ordinary Cantharides-plaster, followed by a poultice to raise the blister, may be em- 
ployed; but a quicker method is to place upon the skin a piece of Hnt soaked in Stronger 
Water of Ammonia, covering it with a watch-glass or a piece of oiled silk to prevent evapora- 
tion. The blister raises rapidly and should be removed with scissors and the medicine in 
powder is then placed on the raw surface. Morphine, Atropine, Quinine, and Strychnine 
were the agents generally used in this manner. 

The Enepidermic Method consists in placing the medicine in simple con- 
tact with the epidermis, no friction being used to hasten its penetration. Chloro- 
form and oleic acid solutions of the alkaloids pass by osmosis in this manner 
with comparative ease, but aqueous solutions act very slowly, and alcoholic 
ones with great difficulty if at all. Drugs are readily absorbed from the sur- 
face of hot, moist poultices, a fact to be remembered in directing such appli- 
cations for children, as narcotic poisoning may follow the liberal use of opium 
in this manner. A good belladonna plaster will cause dilatation of the pupils 
and may produce the characteristic rash all over the body. 

The Epidermic Method or Inunction consists in the use of friction to pro- 
mote the passage of the medicament between the cells of the epidermis. Mer- 
curial ointment, cod-liver oil, and other fats, oleates, etc., are rubbed into the 
skin of the armpits, the popliteal space, and other parts of the body, for their 



DOSAGE OF MEDICINES. 51 

local and systemic effects. Oil inunctions are an excellent method of introduc- 
ing fatty substances into children and persons who cannot take oils by the 
stomach. The inunction of castor oil will produce a purgative effect. 

Inoculation is the introduction of medicinal agents through the scraped or 
punctured skin by an operation which is similiar to that employed for vac- 
cination. 

Recently intraspinal therapy has been resorted to, especially in the 
treatment of neurosyphilis. S toner, who has reported an experience with this 
method in 72 cases in which salvarsanized serum was used, states that there 
are no evidences of untoward signs following this method, and that with ex- 
perience one feels no greater risk in giving intraspinal treatment than intra- 
venous. The procedure which he described is that known as the Ogilvie 
modification of the Swift-Ellis method as follows : Fresh blood serum is taken 
from the patient on the day of the injection, from 0.25 to 0.75 mg. of salvar- 
san, arsenobenzol or diarsenol is added, and it is placed in a water-bath at 
37 C. (98. 6° F.) for forty-five minutes and then 56° C. (132.8 F.) for thirty 
minutes. The usual quantity of blood serum so treated is 10 c.c. ; it is injected 
into the spinal canal by replacing an equal quantity of cerebrospinal fluid. 
All patients are required to go to the hospital for from twelve to twenty-four 
hours and remain quietly in bed. The lumbar puncture is done in the usual 
manner by inserting the needle in the median line between the spinous proc- 
esses of the third and fourth lumbar vertebrae. The discomfort is generally 
no greater than that experienced in taking blood from a vein ; hence no local 
anesthetic is needed. Rest in bed is essential, but restriction of diet is not 
necessary. At least 50 per cent, of the patients do not experience any dis- 
comfort, and are able to resume their work the following da)'. Head pains, 
such as follow lumbar puncture, in which fluid is not replaced, do not occur. 
(See article on Locomotor Ataxia for original Swift-Ellis method, p. 726.) 



1 



DOSAGE OF MEDICINES. 



The Doses given throughout this book are for adults; for children the fol- 
lowing rule (Young's) will be found the most convenient. Add 12 to the age 
and divide by the age, to get the denominator of a fraction, the numerator of 
which is 1. Thus, for a child two years old, ^^=7, and the dose is one- 
seventh of that for an adult. Of powerful narcotics scarcely more than one- 
half of this proportion should be used. Of mild cathartics, two or even three 
times the proportion may be employed. 

For Hypodermic Injection, the dose should be two-thirds or three-fourths of that used 
by the mouth, by rectum five-fourths of the same. Strychnine acts more actively when given 
per rectum than by the stomach. 



> 



Jj DOSAGE OF MEDICINES. 

Children bear Opiates badly: — but on the other hand they stand comparatively large 
doses of several other drugs; such being Arsenic, Belladonna, Ipecacuanha, Calomel and 
other preparations of Mercury, also Squill, Rhubarb, and several other purgatives. _ Pilocar- 
pine has verv little effect on children, though it readily induces perspiration and salivation in 
adults. 

Conditions which modify the action of medicines, and therefore affect 
their dosage, are — age, body-weight, temperament and idiosyncrasy, drug- 
habits, intervals between doses, time of administration, condition of the stom- 
ach, temperature of the body, cumulative drug-action, mode and form of 
drug-administration, disease, climate, race, etc. 

The Dosage of Medicines is the weakest part of the therapeutic arma- 
ment, the flaw in our weapons which may be the cause of their failure at any 
moment, perhaps the most critical one for a life. If the accumulated rubbish 
of ages, which has been called therapeutic knowledge, is ever to be given scien- 
tific shape, or placed in process of becoming a science, the question of dosage 
must form one of the principal corner-stones in the foundation. Drugs have 
widely differing actions on the human organism in health and in disease, ac- 
cording as they are administered in different doses, in different menstrua, and 
during different conditions of the subject's health. This difference, when be- 
tween extremes of dosage, is often so wide as to separate actions directly con- 
trary to each other, the action of the very large dose opposing that of the very 
small one: — a truth hidden by one set of dogmatists under their former doctrine 
(now rule) of similars, and avoided by the great mass of the medical profession, 
through dread of the bogy -name irregular. 

The U. S. Pharmacopoeia now gives an average approximate dose for adults of each drug 
and preparation intended for internal administration, but disclaims any intention to have 
them regarded as obligatory. In the British Pharmacopoeia a minimum and maximum 
dose is stated for all the more important medicines, the quantities being intended to represent 
the average range in ordinary cases, for adults. As a matter of fact, most British practitioners 
ignore the doses given in their pharmacopoeia, or at best consider them as mere indications. 
The German Pharmacopoeia has appended to it a table giving the maximum single dose and 
the maximum daily dose for a number of drugs and preparations, but they are of little value 
in practice except to catch an unwary physician in a legal proceeding for mal-practice. 

In the following pages an effort has been made, whenever possible, to indi- 
cate the different doses of active agents for different purposes, and the proper 
intervals for repetition in certain cases, as determined by the accumulated ex- 
perience of clinicians, which is the only safe guide in this respect at present. 
The average doses of official drugs and preparations are given in brackets, 
preceded by the contraction av., thus — [av. gr. xxx]. 



PART I. 

MATERIA MEDICA AND THERAPEUTICS. 



ABRUS, Jequirity (Unofficial), — is the seed of Abrus precatorius, the 
Wild Licorice, a plant of the nat. ord. Leguminosae, indigenous in India, but 
growing wild in most tropical countries. The seeds are small, hard, of a bright 
scarlet color, and contain some fixed oil, Abric Acid, and two protein poisons, 
a paraglobulin and an albumose, the latter of which is named Abrin. The 
root, leaves and branches contain sugar and a principle which closely resembles 
glycyrrhizin. 

Preparation. 

Infusum Abri, Infusion of Jequirity (Unofficial), — prepared by macerating three pow- 
dered seeds in § ss of cold water for twelve hours, adding § ss of boiling water, and filtering 
when cold. It should be used while fresh, as after two or three days it is worthless, and is 
found in a short time swarming with bacteria. Another formula contains gr. ix to the 5. 
with gr. iv of Boric Acid to prevent decomposition. 

Physiological Action and Therapeutics. 

Jequirity seeds, when moistened with water, become highly poisonous. If 
applied to the conjunctiva, a severe inflammation is set up, with edema and 
false membrane, ulceration of the cornea, and extension to the lids, face, neck, 
and submaxillary glands. Inserted into a wound in cattle, they cause death 
in a few hours. Sidney Martin has shown that the protein poisons contained 
in Jequirity seeds are almost identical in their physiological and toxic proper- 
ties with the similar principles found in snake venom, although less powerful. 

Jequirity was formerly used for the purpose of producing a purulent or 
croupous conjunctivitis, by which to destroy old granulations (trachoma) and 
pannus. A mild infusion is applied to the eye two or three times a day for 
two days, followed by weak solutions of Alum or Borax, and repeated after 
three weeks if necessary. An emulsion of the seeds in water is a useful ap- 
plication to unhealthy ulcers and lupus. 

ABSINTHIUM, Wormwood (Unofficial), — the leaves and tops of Artemisia Absinthium, 
a perennial garden herb of the nat. ord. Compositas, indigenous in Europe, but cultivated in 
the United States. It contains a volatile oil and a bitter principle, Absinthin. Dose, gr. xx-xl, 
in infusion. 

Absinthe, the French liqueur, is an alcoholic solution of the oil, containing also extracts 
of Anise, Marjoram and Angelica. Its continued use produces various nervous symptoms, 
morning nausea and vomiting, also a tendency to epileptiform convulsions. 

53 



I 



> 



54 ACACIA — ACETANILIDUM. 

The bitter constituent of Absinthium is stimulant to the digestive organs, but the oil is a 
narcotic poison. It increases the cardiac action, and produces tremor, stupor, epileptiform 
convulsions, involuntary evacuations, and stertorous breathing. It is but little used in medi- 
cine, only as a stomachic tonic is dyspepsia. 

ACACIA, Gum Arabic, — is a gummy exudation from Acacia Senegal, a 
small tree of the nat. ord. Leguminosae, indigenous in Africa. It occurs in 
spheroidal tears of various sizes, breaking with a glassy, somewhat iridescent 
fracture ; insoluble in alcohol, but soluble in water, forming a thick and mucil- 
aginous liquid. It consists of Arabin or Arabic Acid, C 12 H 22 O n , combined with 
calcium, potassium and magnesium. 

Preparations. 

Mucilago Acaciae, Mucilage of Acacia, — has of Acacia 35, Water to 100 parts. It 
should not be prescribed with tinctures or spirits except in very small quantity. Dose, 3 
ij-vj [av. 5 iv.] 

Syrupus Acaciae, Syrup of Acacia, — has of Acacia 10 per cent. Should be freshly made. 
Dose, indefinite. 

Acacia enters into the composition Mistura Glycyrrhizae Composita, Pulvis Cretae Com- 
positus and Trochisci Cubebse. 

I ncompatibles 

Incompatible with Acacia are: Acids (mineral), Alcohol, Ammonia, Ant. et Potas. Tar- 
trate, Borax (unless syrup or glycerin are present), Ether, Ferric Salts (unless excess of acid 
is present), Lead Subacetate (but not the acetate), Lead-water, Mercuric Chloride (con- 
centrated solution), Ammonium Oxalate (concentrated solution), Potassium Tartrate and 
Bitartrate, Silicates, Syrup of Squill, Tincture of Guaiac (blue color), Tinctures (alcoholic 
and ethereal). 



Gum Arabic has no activity except the negative one of a demulcent, and is 
chiefly used in coughs, sore throats, catarrhal inflammation of the stomach and 
intestines, and irritant poisoning. It is much employed in pharmacy to suspend 
insoluble powders in mixtures, for which purpose the mucilage is generally used. 

ACETANILIDUM, Acetanilid, Antifebrin, C 8 H 9 NO— is a synthetic 
compound obtained by the interaction of aniline and glacial acetic acid. Chem- 
ically it is Phenyl-acetamide, the radicle phenyl, C 6 H 5 , being substituted for one 
atom of hydrogen in Acetamide, a base obtained by heating ethyl acetate with 
strong water of ammonia, or by distilling ammonium acetate. The trade name 
Antifebrin is copyrighted, and should be dropped from professional usage. 

Acetanilid occurs in colorless, inodorous, glistening, lamellar crystals, of 
slightly pungent taste, soluble in 190 of cold water, 20 of boiling water, 3.4 
of alcohol, freely in ether and in chloroform. Dose, gr. j-iij (B. P.) ; average 
dose, gr. iii (U. S. P.). Death has occurred from 5 grains, and recovery has 
taken place after a drachm. 



ACETANILIDUM. 55 

Unofficial Derivatives and Allied Compounds* 

Agathin, Salicyl-aldehyde-a-methyl-phenyl-hydrazone, — is a synthetic compound, which has 
been used extensively in Europe as an anti-neuralgic and anti-rheumatic remedy. Dose, gr. 
v-x, two or three times a day, but from 5ss to 3jss must be given before any effect is 
produced. 

Ammonol, Ammoniated Phenylacetamide, — a proprietary antipyretic and analgesic, 
claimed to possess unusual stimulating and expectorant properties due to the loosely com- 
bined Ammonia in its composition. Beringer concludes that it is merely an admixture of 
Acentanilid 2 parts, Sodium Bicarbonate 1 and Ammonium Carbonate 1, with a minute 
quantity of the dye Metanil-yellow. A similar mixture is used at the Philadelphia Hospital 
under the name Ammoniated Acetanilid, which consist of Acetanilid i\ grains, Sodium 
Bicarbonate, \\ grains, Ammonium Carbonate, 1 grain; this for a minimum dose. Dose, 
of Ammonol or Ammonol Salicylate, gr. v-xx. 

Analgen, — a Chinoline derivative; was re-formed by inserting benzoyl instead of the 
acetyl radicle, and re-christened Quinalgen. (See next page.) 

Analgesine, — a proprietary preparation, consisting of Acetanilid 60, Ammonium Chloride 
20, Citrated Caffeine 10, Sodium Bicarbonate 10. Dose, gr. v-xv. 

Antinervin, Salbromalide (Salicylbromalide), — is a mixture of Acetanilid 2, with 1 part 
each of Salicylic Acid and Ammonium Bromide. It was used with satisfaction as an analgesic 
and antipyretic during the epidemic of influenza in England in 1801, and has been of benefit 
in acute rheumatism, and in abnormal excitement of the nervous system, either against neural- 
gia or as a general nerve sedative. The best way to prescribe it is as an extemporaneous 
mixture, containing the proper proportions of its ingredients, viz. — Acetanilid 50, Salicylic 
Acid 25, and Ammonium Bromide 25 per cent., mixed secundem artem, and administered in 
doses of gr. v-xv every two hours until relief is obtained. 

Benzanilid is obtained by the action of benzoyl chloride on aniline, is soluble in alcohol, 
insoluble in water, and is used as an antipyretic for children, in doses of gr. jss-viij. 

Bromo-seltzer, contains in each teaspoonful, — Potassium Bromide, gr. vij; Acentanilid 
gr. iij, and Caffeine gr. viij. 

Euphorin, Phenyl-ur ethane, — is antipyretic, antirheumatic and analgesic,* in doses of gr. 
ij — viij ; and may be used as an antiseptic dusting powder for ulcers and skin diseases. 

Exalgin, Methyl-acetanilid, — is a crystalline compound allied to Acentanilid, occurring 
in acicular needles, readily soluble in dilute alcohol, less so in warm water, with difficulty 
in cold water. Dose, gr. j-v, in wine, or other dilute alcoholic mixture. Alcohol 5ss, and 
Water § j, form a permanent solution with gr. xvj of Exalgin. Its name, derived from e£, out 
of, dXyos, pain, denotes its principal therapeutic action. In overdose it is highly dangerous, 
having produced symptoms resembling those of angina pectoris, also toxic effects resembling 
those of carbolic acid, with delirium, dyspnea, cyanosis, and renal disturbances. It has been 
used with most excellent results in neuralgias; also in chorea. In the latter affection daily 
doses of 3 grains were sufficient. 

Exodyne is a mixture of Acetanilid 90, Sodium Salicylate 5, and Sodium Bicarbonate 
5. The name (from ef out of, o5vi>rj, pain) sufficiently states its claims to medicinal virtue. 
Dose, gr. iij— x. 

Febrinol, M ethyl-par a-acet-phenetidin, — so called by its proprietors, is a mixture of 
Acetanilid and inert substances, advertised at one-half the price of similar preparations. 

* Throughout this book numerous references to unofficial preparations, proprietary and 
non-proprietary, will be found. Their inclusion in, this book is in no sense a recommenda- 
tion in every instance. Some are of considerable value, others of doubtful potency and 
still others are mentioned to be condemned. They are included in many instances as a 
matter of reference for those who use the book in this way. The student and practitioner 
will do well to adhere to the general rule that official drugs and preparations should be used 
to the exclusion of unofficial preparations except upon rare occasions. (See Preface to 
present Edition.) 



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56 ACETAN1LIDUM. 

Neurodin, Acteyl-para-oxy-phenyl-ureihane, — an analgesic, antineuralgic and antirheu- 
matic remedy. Its antipyretic action is too sudden for it to be used as a generalanti- 
pyretic. Its action is uncertain and much inferior to that of phenacetin or antipyrine (Lippi). 
Dose, gr. v-xxv, but o jss has been taken in 24 hours without ill effects. 

Phenacetin, Methacetin and Phenocoll, — are closely allied to Acetanilid, both chem- 
ically and medicinally, and are described under the tide Acetphenetidinum. 

Phenatol, — contains Acetanilid, Sodium Carbonate, Bicarbonate, Chloride, and Sul- 
phate, also Caffeine. Dose, gr. v-x. 

Phenolid, — is a mixture of Acetanilid 58, and Sodium Salicylate 43, and competes with 
the above as a panacea. Dose, gr. v-xv. 

Pyretine, — contains Acetanilid, Caffeine, Sodium Bicarbonate and Chalk, in varying 
proportions. Dose, gr. v-x. 

Quinalgen, — is a re-formed and re-named variety of the preparation named Analgen, 
and is described under the title Chinolina. 

Salfene and Kaputin are Acetanilid mixtures, the latter being simply powdered Acetani- 
lid colored with some indifferent substance. 

Thermodin, AcetyUpara-ethoxy-phenyl-methane, — is closely allied to Neurodin (see above), 
which it resembles in all respects except its smaller dose, gr. v-x. 

Incompatibles. 
Incompatible with Acetanilid are: Amyl Nitrite, Bromine and alkaline Bromides, Hydrated 
Chloral, Iodides of alkalies, Nitrites, Phenol, Piperazin, Potassium Hydroxide, Pyrocatechin, 
Resorcin, Sodium Hydroxide, Spirit of Nitrous Ether, Thymol. With Euphorin are; Anti- 
pyrine, Borneol, Bromal Hydrate, Camphor, Hydrated Chloral, Exalgin, Menthol, Phenol, 
Pyrocatechin, Rosorcin, Salol, Thymol, Urethane. With Exalgin are: Bromal Hydrate and 
the others named under Euphorin, also Euphorin, Naphthol, Pyrogallol, Salicylic Acid. 

Physiological Action. 

Acetanilid is a typical member of the antipyretic group of the aromatic 
series, commonly called coal-tar derivatives. Its principal action in medicinal 
doses is antipyretic and analgesic. On the normal temperature it has little 
effect, but it lowers the temperature in fever by central action on the heat-reg- 
ulating centre, decreasing heat production and to a less degree increasing heat 
dissipation. It depresses the heart and the respiration. It lowers the reflex 
function of the spinal cord, Represses the sensory nervous system, and is 
strongly analgesic, is mildly diaphoretic and diuretic, and promotes the excre- 
tion of urea and uric acid. A toxic dose is powerfully depressant to the heart, 
respiration, and blood-pressure, causes profuse sweating, vomiting, cyanosis, 
chills, convulsions, coma, and paralysis of the motor nerves and the muscles, 
death occurring by failure of the respiration. Large doses are injurious to the 
blood, disintegrating its red corpuscles, changing the hemoglobin to methe- 
moglobin, and arresting the movements of the leucocytes. The heart, liver 
and kidneys of animals poisoned thereby are found in a state of acute fatty 
degeneration. Skin eruptions of erythematous or urticarial type are fre- 
quently produced by it, and it often causes cyanosis without other toxic 
symptoms, probably due to the liberation of aniline in the blood-current. 
Collapse may be produced in some susceptible persons by an ordinary medi- 
cinal dose. When given in solution it is absorbed within half an hour, and it 
is completely eliminated in about 24 hours. 



ACETANILIDUM. 57 

Acetanilid is the principal constituent of the so-called "headache pow- 
ders" which are sold in drug-stores without prescription to any applicant, and 
have caused serious toxic effects in many cases. In one instance, investi- 
gated by the coroner of Pittsburg, a single dose of such a preparation was fol- 
lowed by death within 45 minutes. Many of these preparations contain 
caffeine which is added to counteract the circulatory depression. Worth 
Hale has shown experimentally that such combinations are dangerous, caf- 
feine increasing the toxicity of acetanilid. The addition of sodium bicarbon- 
ate to acetanilid alone or its preparations render such combinations distinctly 
less toxic. An acetanilid habit is 'occasionally observed among the victims 
of this commerce, the subjects presenting blue mucous membranes, a weak 
and irregular heart, albuminuria, and edema of the feet and ankles, together 
with the moral depravity characteristic of morphine maniacs. 

Locally applied, Acetanilid is feebly irritant, dessicant, hemostatic, some- 
what analgesic and antiseptic, but not germicidal. Toxic symptoms have been 
produced by its external use on extensive burns and other wounded surfaces 
of large extent. 

In its actions as an antipyretic, an analgesic, and a cardiac depressant, Ace- 
tanilid has many analogues among the coal-tar derivatives, the most important 
being Antipyrine, Chinoline, and Phenacetin (Acetphenetidin) , which are de- 
scribed elsewhere in this volume. It is probably the most toxic of those in gen- 
eral use, Antipyrine, Phenacetin and Lactophenin following it in the order stated 
as to liability to cause collapse. Compared with the action of Antipyrine., the 
effect of Acetanilid on the body-temperature is manifested more slowly (1 hour 
against J hour), but lasts a longer time (6 against 2 hours). Furthermore, 
Acetanilid frequently produces nearly the same degree of reduction of body- 
temperature as Antipyrine, with the ingestion of only one-fourth the dose ; and, 
like the latter agent, it has little or no effect on the normal temperature, but 
its continued use begets tolerance of its action. Its antipyretic effect is how- 
ever less reliable than that of Antipyrine, and corresponds in degree and in dura- 
tion to the size of the dose. 



Therapeutics. 

Acetanilid is chiefly used to reduce pyrexia and to relieve pain. With the 
former object it has been extensively employed in phthisis, scarlet fever, and 
the other exanthemata, also in acute rheumatism, bronchitis, influenza, and 
typhoid fever. In the latter affection it is too depressant for ordinary use, and 
its continued administration has seemed in several cases to increase the liability 
to periostitis of the ribs, gangrene of the tissues, and other serious sequelae, 
depending probably on impairment of the blood. The antipyretics should be 
used with great caution, if at all, in fever cases presenting exhaustion or asthenia, 



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;> ACETPHENETIDINUM. 

especially when accompanied by anemia. The opinion that fever is the ex- 
ponent of a defensive action by the organism against toxins, is gaining ground 
in professional esteem, and tends to restrict the use of antipyretic drugs to cases 
of hyperpyrexia only, and even in such the cold bath is preferred by many 
prominent clinicians. The toxic effects of Acetanilid and its congeners are 
probably due to the liberation in the blood of aniline, which is oxidized into 
paramidophenol. This change occurring more rapidly from Acetanilid than 
from the phenetidin compounds, the latter are safer and have largely replaced 
it in therapeutics. 

As an analgesic Acetanilid is efficiently palliative in headaches and neuralgia, 
in the pains of locomotor ataxia and those of rheumatic origin, as in sciatica 
and lumbago. It has been successfully used in epilepsy, to prevent the seizures 
by modifying reflex excitability. In all cases overdosing should be avoided, 
both as to quantity and repetition, especially in persons who are strangers to 
the prescriber, on account of the susceptibility to the poisonous action of the 
drug which is possessed by many individuals. 

Acetanilid is employed as a dry dressing, for its antiseptic and analgesic 
qualities, in the treatment of chancroids, ulcers, burns, wounds, and other 
breaches of tissue of small extent, often in mixture with an equal part of boric 
acid. It frequently proves irritant to tender tissue, exciting sharp and burning 
pain, instead of the analgesia usually ascribed to it. Added in minute propor- 
tion to solutions of salts of the alkaloids for hypodermic use it effectually pre- 
vents their decomposition. 

ACETPHENETIDINUM, Acetphenetidin, (Phenacetin), C 10 H 13 NO 2 ,— 4s 

a phenol derivative (acetparaphenetidin), the product of the acetylization of para- 
amidophenetol. It occurs in white, glistening, crystalline scales, or fine, crys- 
talline powder, odorless and tasteless, soluble in 82 parts of boiling water, in 
15 of alcohol, nearly insoluble in water. Dose, gr. v-x, [av. gr. v] in powder, 
tablets or cachets, hourly or every two hours, but larger doses, gr. xv-xx, 
are frequently administered for analgesia, up to a maximum of 5 j in 24 hours. 

Unofficial Analogues. 

Citrophen, Phenetidin Citrate, — a white, crystalline powder of acidulous taste, soluble in 
about 40 of water, and used as an antipyretic and antineuralgic. Dose, gr. viij-xv. 

Lactophenin, LactyUpara-phenetidin, — is another phenetidin derivative, containing a 
lactic add constituent instead of the acetic acid one of phenacetin. Its action is antipyretic, 
analgesic, and hypnotic, and it has been recommended as a substitute for phenacetin on account 
of its greater solubility. It has been used with especial benefit in abdominal typhus (Jaksch); 
also in acute rheumatism, chorea and locomotor ataxia (Von Roth). Dose, gr.' viij-xv or more, 
up to 3jss daily, in wafers. 

Methacetin, Oxy-methyl-acetanilide, — derives its name from its analogy to Phenacetin, 
from which it differs only in containing a methyl group in place of an ethyl one. It occurs as 
lustrous, scaly, colorless, odorless crystals; soluble in 12 of hot water, in alcohol, chloroform, 
glycerin and fatty oils, scarcely soluble in cold water. Methacetin was introduced as an anti- 
pyretic for children and feeble persons, and promised at one time to supersede phenacetin. 
It is well borne, and no malaise, tinnitus, cardiac weakness or exanthem follow its ingestion; 
but it often gives rise to a violent and exhausting perspiration. Its advantages, over all 



ACETPHENETIDINUM. 59 

the other antipyretics of its class, are its lack of toxic properties and its comparatively ready 
solubility in water, being five times more soluble than its rival, phenacetin. Dose, gr. iij-v, 
or more. 

Phenocoll Hydrochloride, — is another synthetical antipyretic^ closely allied to Phenace- 
tin, both chemically and medicinally, and distinguished by its comparatively free solubility. 
It is produced by the interaction of Phenetidin and Glycocoll (amido-acetic acid), and occurs 
as a white, micro-crystalline powder, soluble in about 16 of water, therein forming a neutral 
solution. Dose, gr. v-xx, 3 or 4 times a day. 

Phenocoll Salicylate, — is a salicylate of the synthetic base phenocoll and is supposed 
to combine the therapeutic actions of phenocoll and salicylic acid. It is used in conditions 
where the salicylates are indicated but is more toxic than the salicylates alone. Dose, 
gr. xv-xxx. 

Thermodin, — Acetylparethoxy-phenyl-urethane (Phenacetine-Urethane) is related to 
phenacetine and is used as an analgesic, antipyretic and antiseptic. It is said to be useful 
in the infectious diseases as a mild antipyretic but like all others of this group its applica- 
tion is limited. Dose, gr. v-xx. 

Triphenin, — Propionyl-phenetidin, a derivative of paraphenetidin, differing from 
phenacetine in that the acetic acid residue has been replaced by the propanoic acid residue. 
It is less soluble than phenacetine and its action slower, milder and free from by- or after- 
effects. Dose, gr. v-xx. 

Incompatibles . 
Incompatible with Acetphenetidin are: Acids (strong), Alkalies (strong), Chloral Hydrate, 
Oxidizers, Piperazin, Phenol, Pyrocatechin, Salicylic Acid. With Phenocoll Hydrochloride 
are: Alum, Benzoates, Chloral Hydrate, Cinchona decoction or compound tincture, Mercuric 
Chloride, Nitric Acid, Nitro-hydrochloric Acid, Piperazin; Potassium Acetate, Bicarbonate 
Bromide, Citrate, and Sulphate. With Methacetin are: Bromal Hydrate, Chloral Hydrate, 
Phenol, Pyrocatechin, Resorcin. 

Physiological Action and Therapeutics. 

The physiological action of Acetphenetidin is similar to that of Acetanilid. 
It is one of the safest of the new synthetical antipyretics, yet in sufficiently large 
doses it is as poisonous as any of its analogues. In one case 22 J grains, taken 
by a woman within six hours, produced collapse with marked lividity, great 
dyspnea and restlessness, cold perspiration, and slightly dilated pupils ; in another 
case 120 grains were taken in twelve hours without the production of any symp- 
toms (Wood). A toxic dose causes vomiting, cyanosis, chocolate-colored urine, 
yellow discoloration of the body, leucocytosis, and death by respiratory paralysis. 
In medicinal doses it depresses the heart slightly, and does not affect the blood 
or the respiration. It acts more gradually than other antipyretics, its maximum 
effect being reached in three or four hours. It reduces fever by lessening heat 
production and causes perspiration without producing collapse. It is also 
analgesic and hypnotic, relieving pain and inducing sleep. It has been ad- 
ministered with benefit, in 2-grain doses with \ grain of citrated caffeine 
at short intervals, for migraine; also in epidemic influenza, both as a pro- 
phylactic and as a remedy. As an antipyretic it is extensively employed 
in phthisis, polyarthritis, endocarditis, typhus and typhoid fevers; and as an 
analgesic in vaso-motor neuroses, for the lancinating pains of locomotor 
ataxia, also in neuralgia and hemicrania. It is highly praised in whooping- 
cough, rheumatic and other fevers, and though slower in action than anti- 
pyrine or acetanilid it is deemed fully as efficient in reducing pyrexia, while 



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60 ACIDUM ACETICUM. 

usually free from the depressant after-effects of the latter agents. It is strongly 
commended as a local antiseptic dressing. 

Phenocoll Hydrochloride is powerfully antipyretic, acting by causing a great 
diminution of heat production, without affecting heat dissipation. It is also 
analgesic and antirheumatic, and is believed to increase nitrogenous elimina- 
tion. It is rapidly absorbed and quickly eliminated, imparting a brown color 
to the urine. In medicinal doses it has no effect on the circulation, and rarely 
causes gastrointestinal irritation or other disagreeable symptoms, but a very 
large dose depresses the heart and lowers the blood pressure. It has no injurious 
effect on the blood corpuscles, and it is one of the safest and most efficient mem- 
bers of its class. It has been used with satisfaction as an antipyretic in hectic, 
malarial, typhoid and other fevers, also as an analgesic in acute and chronic 
rheumatism, gout, epidemic influenza and neuralgia. 

Citrophen is readily soluble in carbonated water, making a pleasant, acidu- 
lous drink. It has been used with benefit as an analgesic in migraine, lumbago, 
neuralgia, sciatica, and the pains of neurasthenia and chronic morphinism, 
also in pertussis and influenza. 

ACIDUM ACETICUM, Acetic Acid,-— is an aqueous sloution containing 

not less than 36 per cent, nor more than 37 per cent, of absolute Acetic Acid, 

HC2H3O2. It is a clear, colorless liquid, of a distinctly vinegar odor, a purely 

acid taste, and a strongly acid reaction; miscible in all proportions with water 

or alcohol, and wholly volatilized by heat. It is prepared from wood by 

destructive distillation and purification. Acetic Acid is also official in two 

other degrees of concentration, viz. — 

Acidum Aceticum Glaciale, Glacial Acetic Acid, HC2H3O2, a clear colorless liquid with 
a very pungent,' acid taste, containing not less than 99 per cent, absolute acetic acid. Is 
strongly escharotic and only used locally. 

Acidum Aceticum Dilutum, Diluted Acetic Acid, — an aqueous solution containing not 
less than 5.7 nor more than 6.3 per cent, of absolute acetic acid. It is used in the prepara- 
tion of Acetum Scillae. Dose, TTgxv-3iij lav. ttrxxx.] 

Acetum, Vinegar (Unofficial), — is an impure dilute acetic acid, formed by the action of a 
ferment on a dilute alcoholic liquid, the alcohol being oxidized thereby. 

Acetates of Ammonium (solution), Iron (solution), Lead, Potassium, Sodium, and Zinc, 
are official. The Mineral Acids are incompatible with them. 

Physiological Action and Therapeutics. 

Acetic Acid, like the other vegetable acids (citric and tartaric), in concen- 
trated form is escharotic and produces gastro-enteritis if swallowed. In dilute 
form it acts as a refrigerant, diminishing thirst and allaying restlessness. It 
is seldom used internally. A small quantity of the dilute acid placed upon a 
gauze sponge and inhaled will oftentimes relieve postanesthetic nausea. 
Investigations into its germicidal powers have given it high rank among germ- 
destroyers, a solution containing 7 per cent, proving destructive to many patho- 
genic bacteria. 



ACIDUM BORICUM. 6 1 

The glacial acid is used as a caustic in many skin affections, as warts, con- 
dylomata, etc., and to destroy the parasite in ringworm and pityriasis. The 
dilute acid is used locally in superficial inflammations of the skin, and may be 
sponged over the body to check perspiration and reduce the surface temper- 
ature in fevers. It is occasionally administered internally to reduce obesity, 
which it does only by impairing digestion. Locally, it may be employed to 
arrest slight hemorrhages, as epistaxis; and it is occasionally used by enema 
for the destruction of ascarides. It is highly praised by Squibb as a solvent 
for the active principles of drugs, which it extracts completely, so that it may 
be substituted for alcohol in the preparation of both fluid and solid extracts. 

Vinegar was the popular antiseptic during the plague in London in 1666, 
and Acetic Acid in alcoholic solution, Tfl,xx in §iij, is still employed occasion- 
ally on dressings after operation and for the disinfection of suture materials, 
as an efficient preventive of infection. 

Acidum Trichloraceticum, Trichloracetic Acid, HC2CI3O2, — a mono- 
basic organic acid of not less than 99 per cent, strength. It occurs in 
colorless, deliquescent crystals, which are readily soluble in water and in 
alcohol. A powerful antiseptic and caustic, it is used in 2 per cent, solu- 
tion as a dressing for wounds, and as a lotion and spray in acute coryza. 
It is used by dentists as an application to the gums in pyorrhea alveolaris, 
and internally in doses of gr. ss-j well diluted, for the gastric catarrh and 
summer diarrhea of children. It is a test for albumin in urine. Dose, 
gr. ij-v, well diluted. 

ACIDUM BORICUM, Boric Acid, Boracic Acid, H 3 B0 3 — is a weak 
acid occurring in transparent, colorless, six-sided plates, of unctuous touch, 
odorless, of a cooling and slightly bitter taste, soluble in 18 of water, in 18 of 
alcohol and in 4 of glycerin. Its aqueous solubility is increased by the addi- 
tion of hydrochloric acid or borax. It is produced from Borax by the action 
of sulphuric acid; also by the purification of the native acid. Dose, gr. v-xv. 
[av. gr. viii.] There are two official preparations and one Borate. 

Sodii Boras, Sodium Borate {Borax), Na 2 B 4 7 -{-ioH 2 0, — colorless, transparent prisms, 
of cooling and sweetish, afterwards alkaline taste, and alkaline reaction, soluble in 15 of 
water at 25 C, and in 0.6 of boiling water; insoluble in alcohol. Occurs native in ancient 
lake beds in Death Valley region, California, and various other parts of the world. Dose, 
gr. v-xxx, [av. gr. xii.] 

Glyceritum Boroglycerini, Glycerite of Boroglycerin, — prepared by heating together 
Boric Acid 310 and Glycerin 460, until reduced to 500 grammes, then adding an equal weight 
of Glycerin. 

Unguentum Acidi Borici, Ointment of Boric Acid, — has of Boric Acid 10, Paraffin 5, 
White Petrolatum, 85. 

Incompatible with Boric Acid are: Alkaline Hydrates, Earths and Carbonates. Incom- 
patible with Borates are: Mineral Acids, Alkaloidal Salts, Metallic Salts. 



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62 ACIDUM BORICUM. 

Unofficial Preparations. 
Boroglyceridum, Boroglyccride, — is a solid chemical compound, prepared by heating 
- Boric Acid and Glycerin. It is soluble in water, but is generally used in solution with 
the above oftki'al glycerite. It combines readily with Chrysarobin, Phenol, Atro- 
pine and Morphine, and is used as a local application in eye diseases and skin affections. 

Liquor Antisepticus, Antiseptic Solution, — contains of Boric Acid 2, Benzoic Acid 0.1, 
Thymol 0.1. Eucalvptol 0.025, Oil of Peppermint 0.05, Oil of Gaultheria 0.025, Oil of Thyme 
0.01, Alcohol 25, Purified Talc 2, Water to 100. Dose, 3ss-ij, [av. 5j.] 

Listerine, — is a proprietary preparation, much the same as Liquor Antisepticus (see 
above\ advertised to be "the essential antiseptic constituent of Thyme, Eucalyptus, 
Baptisia, Gaultheria and Mentha Arvensis, in combination. Each fluid-drachm also contains 
two grains of refined and purified Benzoboracic Acid," — whatever that may be. It is chiefly 
intended for external use, but may be given internally, in doses of 5 j three or more times a day 
(as indicated), either full strength, or diluted with water, or in combination with other drugs. 

Physiological Action and Therapeutics. 

Boric Acid is feebly germicidal, but in dilute solution (1 in 143) it is anti- 
septic and stimulant, and has a soothing effect on mucous membranes. In con- 
centrated form it is decidedly irritant, but it is used as a dusting powder, also 
in lotion and ointment for ulcers, eczema, burns, scalds, pruritus ani, fetid' 
perspirations, wounds, tinea tonsurans and tinea circinata. A saturated solu- 
tion has been highly recommended as an application in phlegmonous erysipelas, 
and solutions of gr. v-xx to the ounce are employed as antiseptic and soothing 
eye-washes in conjunctivitis. It has been found efficient as an internal remedy 
in cystitis with ammoniacal urine, and a saturated solution as a wash for the 
bladder has given great relief in the cystitis from spinal disease. Its physio- 
logical action is feeble, but poisonous doses have caused lowered temperature, 
depressed spirits, a feeble pulse, and an erythematous eruption with swelling, 
followed by exfoliation, and especially affecting the lower extremities. 

Sodium Borate has considerable antiseptic power, but is inefficient as a 
germicide. It aids the solution of boric and benzoic acids, and increases the 
contractile power of the uterus when given internally. It is used in solution 
to remove the epidermis from the skin, and as a sedative lotion in acne, freckles, 
chloasma, leucorrhea and aphthae, also to allay itching in urticaria, psoriasis, 
impetigo, and in pruritus pudendi, scroti et ani. It has been used internally 
in amenorrhea, dysmenorrhea, puerperal fever, and puerperal convulsions, for 
its supposed specific action on the uterus; and has been found beneficial in 
epilepsy, though far inferior to potassium bromide in efficacy and far more 
dangerous in toxic effects. It is apparently of most service in cases where the 
bromides fail and in those in which the epilepsy is associated with gross organic 
disease. 

When administered in large doses Borax produces certain toxic symptoms 
to which the term Borism is applied. These include intestinal disturbance, 
nausea, vomiting and anorexia, also dryness of the skin, with redness and even 
inflammation of the mucous membranes. There is great general weakness, 
the hair is dry and falls out, and a cutaneous eruption occurs, which may assume 
the forms of seborrheic eczema, reddish patches which desquamate like psoriasis, 



ACIDUM GALLICUM. 63 

or papules attended with much itching. In severe cases albumin may appear 
in the urine, and edema of the face and extremities may occur, so that when- 
ever this drug is given in full doses, a careful watch should be kept upon the 
state of the urine (Fere). 

Boroglyceride in aqueous solution (1 to 40), or as the official Glycerite, is an excellent 
antiseptic, and is used as a lotion in purulent ophthalmia and in the treatment of wounds, also 
as a local application to diphtheritic membranes. It is an efficient preservative of milk and 
food against putrefactive changes, and is entirely harmless. 

An elegant cosmetic cream may be made by dissolving Boric Acid in Glycerin, and then 
incorporating it with White Wax and Almond Oil. 

ACIDUM GALLICUM, Gallic Acid, HC 7 H 5 5 .H 2 0— is an organic acid, 
occurring in long needles and triclinic prisms, having a slightly acid and astrin- 
gent taste, soluble in 87 of water and in 4.6 of alcohol at 25 C, and in 3 of 
boiling water. It is prepared from Tannic Acid or from a paste of powdered 
galls (see Galla, below), by fermenting for six weeks, boiling and reboiling in 
water, filtering and crystallizing. According to some authorities, the tannic acid 
of the galls is split up into gallic acid and glucose by fermentation; according 
to others the glucose is an impurity and the tannic acid is simply converted 
into two parts of gallic acid, thus — HC 14 H 9 9 + H 2 0= (HC 7 H 5 5 ) 2 . Dose, 
gr. v-xx, [av. gr. xv], in solution, pill or powder. 

Acidum Tannicum, Tannic Acid, (Tannin), HC14H9O9, — is a yellowish 
white amorphous powder, of strongly astringent taste and acid reaction, ob- 
tained from powdered galls (see Galla below), by exposure for three days in a 
damp atmosphere, then macerating with ether, pressing,- and drying the liquid 
portion. It is soluble in 1 of water, in o . 6 of alcohol, at 59 F., and in about 1 
of glycerin with moderate heat; very soluble in boiling water and in boiling 
alcohol, almost insoluble in ether, chloroform, benzol or benzin. Dose, gr. 
j-xx, [av. gr. viii] in wafer, pill or capsule. 

Galla, Nutgall, — is an excresence on Quercus infectoria, nat. ord. Cupuli- 
feras, caused by the punctures and deposited ova of the insect Cynips tinctoria. 
It occurs as hard, globular bodies, of blackish-gray color, tuberculated on the 
surface. They contain Gallic Acid about 5 per cent., Tannic Acid 15 to 75 
per cent., and other unimportant constituents. Their sole value is as the source 
of these two substances, and they are rarely used in their own form medicinally. 
Dose, gr. v-x, [av. gr. vijss.] 

Quercus, White Oak (Unofficial), — is the bark of Quercus alba, the white-oak tree, nat. 
ord! Cupuliferse. It contains a variety of tannin named Quercitannic Acid, C28H24O12, 
also Pectin and a bitter principle named Quercin, but no gallic acid. It is sometimes used 
locally in the form of an infusion or a decoction made by adding one ounce of the crude 
drug to a pint of water. 

Vegetable Astringents contain some form of Tannic Acid, as Quercitannic Acid from 
Oak-bark, Rhatania-tannic Acid in Rhatany, etc. The official acid is Gallotannic Acid, being 



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04 ACIDUM GALLICUM. 

that produced from Galls. These astringents depend for their medicinal value upon the 
Gallic and Tannic Acids contained in them. Such are — 

Alnus, Alder Bark. Granatum, Pomegranate. Myrica, Wax Myrtle. 

Castanea, Chestnut. Hamamelis, Witch Hazel. Nymphaea, Pond Lily. 

Catechu, Catechu. Haematoxylon, Logwood. Quercus Alba, Oak Bark. 

Diospyros, Persimmon. Heuchera, Alum Root. Rosa Gallica, Red Rose. 

Galla,' Xut Gall. Kino, Kino. Rubus, Blackberry. 

Geranium, Cranesbill. Krameria, Rhatany. Statice, Marsh Rosemary. 

Preparations. 

Unguentum Acidi Tannici, Ointment of Tannic Acid, — is a 20 per cent, ointment, made 
with Glycerin and Ointment. 

Trochisci Acidi Tannici, Troches of Tannic Acid, — each troche contains nearly one grain 
of Tannic Acid. 

Glyceritum Acidi Tannici, Glycerite of Tannic Acid, — has a strength of 1 part of Tannic 
Add to 4 of Glycerin. 

Unguentum Gallse, Nut gall Ointment, — strength 20 per cent. 

Unofficial Preparations, Allied Substances and Derivatives. 

Suppositoria Acidi Tannici, Suppositories of Tannic Acid (Unofficial), — have 1 part of 
Tannic Acid in 5 of Cacao Butter. 

Collodium Stypticum, Styptic Collodion, — has of Tannic Acid 20, Alcohol 5, Ether 25, 
Collodion to make 100 parts. 

Gallobromol, Dibromogallic Acid, C 6 Br 2 (OH) 3 COOH, (Unofficial), — occurs in small, 
white, needle-shaped crystals, soluble in 10 parts of lukewarm water. The solution gradually 
darkens and after a few days becomes brown. Lepine states its internal action as similar to 
that of potassium bromide. In 1 or 2 per cent, solutions it has been used with remarkable 
success as a local application in gonorrhea of all stages. It seems to readily destroy the 
gonococcus. 

Pyrogallol, Pyrogallic Acid, Tri-hydroxy-benzene (Official), C 6 H 3 (OH) 3 ,— is a triatomic 
phenol, obtained chiefly by the dry distillation of Gallic Acid. It occurs in light, white, 
shining laminae, or fine needles, of bitter taste; soluble in water, alcohol and ether. Dose, 
gr- HJ. 

Tannigen, Diacetyl-tannin, — is an acetic acid ester of tannin, prepared by the action of 
glacial acetic acid on tannic acid. It occurs as an odorless and tasteless powder, insoluble 
in cold water and dilute acids, but soluble in cold alcohol and in dilute solutions of soda, 
sodium phosphate and borax. It is said to pass through the stomach unchanged and to be 
gradually decomposed in the intestines, thus exerting an astringent effect upon the entire 
intestinal canal. Its uses have been those of an intestinal astringent. Dose, gr. iij-viij, 
four times daily. 

Tannismuth, Bismuth Tannate. — The bismuth salt of tannic acid containing one atom 
of former combined with two molecules of the latter. Dose, gr. v-x, three to five times 
daily. 

Tannalbin, Exsiccated Tannin Albuminate, — occurs as a light-brown, odorless, and 
tasteless powder, containing 50 per cent, of Tannic Acid combined with egg-albumin, 
insoluble in water and in acid fluids. Dose, gr. xv-xxx, up to 5 j or 5 jss daily, as an intes- 
tinal astringent. 

Tannocol, — consists of equal parts of Tannic Acid and Gelatin, and occurs as a light- 
brown powder, without odor or taste. Dose, gr. vij-xv, 3 to 5 times a day, as an intes- 
tinal astringent. 

Tannoform, Tanninformaldehyde, — is a condensation product of Tannic Acid and For- 
maldehyde, and occurs as a bulky, odorless powder, insoluble in water, but soluble in 
alcohol or ether, also in alkalies. Dose, gr. iv-viij, as an intestinal astringent. 

Tannopin, Hexamethylene-Tetramine-Tannin, — a condensation product of tannin with 
hexamethyleneamine. It is used as an astringent and intestinal antiseptic. Dose, gr. 
v-xx, 4 times daily. 



ACIDUM GALLICUM. 65 

Incompatibles. 

Incompatible with Gallic Acid are: Arsenic, Carbonates, Copper salts, Ferric salts, (unless 
excess of acid present), Gold salts, Lead Acetate, Iodine, Lime-water, Nitric Acid, Opium in 
solution, Potassium Permanganate, Silver salts, Sodium Bicarbonate, Tartar Emetic. 

Incompatible with Tannic Acid are: Albumin, Alkaloids, Amyl Nitrite, Antipyrine, Ar- 
senic, Bromine, Calcium Chloride (concentrated solution), Chlorine, Chromic Trioxide, Fer- 
ric salts, Gelatin, Glucosides, Gluten, Hydrochloric Acid, Iodine, Iodoform, Lime-water, 
Nitric Acid, Permanganates, Piperazin; Salts of Antimony, Bismuth, Chromium, Copper, Gold, 
Lead, Mercury and Silver; Spirit of Nitrous Ether, Potassium Chlorate and other oxidizers, 
Potassium Dichromate, Sulphuric Acid. 

Physiological Action and Therapeutics. 

Gallic Acid, and its congener Tannic Acid, are astringents, the former 
being the feebler of the two. They differ in that tannic acid coagulates albumin 
and gelatin, while gallic acid does not. The latter is practically useless as a 
local remedy. According to some authorities the difference between gallic 
and tannic acids is one of oxidation, according to others, of hydration; the lat- 
ter assuming tannic acid to be simply gallic acid anhydride. They constringe 
the muscular tissue in the walls of the minute vessels, thus checking secretion 
and hemorrhages and cutting short local inflammations. Except in enor- 
mous doses, they are harmless. Gallic Acid is preferred to tannic acid when 
an astringent action is desired upon remote parts, as the lungs, kidneys, etc., 
which can be reached only through the circulation. In hematuria, distant 
passive hemorrhages, albuminuria, diabetes insipidus, bronchorrhea, night- 
sweats, chronic diarrhea, and chronic cystitis, it is a most useful internal 
remedy. 

Tannic Acid is a powerful astringent. It precipitates pepsin and coagu- 
lates albumin, impairs digestion, stops peristalsis, and causes constipation, 
A part of that taken into the stomach unites with the pepsin and albumin, while 
a part is converted into gallic and pyrogallic acids, and in these forms it is both 
absorbed and excreted. It is a cystalloidal body, but combines with colloids, 
and is a valuable antidote in poisoning by the alkaloids and tartar emetic, with 
which it forms tannates which are nearly insoluble. Its continued use disorders 
digestion, irritates the mucous membranes, and produces emaciation. Injected 
into the veins it forms emboli and thus may cause death, but by the stomach 
it is non-toxic. Tannic Acid is preferred to Gallic Acid for local use and for 
astringent effect on the intestinal canal. It is well employed in hemorrhoids 
and hemorrhages from the lower bowel, in hematemesis, epistaxis, rectal 
ulcers or fissures, catarrhs and chronic affections of the mucous membranes, 
endocervicitis, conjunctivitis, dysentery and diarrheas, eczema, impetigo and 
other forms of skin-disease, otorrhea, bed-sores, prolapsus ani, and many 
other affections. 

Styptic Collodion is used to stanch the bleeding from an open wound, to 
unite and protect incised or lacerated wounds, and to cover and change the 
character of foul ulcers. 



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66 ACIDUM HYDROCHLORICUM. 

Pyrogallic Acid has been absorbed from the surface with fatal results, pre- 
ceded by vomiting, diarrhea, rigors, fever, a black urine charged with globulin 
and disintegration of the red blood-corpuscles. It has great affinity for oxygen 
and may be used as an antiseptic and disinfectant in i to 3 per cent, solutions. 
Externally as an ointment, 1 to 8 of lard, it is used in chronic psoriasis, lupus, 
leprosy, and epithelioma. Internally it has been administered in 2 grain doses 
for internal hemorrhages. 

Tannalbin and Tannocoll are very similar in action and uses. They do 
not precipitate pepsin, coagulate albumin, or impair digestion. They pass 
through the stomach unchanged, and are resolved into their constituents by the 
alkaline secretions of the intestinal canal and the pancreatic juice, gradually 
setting free their tannin in the intestinal tract. They are free from irritant 
action on the stomach, and are valuable remedies in all forms of diarrhea in 
which astringents are indicated. 

Tannoform is siccative, antiseptic, deodorant, and astringent. In 20 to 
50 per cent, triturations with starch or talcum, it is used with benefit in many 
skin diseases, and for the night-sweats of phthisis. Internally it has given satis- 
faction in intestinal catarrh. 

Oak-bark is astringent and tonic, but is seldom used internally. Its actions 
and uses are those of Tannic Acid. A decoction is much used in country prac- 
tice as a cheap astringent application for injection in leucorrhea, prolapsus 
ani, and hemorrhoids, and as a gargle in faucial inflammation and prolapsed 
uvula. It has also been used as an injection into dropsical cysts, and as a lotion 
for flabby ulcers and suppurating wounds. The powdered bark as a poultice 
has proved an excellent application in gangrene, and in finely pulverized state 
it is a useful ingredient of tooth-powders. A concentrated fluid extract was 
formerly used in the Heaton-Warren operation for the radical cure of hernia, 
by injection into the tissues around the margin of the ring, with the object of 
exciting inflammation and occlusion of the opening. 

ACIDUM HYDROCHLORICUM, Hydrochloric Acid, Muriatic Acid,— 
is a liquid composed of from 31 to 33 per cent, of absolute Hydrochloric Acid 
Gas, HC1, and water. It is colorless and fuming, of specific gravity 1.155, 
pungent odor, intensely acid reaction and taste, and is obtained by the 
action of sulphuric acid upon sodium chloride, the resulting gas being carried 
through water, which dissolves it. It is sometimes used as a caustic. Its union 
with basic substances forms salts, called Hydrochlorides. 

Acidum Hydrochloricum Dilutum, Diluted Hydrochloric Acid,— -is a 10 per cent, solu- 
tion by weight of the absolute acid in water. Dose, TTj?iij-xx, [av. nj£xv]. 

Acidum Nitro-hydrochloricum, Nitro-hydrochloric Acid—\s described under Acidum 
Nitricum. 

Incompatible with Hydrochloric Acid are: Alkalies, Bromates, Carbonates, Chlorates 
Lead salts, Mercurous salts, Oxides, Permanganates, Silver salts, Tartar Emetic. 



acidum hydrochloricum. 67 

Physiological Action of the Mineral Acids.' 
The mineral acids, including hydrochloric, nitric, nitro-hydrochloric and 
sulphuric acids, resemble each other closely in their general action. These 
strong acids are escharotic, abstracting water from the tissues, combining with 
their albumin, and destroying the protoplasm. Sulphuric Acid has a strong 
affinity for water, completely decomposing the tissue, and is therefore the most 
powerfully escharotic. Nitric Acid does not readily redissolve the albumin 
precipitated by it, which thus forms a barrier against the deep action of the acid. 
Sulphuric Acid chars or carbonizes the tissues black, while Nitric and Hydro- 
chloric tan them yellow. 

Acute poisoning by the mineral acids has for its principal symptoms pain 
in the mouth, gullet, and epigastrium, violent vomiting, and rapid collapse 
characterized by cold perspiration, feeble pulse, and suppressed voice. After 
death the esophagus and stomach are found to be corroded, the lesions showing 
sloughs of black color after sulphuric acid, of yellow color after nitric or hydro- 
chloric acids. If death does not take place early, the internal organs show 
wide-spread degeneration of their protoplasm, and desquamative nephritis has 
been frequently observed. In cases of recovery prolonged illness from local 
organic changes is the usual result. 

In dilute preparations these acids produce a sour taste in the mouth and 
a sensation of roughness on the teeth. They stimulate the flow of saliva, bile, 
and the intestinal secretions, but decrease the production of the gastric juice; 
in accordance with the somewhat doubtful rule that acids in contact with the 
mouths of ducts from glands stimulate the action of those glands which pro- 
duce alkaline secretions, and check that of those producing acid secretions. 
Nitrohydrochloric Acid is an efficient cholagogue, a quality possessed also, 
but in less degree, by the others. Secretion generally is promoted by Nitric 
and Hydrochloric Acids, and is lessened by Sulphuric Acid, which is the most 
astringent of the three. In small doses given before meals they aid digestion, 
by synergizing the action of the pepsin, but if long continued they will impair 
digestion by lessening the production of the gastric secretions. Hydrochloric 
Acid is the normal digestive acid of the stomach, existing in the gastric juice 
in the proportion of 0.2 per cent. These acids check fermentation and consti- 
pate the bowels, except Nitric Acid, which relaxes them. They render the urine 
slightly more acid than its normal reaction, but will not acidify an alkaline urine 
as the vegetable acids do. In the blood they exist as salts which are rapidly 
excreted by the kidneys. Phosphoric Acid is described under the title 
Phosphorus. 

Therapeutics of the Mineral Acids. 

All the members of this group are useful in fevers, if well diluted, Hydro- 
chloric being usually preferred, especially in typhoid. In atonic dyspepsia, 
hypo-acidity of the stomach, and locally in ulcerations of the throat, Hydro- 



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6S ACIDUM HYDROCYANICUM. 

chloric Acid is best used. Nitric is the acid generally preferred as a caustic, 
its action being effectual and superficial. As such it is applied undiluted to 
phagedenic ulcers and sloughs, warty growths, and to the cavity of the womb 
in chronic endometritis. Dilute Nitric Acid is used internally in oxaluria and 
lithemia, intermittent and remittent fevers, and aphonia of singers. Dilute 
Nitro-hydrochloric is more suitable for chronic hepatic disorders due to ma- 
laria; Sulphuric in hemorrhages, diarrheas, colliquative sweating, and as a 
prophylactic against lead-poisoning. Dilute Sulphuric Acid is used as an 
acid drink in fevers, and before meals in acidity of the stomach. It is very 
doubtful whether the latter has any special influence on the nervous or 
osseous systems. 

All these acids act injuriously on the teeth, by attacking the enamel. They 
should always be largely diluted, taken through a straw or glass tube, and the 
mouth should be thoroughly rinsed at once with an alkaline wash. 

ACIDUM HYDROCYANICUM, Hydrocyanic Acid, Prussic Acid, HCN, 
— is a colorless, unstable, inflammable liquid, soluble in water and in alcohol, 
very volatile, and so toxic that death has resulted from smelling it. It is never 
found outside the chemical laboratory, and is official only in the dilute form — 

Acidum Hydrocyanicum Dilutum, Diluted Hydrocyanic Acid, — an aqueous 
solution composed of not less than 1.9 nor more than 2.1 per cent, of abso- 
lute Hydrocyanic Acid, HCN. It is colorless, faintly acid, of peculiar odor, 
and is prepared by distilling solutions of potassium ferrocyanide and sulphuric 
acid together, or extemporaneously by adding 6 grammes of silver cyanide to 
a solution of 15.54mils.of diluted hydrochloric acid in 44.10 mils, of distilled 
water, shaking together and pouring off the supernatant liquid. TTlxl have 
proved fatal. Dose, Tflj-iij, [av. Tfljss] of a recent preparation; as, even under 
the most favorable conditions, it will decompose within a year. 

Preparations containing Hydrocyanic Acid. 

Aqua Laurocerasi, Cherry-laurel Water (Unofficial), — is a water distilled from the fresh 
leaves of Prunus laurocerasus, the common Laurel or Cherry Laurel, a small tree of the nat. 
ord. Roseacae. sub-order Amygdalese. The leaves contain a variable amount of Hydrocyanic 
Acid and a volatile oil. Dose, ttjjv-xxx, cautiously. 

Scheele's Dilute Hydrocyanic Acid (Unofficial), — is a 4 or 5 per cent, solution, and is 
highly dangerous even by inhalation. 

Amygdala Amara, Bitter Almond (see its title) and its essential oil; also various other 
members of the sub-order Amygdaleae, including the official Prunus Virginiana, perhaps the 
unofficial Prunus laurocerasus, and the leaves and kernel of the peach and cherry trees, contain 
a proximate principle Amygdalin, and a ferment Emulsin, which in the presence of water 
react on each other, forming Hydrocyanic Acid, a volatile oil, and glucose. C 20 H 27 NO U 
(Amygdalin) - 2H 2 = C 7 H e O (Oil of Bitter Almond) + HCN (Hydrocyanic Acid) + 2C 6 H 12 6 
(Glucose). 

Hydrocyanic Acid exists ready formed to a considerable extent in the juice of the bitter 
cassava. 

Other Cyanogen Compounds. 

Potassii Cyanidum, Potassium Cyanide, KCN, — a white, opaque salt, of alkaline reaction, 
bitter-almond taste, and a peculiar odor when moist; soluble in 2 of water, sparingly soluble in 
alcohol. Dose, gr. £ 6 — ^ [av. gr. £%.] 



ACIDUM HYDROCYANICUM. 69 

Sodii Cyanidum, Sodium Cyanide, NaCN (Official), became official in U. S. P. IX 
replacing potassium cyanide of U. S. P. VIII; it is a white, granular powder which is odor- 
less when dry; deliquescent in the air and exhaling the odor of hydrocyanic acid. It is 
freely soluble in water. 

Potassii Ferrocyanidum, Potassium Ferrocyanide, K 4 Fe(CN) 6 3H 2 0, — large, lemon- 
yellow prisms or tablets, efflorescent, odorless, of sweetish taste and neutral reaction, soluble in 
4 of water, insoluble in alcohol. Employed in pharmacy as a test solution, and in the prepara- 
tion of Iron Ferrocyanide, Diluted Hydrocyanic Acid and Potassium and Silver Cyanides. 
Rarely used medicinally. 

Incompatibles. 

Incompatible with Hydrocyanic Acid are: Acids (mineral), Antimony Oxides, Iron and 
Copper salts, Mercury Oxides, Silver Nitrate, Sulphides; with Cyanides are: Acids, Alkalies, 
Hydrated Chloral, Iodine; Lead, Mercurous, and Silver salts; Permanganates, Potassium 
Chlorate, Potassium Nitrate. Atropine is physiologically incompatible. 

* 

Physiological Action. 

Hydrocyanic Acid is one of the most powerful and rapid poisons known, 
half a grain having proved fatal almost immediately. Its action on the organ- 
ism is one peculiar to itself, the inhalation of a strong preparation produc- 
ing rapid insensibility and almost immediate exhaustion; — death from a full 
dose occurring by sudden paralysis of the heart, from a less but still a fatal 
dose, by paralysis of respiration. The symptoms are those of sudden and com- 
plete asphyxia, but some volitional movements may be made before death, 
unless the dose be very large. In cases in which the dose, though fatal, per- 
mitted of the observance of its effects, they were usually divisible into two 
marked stages, (i) dyspnea, slow and full pulse, giddiness, loss of muscular 
power; (2) vomiting, dilated pupils, unconsciousness, spasms, muscular rigidity, 
and cessation of the heart's action. In poisonous, but not fatal doses, the 
following effects have been observed: feeble pulse, dilated pupils, turgid and 
dusky face, insensibility, convulsions or rigidity, but no paralysis. Large 
medicinal doses may produce salivation, irritation of the throat, dizziness, buz- 
zing in the ears, headache, numbness, dusky countenance, staggering gait, 
sense of constriction in the chest, palpitation of the heart, a frequent or an ab- 
normally slow pulse, a sense of great weariness and drowsiness. Postmortem 
examination usually shows dilated pupils, the eyes having a marked glassy 
lustre, the cadaveric rigidity very great. The blood, in cases which have been 
rapidly fatal, may show the arterial color in both the arterial and the venous 
systems; but in slower cases it is dark and fluid, engorging both sides of the 
heart, the venous trunks, and the cerebral sinuses. The paralyzant action of 
the drug is chiefly exercised on the nerve-centres in the medulla; next on the 
peripheral afferent nerves, the spinal cord, the motor nerves, and finally on 
the muscular tissue. It stops the heart by irritation of the vagus-roots in the 
medulla, as well as by paralyzing the cardiac motor ganglia. It is said to form 
with hemoglobin a compound (cyan-hemoglobin), which does not readily give 
up oxygen. The odor of the acid is fragrant, resembling that of bitter almonds 
or peaches, and may be detected in the lungs shortly after death. The effects 
of a medicinal dose pass off in an hour at the farthest. 



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70 ACIDUM HYDROCYANICUM. 

Locally applied to the skin, Hydrocyanic Acid penetrates the epidermis 
and paralyzes the end-organs of the sensory nerves in the derma. It is rapidly 
absorbed from mucous surfaces. 

Potassium Cyanide has similar action, but in addition has some few peculiar 
to itself. Locally used it produces dermatitis, with an eczematous eruption, 
and if applied to an abraded surface freely may cause fatal effects. Internally 
it has proved fatal in doses of 3 to 5 grains, with all the symptoms of hydrocyanic 
acid poisoning, but its action is less rapid. In the stomach it is converted into 
hydrocyanic acid by the displacement of K by H in the presence of an acid. 
As the amount of acid in the stomach is small, this reaction proceeds gradually, 
and there is generally an interval of several minutes, up to 15 or 20, before the 
onset of toxic symptoms, which are much less violent than those from hydro- 
cyanic acid, and the tetanic convulsions of the latter agent may be entirely absent, 
but the result is no less fatal. This Cyanide is much used in photography, and 
many cases of poisoning by it have occurred in persons employed in that art. 

Therapeutics. 

Diluted Hydrocyanic Acid is used for its antispasmodic and sedative effects. 
In vomiting, whooping-cough,' and coughs of spasmodic character, in asthma 
and other neuroses of the respiratory organs, in affections involving the pneu- 
mogastric nerve, vertigo and headache from stomachal derangements, gastralgia 
painful dyspepsia, and vomiting, it is very efficient as a palliative. In acute 
mania and melancholia it has been used with advantage; and in various skin 
diseases, accompanied by itching and tingling, its use as a lotion (tn.xxx-3j ad 
§ j aquae rosse) to the unbroken surface, promptly relieves the pruritus and other 
distressing sensations. Being rapidly eliminated it requires frequent admin- 
istration for its effects to be of service. 

Potassium Cyanide in ointment (gr. v ad §j) is used to allay pruritus, and 
in solution (gr. iij-v ad §j) is applied locally with benefit in reflex headaches 
and is used as a wash to remove nitrate of silver stains. It has been used inter- 
nally in doses of gr. j for acute articular rheumatism, but such employment 
of it is highly dangerous. In smaller doses (gr. tVtV), it is a useful in- 
gredient of cough mixtures, where opium or its alkaloids are not admissible. 

Potassium Ferrocyanide has been used in doses of 8 to 15 grains as an 
astringent and anodyne, but it is seldom employed in medicine. 

Cherry-laurel water has been extensively used as a flavoring agent, 
having a very agreeable taste. It is official in the British Pharmacopoeia, 
and is supposed to be a rather elegant mode of administering prussic acid, 
but the uncertainty of its strength is such that it should never be used 
internally, except in very small quantities. It has been employed as an 
anesthetic injection into the urethra prior to catheterization, and was 
formerly employed by ophthalmologists as an eye-wash in painful affections 
of that organ. 



ACIDUM LACTICUM. 7 I 

ACEDUM LACTICUM, Lactic Acid,— is a liquid containing Lactic Acid 
and lactic anhydrides of not less than 85 nor more than 90 per cent, of C3H6O3. 
It is a nearly colorless, odorless, syrupy liquid of acid taste and reaction, freely 
miscible with water, alcohol and ether, but nearly insoluble in chloroform. It 
is produced by the lactic fermentation of milk sugar or grape sugar, has a sp. 
gr. of 1.206 and is difficult to obtain pure. Dose, Tfl,xx-5j [av. TTtxxx] 
well diluted. 

Unofficial Preparations Containing Lactic Acid Producing Organisms. 

BACILLARY MILK, — a sterilized, fat-free milk acted upon by Bacillus 
bulgaricus and containing over 2 per cent, of lactic acid. 

BULGARA AND LACTIC BACILLARY TABLETS— tablets consisting 
of slowly dried cultures mixed with milk sugar and starch, each weighing 
about 5 grains and containing sufficient viable organisms to sour a given 
quantity of sterile milk in less than twenty-four hours. Dose, 1 or 2 
tablets before or after meals. 

BULGARIAN BACILLUS CULTURES,— pure cultures of Bacillus bulgari- 
cus for internal administration, local application and the inoculation of milk 
are marketed by a number of firms in vials, ampules and larger containers. 
Dose, 5 j-ij in sweetened water or milk, once to thrice daily. 

MASSOLIN, — a pure culture of the Bacillus bulgaricus grown on special 
media and said to be a useful local application in the treatment of suppura- 
tive conditions such as inflammation of the middle ear and nasal accessory 
sinuses, atrophic rhinitis, etc. 

KEFIR FUNGI, — Kefir occurs in the form of white, irregular bodies about 
the size of a walnut and contains principally the Saccharomyces cerevisiae 
(Heyden) and Bacillus acidi lactici (Hueppe). It is used for the preparation 
of fermented milk containing lactic acid and alcohol. It acts on milk as 
follows : lactose is gradually decreased and lactic acid increased. Alcohol and 
carbon dioxide are produced. Ten per cent, of the casein is converted into 
acid albumin and peptones, 10 per cent, into hemialbumose and the rest 
loses its lime. Kefir kumyss may be prepared by adding active kefir grains 
to fresh cows' milk kept at a temperature of 21 to 27 C. until the effect of 
fermentation becomes apparent by the rising of the grains to the surface. 
The grains may then be strained off, and the milk, which now contains suffi- 
cient yeast-cells to insurec ontinuance of the fermentation, is left to itself in 
well-corked bottles. 

Physiological Action and Therapeutics. 

Lactic acid is rarely used internally at the present time and finds its 
greatest field of usefulness as a local application in chronic ulcers, especially 



72 ACIDUM NITRICUM. 

tuberculous ulceration of the throat, in which it is applied in 10 to 50 per cent, 
solution in glycerine. 

Lactic bacilli administered internally have attained quite a vogue recently. 
For this purpose they are prepared in pure cultures and dispensed in liquid 
suspensions or in tablets consisting of dried cultures mixed with sugar of 
milk and starch. They are asserted to be of value in all conditions in which 
putrefactive changes in the intestines occur. Following Metchnikoff a group 
of observers have endeavored to explain arteriosclerosis, premature senility, 
chronic nephritis, chronic arthritis and a number of other conditions on the 
basis of a chronic autointoxication of intestinal origin. It is believed that the 
putrefactive changes inducing the chronic intoxication are due to the growth 
of proteolytic organisms which may be prevented or modified by the presence 
of lactic acid bacilli. 

Cultures of lactic acid bacilli have also been applied locally to prevent the 
growth of pathogenic and putrefactive germs in the treatment of suppura- 
tive conditions about the nose and ear. Good results are claimed in the 
treatment of atrophic rhinitis, chronic nasal catarrh, inflammation of the 
nasal accessory sinuses, middle ear, etc. 

Internally, it has been found useful in the treatment of infantile diarrheas 
of putrefactive origin. In the treatment of typhoid carriers it has been found 
effective in a number of cases. 

ACIDUM NITRICUM, Nitric Acid, — is an aqueous solution composed of 
not less than 67 nor more than 69 per cent, of absolute Nitric Acid, HNO3. It 
is colorless, fuming, very caustic and corrosive, of sp. gr. 1.403, strongly acid 
in reaction, and is obtained by the action of sulphuric acid on potassium 
nitrate. It is only used externally as a caustic. 

Preparations. 

Acidum Nitrohydrochloricum, Nitrohydrochloric Acid, {Nitromuriatic Acid, Aqua 
Regia) — a golden yellow, fuming, corrosive liquid, composed of Nitric Acid 18 vols., Hydro- 
chloric Acid 82 vols. Is wholly volatilized by heat, usually dissolves gold-leaf, and a drop 
added to test-solution of potassium iodide liberates Iodine in abundance. Dose, n^j-viij, 
[av. TTjriij], well diluted. 

Acidum Nitrohydrochloricum Dilutum, Diluted Nitrohydrochloric Acid, — consists of 
Nitric Acid 4, Hydrochloric Acid 18, Water 78 vols. Dose, tt^v-xx, [av. ttjjxv], well diluted. 

Incompatibles. 

Incompatible with Nitric Acid are: Alcohol, Alkalies, Carbonates, Ferrous Sulphate, 
Lead Acetate, Oils (essential), Sulphides. 

Physiological Action and Therapeutics. 

The action and uses of these agents are described with those of the other 
mineral acids, under the title Acidum Hydrochloricum. Some special proper- 
ties are as follows: — 

Nitric Acid is an exceedingly powerful escharotic, but, as it coagulates and 
does not redissolve the albumin of the tissues, it forms a barrier to its own 



ACIDUM NITROSUM ACIDUM OLEICUM. 73 

excessive action. The vapor may cause edema of the glottis, intense bronchitis, 
and death from suffocation. It is used for the destruction of chancres, warts, 
hemorrhoids, phagedenic ulcers, etc. ; and internally in dilute form for bilious 
affections, as it is somewhat cholagogue in its action on the liver. It is ques- 
tionable whether any of the mineral acids exert any appreciable effect on the 
flow of bile. It is excreted to a small extent as ammonia, slightly decreasing 
the acidity of the urine and lessening phosphatic deposits therein. It is one 
of the principal tests for determining the presence of albuminuria. 

Nitrohydrochloric Acid is an efficient cholagogue, and is employed with 
benefit in jaundice, dyspepsia, and the so-called bilious condition; also in acid- 
ity of the stomach and in frontal headache situated just above the eyebrows 
when unaccompanied by constipation. In hepatic disorders it may be used 
in dilute form as baths, or applied to the hepatic region on compresses. The 
official dilute acid is of little use therapeutically, as it rapidly deteriorates, and 
the same is true of the strong acid when old enough for the color to change to 
a lemon-yellow. The most efficient is the strong acid freshly prepared, which 
is of an orange-red color. This should be properly diluted when required for 
use, and should be constantly protected from light. 

ACIDUM NITROSUM, Nitrous Acid, HN0 2 . This acid does not exist in the free 
state, but occurs in combinations called nitrites, some of which are official, e.g., Amyl Nitrite, 
Sodium Nitrite, and Nitrous Ether. The so-called Nitrous Acid of commerce is a weak nitric 
acid colored red by nitrogen tetroxide. 

ACIDUM OLEICUM, Oleic Acid, Ci 8 H 3 40 2 ,— is one of the constituent 
acids of oils and fats, obtained commercially as a secondary product in the 
manufacture of stearin candles. It is a yellowish, oily liquid, semi-solid at 
40 F., odorless, tasteless, and of neutral reaction, insoluble in water but 
soluble in alcohol, chloroform, benzol, benzin, turpentine, and the fixed oils. 
It dissolves most of the metallic oxides and the uncombined alkaloids, forming 
the so-called Oleates, which, however, are not pure chemical compounds, but 
merely compounds of an oxide or an alkaloid, as the case may be, with oleic 
acid, dissolved in a great excess of the latter. Only one of these is official, 
viz. — 

Oleatum Hydrargyri, Oleate of Mercury, — strength 25 per cent, of yellow mercuric oxide. 

Unofficial Preparations. 

Oleates (Oleata) of Aconitine (2 per cent.), Atropine (2 per cent.), Cocaine (5 per cent.), 
Morphine (10 per cent.), Morphine and Mercury (2 per cent, morphine and 20 per cent, 
mercuric oxide), Quinine (25 per cent.), Veratrine (2 per cent.), Strychnine (2 per cent.), 
Arsenic (gr. xx of arsenic oleate to the §), Aluminum, Bismuth, Copper, Iron, Lead, Silver, 
etc., are prepared by the manufacturing pharmacists, and are to be obtained in the shops. 
Most of them answer to the description given above, but several are Oleo-palmitates, or 
double salts of Oleic and Palmitic Acids, being prepared from oils which yield the latter 
acid in considerable quantity. 

Oleic Acid is used only in making the oleates, which were introduced by 
Marshall as substitutes for ointments, being cleaner, more elegant, and more 



1 



,: 



74 ACIDUM OXALICUM ACIDUM SULPHURICUM. 

penetrating, but decidedly more irritating if applied with friction. Their medic- 
inal properties depend upon the bases employed, hence their actions and uses 
will be described under the corresponding basic titles. As parasiticides, the 
Oleates of Copper and Mercury are most efficient, and in skin diseases generally 
these preparations are rapidy gaining favor. 

ACIDUM OXALICUM, Oxalic Acid, C 2 H 2 4 , (Unofficial),— is an organic 
acid which exists as oxalates in many plants, particularly rhubarb, spinach, 
and those of the genus Rumex, commonly called "sorrel." It may be prepared 
by the oxidation of sugar, starch, or many organic substances, by Nitric Acid, 
or by fusing sawdust with a mixture of potassa and soda. It occurs in small, 
colorless crystals, which are soluble in 10 of water and in i\ of alcohol. Dose, 
gr. J-J, but the latter amount has caused serious respiratory depression. 

Acid Potassium Oxalate, Salt of Sorrel, Salt of Lemons (Unofficial), — is used in house- 
holds for removing ink and iron stains, cleaning brass, etc. It is nearly as toxic as the acid. 

Ferri Oxalas, Ferrous Oxalate (Unofficial), — a ferruginous salt, highly esteemed by 
Hayem. Dose, gr. j-iij. 

Cerii Oxalas, Cerium Oxalate, — is described under its own title. 

Incompatible with Oxalic Acid and the Oxalates are: Arsenates, Metallic Salts, except 
those of aluminum, chromium, and magnesium. 

Physiological Action and Therapeutics. 

Oxalic Acid derives its importance from its frequent use as a poison. It 
is largely used in the arts, for bleaching and dyeing, also in households for 
cleaning brass and removing ink and iron stains, and has often been mistaken 
for Epsom salts, which it resembles in appearance. It is a rapid and powerful 
poison, causing burning pain in the throat and abdomen, vomiting of acid, 
greenish or bloody mucus, a small and irregular pulse, collapse, stupor, some- 
times convulsions, and death from paralysis of the respiration. In some cases 
the nervous symptoms mask the gastric effects entirely, so that the patient may 
suddenly fall unconscious immediately after the ingestion of the poison. Death 
has occurred from 5j (Taylor), but recovery has occurred after 3iv (Murrell). 
It paralyzes the respiratory, vaso-motor, and other spinal motor centres, also 
the heart, which is arrested in systole. It is eliminated by the kidneys and pro- 
duces glycosuria; is emmenagogue and abortifacient, and a powerful germicide. 
It is probably a constant product of metabolism, traces of calcium oxalate being 
found in normal urine, and occurs in excess (oxaluria) in that of many hypo- 
chondriac and gouty subjects. It has been used medicinally in the treatment 
of amenorrhea, as a sedative in acute cystitis, and in connection with Potassium 
Permanganate for disinfecting the hands of the surgeon. 

ACIDUM SULPHURICUM, Sulphuric Acid, Oil of Vitriol— is a strongly 
caustic and corrosive liquid, oily, inodorous, of strongly acid reaction, and is 
composed of not less than 93 per cent, nor more than 95 per cent, of absolute 
Sulphuric Acid, H2SO4. It is obtained from the combustion of Sulphur and 



ACIDUM SULPHUROSUM. 75 

its oxidation by nitrous fumes. Its specific gravity should not be below 1.83, 
and it is miscible in all proportions with water and alcohol, with evolution of 
heat. Being dibasic it forms both acid and normal salts (sulphates) with 
monad bases. It decomposes many organic substances, extracting their H 
and O in the proportion to form water, and leaving the carbon behind. 

Acidum Sulphuricum Dilutum, Diluted Sulphuric Acid, — has of the strong acid 1 part 
to 8j of distilled water, and contains about 10 per cent, by weight of absolute sulphuric acid. 
Dose, tt#v-x1, [av. n£xv], well diluted. 

Acidum Sulphuricum Aromaticum, Aromatic Sulphuric Acid, Elixir of Vitriol, is Sul- 
phuric Acid, about 20 per cent., diluted with Alcohol and flavored with Cinnamon and 
Ginger. It is not an acid, but rather an ether formed by reaction between the acid and the 
alcohol. Dose, ttj?v-xx, [av. it£xy], well diluted. 

Incompatible with Sulphuric Acid are: Alcohol, Barium and Calcium salts; Hypophos- 
phorous Acid, Metals, Oils (essential); Lead, Mercurous, Silver and Strontium salts, Or- 
ganic substances, Sulphides, Vegetable astringent infusions. 

The actions of Sulphuric Acid are described with those of the other mineral 
acids under the title Acidum Hydrochloricum. Its principal uses are those 
of an astringent and a hemostatic, though it is occasionally employed as a caustic. 
Internally it is used in lead-poisoning to form the insoluble sulphate of lead, 
also as a remote astringent in diarrhea, hemorrhoids, hemorrhages, night-sweats, 
and mucous discharges. In choleraic diarrhea and lead-poisoning it is gener- 
ally administered in combination with opium. The only hemorrhages in which 
it is efficient are those from mucous surfaces. It is excreted chiefly by the kid- 
neys, part escaping by the bowels as sulphates, part also by the skin. Like the 
other mineral acids, it does not increase the acidity of the urine to any con- 
siderable extent. 

ACIDUM SULPHUROSUM, Sulphurous Acid (not ofiicial)— is a color- 
less liquid of sulphurous taste and highly acid reaction, prepared by heating 
sulphuric acid with charcoal and dissolving the evolved gas in water. It was 
formerly ofiicial in the strength of 6 per cent, by weight of sulphur dioxide in 
water. Dose ITlv-xxx well diluted with water. It is very rarely used intern- 
ally. Its salts are the Sulphites and Hyposulphites of which the following 
are ofiicial: — 

Sodii Sulphis Exsiccatus, Exsiccated Sodium Sulphite, Na 2 S0 3 , a white powder, odorless, 
of cooling, saline, and sulphurous taste, and feebly alkaline reaction; soluble in 3.2 of water 
and in 0.9 of boiling water, very slightly soluble in alcohol. Dose, gr. v-xxx or even up to 
3j, [av. gr. xv.] 

Sodii Thiosulphas, Sodium Thiosulphate {Sodium Hyposulphite), Na2S 2 3 .5H 2 0, — 
large, colorless, monoclinic prisms or plates, efflorescent in dry air, of cooling and bitter 
taste, and neutral or faintly alkaline reaction; soluble in 0.5 of water and slightly more so 
in boiling water, which partly decomposes it; insoluble in alcohol. Dose, gr. v-xx, [av. 
gr. xv.] 

Incompatibles. 

Incompatible with Sodium Hyposulphite are Acids, Chromates and Permanganates in 
acid solution, Chlorates, Iodine, Nitrates, Oxidizers; Salts of Barium, Lead, Silver; Arsenic, 
Ferric and Mercurous salts. All oxidizers change the Sulphites into sulphates, and the min- 
eral Acids decompose them. 



1 



4 



76 ACIDUM TARTARICUM ACONITUM. 

Sulphurous Acid Gas (sulphur dioxide) is extensively used as a disinfectant, 
being the most powerful agent for this purpose. It is the best, in fact the 
only practical means of killing the yellow fever carrier — Stegomyia Fasciata 
■ — and in spite of the disadvantages is used for this purpose even in living 
rooms (Halsey). Sulphur is burned on a shovel or plate in the room to be 
fumigated, all outlets having been carefully closed. The gas is injurious to 
many fabrics, is irritant to the respiratory mucous membrane, and inhaled 
may cause dangerous inflammation of the glottis. Sulphurous Acid has a 
powerful affinity for oxygen, is strongly disinfectant and deodorant, and very 
destructive to all plant and animal life. It is used as a spray or by a mop 
locally in many affections of the throat, and in diphtheria, stomatitis, aph- 
thae, ulcers of the tonsils, syphilitic and tuberculous laryngitis, and chronic 
bronchitis, it may be thus applied with great benefit. Morbid fermentation 
in the stomach, with growth of penicillium and sarcinae, is quickly stopped by 
5 to 6o-minim doses in water, or by the sulphites in 20-grain doses. In para- 
sitic skin diseases and foul wounds these agents are extremely useful as local 
applications. 

The Sulphites and Hyposulphites are partly decomposed by the acid of 
the stomach, sulphurous acid being given off, and the balance being converted 
into sulphates act as purgatives, and are absorbed, undergoing elimination as 
sulphates by the kidneys and bowels. They were formerly supposed to enter 
the blood and tissues as sulphites, and to arrest morbid processes of the zymo- 
tic character, but both these assumptions have proven erroneous. The Sul- 
phites were formerly used in septic fevers as internal antiseptics on theoretical 
grounds, but their supposed value has not been realized. 

ACIDUM TARTARICUM, Tartaric Acid, H 2 C 4 H 4 6 ,— is a dibasic organic acid, 
prepared from Potassium Bitartrate by neutralizing a solution thereof with chalk and cal- 
cium chloride, then decomposing the calcium tartrate thus formed by sulphuric acid, evaporat- 
ing and purifying. It occurs in colorless, transparent prisms, which are odorless, of acid 
taste and reaction, and soluble in 0.75 of water and in 3.3 of alcohol at 25 C. Twenty 
grains exactly neutralize 27 of Potassium Bicarbonate, 22 of Sodium Bicarbonate, or 155 
of Ammonium Carbonate. Dose gr. v-xx, [av. gr. viij.] 

Tartaric Acid is an ingredient of the Effervescing Powder (see under Potassium) . Two 
Tartrates and one Bitartrate (see Index) are official, and are described, with their actions and 
uses, under the titles of their respective bases. For Potassium Bitartrate see under Potassium. 
The Alkaline Cupric Tartrate Volumetric (Fehling's) Solution is described under the title 
Fe&rum. 

Incompatible with Tartaric Acid are: Alkalies, Calcium salts, Carbonates, Lead salts, 
Lime-water, Mercury salts, Vegetable astringents. 

The actions and uses of Tartaric Acid are similar to those of the other vegetable acids 
as described under Acidum Aceticum. It is chiefly employed in the preparation of effer 
vescing refrigerant drinks and effervescing granulated salts. In large doses it induces symp- 
toms of gastric irritation, and has caused fatal poisoning in a few cases. 

ACONITUM, Aconite, — is the dried tuberous root of Aconitum Napellus, 
the Monk's-hood or Wolf's-bane, a perennial plant of the nat. ord. Ranuncu- 
laceae, found in mountainous regions of Europe, Asia and N. America. This 
plant has deep-blue, helmet-shaped flowers, and leaves which have deeply-cut, 



ACONITUM. • 77 

wedge-shaped segments, exciting slowly when chewed a sensation of tingling in 
the tongue and lips. The root is conical and tapering, with a thick bark enclos- 
ing a seven-rayed, star-shaped pith, odorless, taste sweetish at first, soon be- 
coming acrid. A minute portion, cautiously chewed, causes prolonged tingling 
and numbness of the tongue and lips. Aconite contains the alkaloids Aconitine, 
Cg^jH^NOn, Benzaconine, C 25 H. 39 N0 1V and Aconine, C 22 H 35 N0 9 ; also Aconitic 
Acid, gum, sugar, etc. Dose, gr. J-ij, [av. gr. J.] 

Aconitine may be considered an acetyl-benzaconine, as it is resolvable into benzaconine 
and acetic acid. Benzaconine may be resolved into aconine and benzoic acid. Aconine and 
Benzaconine are the principal constituents of the Napelline and Pier aconitine of older writers 
(Cash and Dunstan). 

Other Aconites are: Aconitum Ferox, • f rom India, yielding the alkaloid Pseudaconitine, 
which is even more toxic than Aconitine; Aconitum Japonicum, from Japan and China, con- 
taining J apaconitine, which is identical with Aconitine; Aconitum Lycoctonum, the alkaloid 
of which is called Lycoctonine. The plant Delphinium Staphisagria contains an alkaloid named 
Delphinine, which acts similarly to Aconitine, but less powerfully. 

Official Preparations. 

Extractum Aconiti, Extract of Aconite, — one grain of the extract represents about 4 
grains of Aconite. The U. S. Pharmacopoeia recommends a biologic assay of the crude 
drug and all its preparations. Dose, gr. T l ^-l [av. gr. |.] 

Fluidextractum Aconiti, Fluidextract of Aconite, — an alcoholic preparation of which 
each drop represents nearly one grain of the powdered drug. Dose, njj^-ij, [av. n£§.] 

Tinctura Aconiti, Tincture of Aconite, — has of Aconite 10, Alcohol and Water to 100. 
Dose, Ti^j-xv, [av. iTgv.] 

The best rule for the administration of Aconite is to give minim doses of the official tincture 
every 15 minutes until the desired effect is produced. 

Aconitina, Aconitine, C 34 H 47 NO n , — is a white, prismatic powder, readily soluble in 
alcohol or chloroform, nearly insoluble in water. It is difficult to obtain it of constant 
strength, some samples being nearly inert, others extremely active. As it occurs com- 
mercially it is a mixture of several alkaloids, and should not be used internally in practical 
medicine (Wood). The Aconitine Crystalisee of Duquesnel is a nitrate of aconitine, and is 
probably the most active preparation on the market (Squibb). Dose, gr. eooloo) [ av « g r - 
?ih$\l; but the amorphous Aconitine may be administered in doses of gr. gV'^o (Merck). 

Unofficial Preparations. 

Oleatum Aconitinae, Oleate of Aconitine, — is a 2 per cent, solution in Oleic Acid, for 
external use. Duquesnel's crystals will not dissolve in Oleic Acid (Squibb). 

Napellina, Napelline, — contains Benzaconine and Aconine, and has been used in doses of 
gr. £-§. It has been studied by Laborde, who claims for it most valuable hypnotic properties, 
and proposes to use it as a substitute for opium and chloral. 

St. Jacob's Oil (a patent medicine), — is a weak Aconite Liniment, which also contains 
Ether, Alcohol, Turpentine, red coloring matter and water (Squibb). It contains Turpentine 
(82 per cent.), Aconite, Ether, Alcohol, Carbolic Acid, Capsicum and a small quantity of 
Origanum (Murrell). 

Incompatibles. 

Incompatible with Aconite are: Acids, Alkalies, or Water (hot). Atropine, Digitalis, 
Morphine, Scoparin, and Strychnine, are physiologically incompatible with Aconitine. 

Physiological Action. 

The taste of Aconite is bitter, acrid and pungent. Soon after the inges- 
tion of even a small quantity, a sensation of numbness and persistent tingling 



! 



< 



78 ACONITUH. 

are felt in the tongue and lips. Full medicinal doses cause a sense of constric- 
tion in the fauces, irritation of the gastro-intestinal mucous membrane with 
increased secretion; sometimes nausea and vomiting, and severe pains in the 
joints and muscles; always more or less salivation, diaphoresis and diuresis; 
reduced respiratory power, cardiac rate and force; lowered arterial tension 
and temperature. 

A lethal dose produces great muscular weakness, dim sight, dilated (some- 
times contracted) pupils; shallow, irregular, and labored respiration, slow and 
weak pulse, cold surface, clammy sweat, great anxiety, numbness and tingling 
in the extremities, lowered body-temperature (2 to 3°F.), abolished sensation, 
impaired reflexes and motility, and finally death from paralysis of the heart 
and respiration, with or without convulsions, consciousness being preserved 
until near the end, when C0 2 narcosis sets in. In two recorded cases, edema 
of the entire body resulted from eating the leaves of the growing plant. 

Aconite is rapidly absorbed and the active principle is destroyed by oxida- 
tion, so that its medicinal effects do not last long and it may be administered 
in small doses at frequent intervals. The effects of a full dose continue for 
three or four hours. Applied externally it paralyzes the sensory nerves of the 
part, and causes its characteristic numbness and tingling. 

The action of Aconite is due to its chief constituent, Aconitine, which is the 
most powerful alkaloid known, and fatal to man in the dose of -5 "o of a grain. Its 
dominant action is depressant to the peripheral nerve terminations, especially 
those of the sensory nerves, but stimulant to the vagus roots, slowing and steady- 
ing the action of the heart and lowering the blood-pressure. It slows the respi- 
ration, relieves pain, lowers the body temperature, is mildly diaphoretic and 
feebly diuretic. In overdose it paralyzes both the motor and sensory nerves — 
the sensory being affected first and from the periphery inward, while the motor 
nerves are affected from the centres outwardly. It stimulates at first but soon 
relaxes the inhibitory apparatus of the heart, and paralyzes finally the vagus 
ends, the cardiac muscle and its contained ganglia, the respiratory centres, 
and the spinal cord in all its functions — sensory, reflex and motor ; but does not 
affect the cerebrum. 

The primary stimulation which the drug produces upon the vagus centre 
in the medulla slows the heart-rate at first; but its depressant action upon the 
motor cardiac centres and the vagus end-organs in the heart is soon mani- 
fested, and finally the vagus centre shares in the increasing paralysis, which 
affects the vaso-motor centre as well as the cardiac nervous apparatus. The 
heart-rate becomes very rapid near the end, from paralysis of the vagus termi- 
nals in its structure. Death is due generally to paralysis of the respiratory 
centre, sometimes to cardiac failure. 

Benzaconine may be resolved into aconine and benzoic acid. It is only 
-^th as toxic as Aconitine, depresses the motor nerves, the vaso-motor centre, 
and the cardiac muscle, but does not paralyze the sensory nerves. It stimu- 



ACONITUM. 79 

lates the vagus, causing slowing of the pulse, and affects the cerebrum, causing 
a semi-comatose condition. 

Aconine is a feeble agent, being 2000 times less toxic than aconitine. In 
quantity it has a paralyzant action on the motor nerve terminations like that 
of Curare, does not affect the vaso-motor centre, but stimulates the vagus roots 
and strengthens the ventricular systole. 

Therapeutics. 

Aconite was well known to the ancients, by whom it was regarded as the 
most virulent of all poisons. It was introduced into medicine by Baron Storck, 
of Vienna, in 1762, and its pharmacology and therapeutics were the subject 
of an essay by Fleming in 1844, for which he was awarded a gold medal by the 
University of Edinburgh. 

Aconite antagonizes the fever process, and rightly used is therefore one of 
the most valuable drugs we possess. It has well been called the "therapeutic 
lancet," and is certainly responsible to a great extent for the disuse of venesec- 
tion. Its power over the circulation, respiration and transpiration renders it 
of the greatest value in all affections characterized by a high, resisting pulse, 
a dry, hot skin, and elevated body-temperature. The chief indication for its 
use is vascular excitement in sthenic subjects; it is contra-indicated when there 
is adynamia, weak action of the heart, cardiac degeneration or dilatation, and 
gastro-intestinal irritation or inflammation. Aconite is not a remedy for use 
in continued fevers, and its prolonged administration is not indicated except 
under very exceptional circumstances. Even in the inflammatory and febrile 
conditions for which it is usefully employed it will be found of greatest value 
in their early and sthenic stages, its later use being often injurious. 

Aconite is very efficient in acute affections of the bronchial mucous mem- 
brane, in coryza, tonsillitis and asthma due to exposure, also in both catarrhal 
and spasmodic croup. One of the best methods of "breaking up a cold" is 
to administer small doses of the tincture at frequent intervals for several hours, 
followed by 10 grains of Dover's powder at bedtime. As a febrifuge and seda- 
tive it is useful in simple and catarrhal fever, also in scarlatina, measles and 
erysipelas. In the early stage of acute inflammations of serous membranes, 
as meningitis, pleurisy and pericarditis, it has great power for good, but its 
employment in these affections should be restricted to the period before the stage 
of effusion. It was formerly used a great deal in the early stage of pneumonia 
for its sedative influence upon the respiration but, it should not be used beyond 
the time when the heart begins to undergo much strain. In acute articular 
and muscular rheumatism it is frequently of great service, and if used from 
the beginning of the attack in rheumatic fever it will generally prevent the 
cardiac complications which are so dreaded in that disease. 

Aconite has proved very efficient in neuralgia, especially if the attack is 
accompanied by high vascular excitement, also when the branches of the fifth 



80 ADEPS. 

nerve are affected. Aconitine has proved remarkably efficient in trigeminal 
neuralgia of obstinate character, but it is a doubtful and dangerous agent for 
internal use, on account of its variable purity and composition, and its great 
toxicity. Aconite gives satisfaction in the treatment of cardiac affections char- 
acterized by overaction or hypertrophy and absence of dilatation or valvular 
lesions, particularly in exophthalmos, nervous palpitation, and tobacco heart. 
Even when valvular disease is present it may be cautiously used in extreme 
hypertrophy to control the forcible cardiac action. 

When diarrhea or dysentery follows a chill and can be ascribed to cold and 
exposure, the patient having high fever and cutting pains in the abdomen, Aco- 
nite will be found a very serviceable remedy. In sudden suppression of menstrua- 
tion following a chill, getting the feet wet, or similar evidences of exposure, 
this agent is efficient in removing the discomfort and causing the reappearance 
of the flow. In congestive dysmenorrhea it frequently gives marked relief. 
In the early stage of gonorrhea drop doses of the tincture, given hourly until 
some physiological effect is produced, will lessen the severity of the inflammatory 
symptoms and prevent chordee. In the so-called urethral fever it is highly 
recommended, and a drop or two of the tincture given immediately after 
the passage of a urethral sound will prevent the chill which often succeeds 
that operation. 

Externally, Aconite is used with benefit as a local anodyne in superficial 
neuralgias, herpes zoster, pruritus and chilblain. For the relief of vague, wan- 
dering pains in the limbs, liniments containing this tincture will prove more 
effective than those of any other form. For odontalgia the tincture may be 
rubbed on the gum in the vicinity of the aching tooth, or it may be introduced 
upon a pledget of cotton into a dental cavity. Any preparation containing 
this drug should be used with great caution upon an abraded cutaneous surface, 
as it is rapidly absorbed by the unprotected derma. 

Aconite is best administered in small doses of the tincture well diluted and 
frequently repeated. Doses of ttlJ to % every 15 minutes give better results 
than larger ones at longer intervals. 

ADEPS, Lard, — is the prepared internal fat of the abdomen of the hog, 
Sus scrofa, purified by washing, melting and straining. It occurs as a soft, 
white, unctuous solid, of bland taste and neutral reaction, entirely soluble in 
ether, benzin, and bisulphide of carbon; composed of 38 per cent, of stearin 
and margarin, and 62 per cent, of olein. Lard forms 70 per cent, of Ceratum, 
and 80 per cent, of Unguentum, and enters into the composition of several of 
the official cerates. Fats are formed of the principles Stearin, Margarin, and 
Olein, which are salts of stearic, margaric, and oleic acids, with the common 
base glycerin, and contain also odorous and coloring principles. 

The action of the Oils and Fats is described under Morrhtle Oleum. Lard 
is only used as an ingredient of ointments and cerates. Lard Oil has been pro- 



ADEPS. 8l 

posed as an inferior substitute for Cod-liver oil in cases where the taste of the 
latter is particularly offensive. 

Preparations. 

Adeps Benzoinatus, Benzoinated Lard, — has i per cent, of Benzoin in powder, incor- 
porated by stirring. 

Official Derivative and Analogues. 

Acidum Stearicum, Stearic Acid, — is an organic acid, usually obtained from the more 
solid fats, chiefly tallow. In its impure, commercial form, it occurs as a hard, white, glossy 
solid, odorless, and tasteless, permanent in the air; insoluble in water, soluble in 45 of alcohol, 
also in ether. It is used as a substitute for wax, and is an ingredient of the Suppositoria 
Glycerini. Stearates of Atropine, Morphine, Cocaine, Copper, Mercury and Zinc are on the 
market, that of Zinc being the only official one, and the most generally used. [See under 

ZlNCUM.] 

Adeps Lanae, Wool Fat, — is the purified fat of the wool of sheep, freed from water. It 
is insoluble in, but miscible with, large quantities of water, sparingly soluble in alcohol. 

Adeps Lanae Hydrosus, Hydrous Wool Fat {Lanolin), — is the purified fat of the wool of 
sheep, mixed with not more than 30 per cent, of water. A yellowish-white, ointment-like 
mass, having a faint, peculiar odor; insoluble in water, but miscible with twice its weight 
thereof. 

Under the name Lanolin this substance was in use for several years before it became offi- 
cial. It is a cholesterin fat, and a very old medicament, having been mentioned by Ovid, 
Herodotus, Pliny and Aristophanes; yet the process of obtaining it from the suds from the 
washings of sheep's wool is patented in this country by Liebrich. It differs from all other 
fatty substances chiefly in resisting saponification and the action of water, having no tendency 
to become rancid; and readily passes through the integument, carrying with it any medica- 
ment with which it is charged. It is a perfectly neutral base, and therefore not liable to de- 
compose any ordinary substance. The difficulty about its use has been its very disagreeable 
sheepy smell, but recent samples seem in great measure to be devoid of this objectionable 
quality. It is particularly useful in chronic skin diseases where there is infiltration, and 
where a penetrative action is desired for medicaments locally applied. In a few cases of 
acute and subacute eczema it has proved irritating, but as a rule it is perfectly bland. Where 
a simple protective action alone is desired it is inferior to Lard, Vaselm or Cold Cream. 

Cetaceum, Spermaceti, — is a peculiar, concrete, fatty substance obtained from the head 
of the sperm whale. It occurs in white, pearly masses, which are odorless, of bland taste and 
neutral reaction, becoming rancid in the air, soluble in ether, chloroform, carbon disulphide 
and boiling alcohol. It is a constituent of — 

Unguentum Cetacei, Spermaceti Ointment (B. P.), — has of Spermaceti 20, White Wax 
8, Almond Oil 72, Benzoin 2. The last-named ingredient renders the ointment irritating, 
and should be omitted when a perfectly bland application is required. 

Unguentum Aquae Rosae, Ointment of Rose Water, (Cold Cream), — contains Spermaceti, 
Almond Oil, Rose Water, etc. [See under Rosa.] 

Spermaceti consists of Cetin (Cetyl Palmitate) with several other fats in small quanti- 
ties. Its action is solely that of an emollient, and it is rarely used internally, though an alco- 
holic preparation was once a regular prescription for coughs, bronchial irritation, and for a 
recently delivered woman. A Cerate is employed as a bland ointment for blisters, abrasions 
and ulcers, but it is too stiff for easy application, and the Ointment is preferred in practice. 
The latter on lint to broken blisters from walking affords great relief, and may be smeared on 
the feet to prevent injury from a rough tramp over broken ground. 

Sevum Praeparatum, Prepared Suet, — is the internal fat of the abdomen of Ovis Aries 
(the Sheep), purified by melting and straining. It should be kept in well-closed vessels and 
not used after it has become rancid, as it will on exposure to air. It is a white, smooth, solid 
fat, of bland taste and neutral reaction, insoluble in water or cold alcohol, soluble in 44 of boil- 
ing alcohol, 60 of ether, and slowly in 2 of benzin. It consists chiefly of Stearin, but also has 
Palmitin and Olein, and is a constituent of Unguentum Hydrargyri. It is a harder fat than 
lard and more liable to turn rancid. It is used in ointments and liniments to give them greater 
consistency, but may be applied alone as a dressing to ulcers. In physiological action and 
therapeutics it follows the other oils and fats. [See under Morrhile Oleum and Oliv^e 
Oleum.1 



1 



82 .ETHER. 

jETHER, Ether, Ethyl Oxide (C 2 H 5 ) 2 0, — in its absolute form is not offi- 
cial. Considered as a generic term an ether is analogous to a salt as an alcohol 
is to a metallic hydroxide. The particular ether officially so named is 
Ethyl Oxide, prepared from ethylic alcohol (ethyl hydroxide) , by a dehydrating 
agent with the aid of heat, and then purified by various processes. The 
agent used is sulphuric acid, hence this ether is improperly called sulphuric 
ether, but the acid simply dehydrates the alcohol and remains in the retort, 
becoming constantly more diluted by the abstraction of water from the alco- 
hol. Consequently H 2 is the difference between Alcohol and Ether. (C 2 H6- 
0) 2 -H20 = (C 2 H 5 )20. 

JEther, Ether, — is a volatile and inflammable liquid, containing not less 

than 95.5 per cent, nor more than 97.5 per cent, of absolute ether (ethyl 

oxide), the remainder consisting of alcohol containing a little water. Its sp. 

gr. is 0.713 to 0.716 at 25 C. It is the preparation employed for anesthetic 

use, and is generally called Sulphuric Ether, a term which properly belongs to 

ethyl sulphate, C 2 HioS04- The dose of Ether for internal administration is 

TTtx-xxx [av. TUxv] in syrup; hypodermically for heart failure, ITtx-xx. The 

best preparation for use in prescriptions is the spirit, which mixes readily with 

water. 

Water dissolves a tenth of its volume of Ether, and reciprocally Ether takes up about the 
same proportion of water. It is colorless, of a strong and characteristic odor, hot and pungent 
in taste. It evaporates speedily in the open air, with the production of considerable cold. 
When good, it evaporates from the hand, without leaving a disagreeable odor. It boils at 
about the temperature of the body, and its vapor is very heavy and very inflammable. It dis- 
solves Hydrargyrum Bichloride, Hydrargyrum Iodidum Rubrum, Iodine and Bromine freely; 
Sulphur and Phosphorus sparingly. It is also a solvent of the fixed and volatile oils, many 
resins and balsams, caoutchouc, and most of the organic vegetable alkaloids. It does not 
dissolve Potash or Soda, in which respect it differs from Alcohol. 

JEther Aceticus, Acetic Ether {Ethyl Acetate) , C 2 H 5 C 2 H 3 0, (Unofficial), — is 
an inflammable liquid, transparent and colorless, of ethereal and acetous odor, 
soluble in alcohol, ether, chloroform, and in 8 of water. It is composed of 
about 90 per cent, by weight of Ethyl Acetate, and about 10 per cent, of alco- 
hol containing a little water. Dose, TTlx-xxx, [av. TUxv.] 

JEthzi Nitrosus, Nitrous Ether, {Ethyl Nitrite), C 2 H 5 N0 2 , — is properly a 
nitrite, and is official in the form of the Spirit (see below). 

Hydro bromic Ether, Ethyl Bromide, C 2 H 5 Br (Unofficial), — is not inflam- 
mable. Dose, internally and hypodermically, TTl.x-3ss. 

Hydriodic Ether, Ethyl Iodide, C 2 H 5 I (Unofficial), — is a colorless liquid, 
non-inflammable, and insoluble in water. Dose, inhaled, Tfl.xv. 

For the Chlorinated Ethers see under Chloroform. 

Preparations. 

Spiritus Athens, Spirit of Ether, — has of Ether one-third, Alcohol two- thirds . Dose, 
T?£x-3ij, [av. 3j-] 

Spiritus jEtheris Nitrosi, Spirit of Nitrous Ether, Sweet Spirit of Nitre, — is an alcoholic 
solution of Ethyl Nitrite, C 2 H 5 N0 2 , containing not less than 3.5 or more than 4.5 per cent, 
of the latter. It turns acid with age, and should not be kept long. It is a constituent of 
Mist. Glycyrrhizse Co. (3 per cent.). Dose TTj>x-5ij, [av. ngxxx.] 



AETHER. 83 

Unofficial Preparation 

Spiritus Athens Compositus, Compound Spirit of Ether {Hoffman's Anodyne), — has of 
Ether 32^ per cent., Alcohol 65, Ethereal Oil i\. Dose T^v-5ij, [av. 5j.] 

Incompatibles. 

Incompatible with Ether are: Bromine, Chromic Trioxide; with Acetic Ether Alkalies 
Chlorine Water, Chromic Trioxide, Water; with Ethyl Bromide Alkalies, Water of Ammonia; 
with the Spirit of Nitrous Ether Acacia, Acetanilid, Alkalies, Antipyrine, Carbonates, Ferrous 
Sulphate, Gelatin, Guaiac tincture, Iodides, Morphine, Tannic and Gallic Acids, Piperazin, 
Thymol, Uva Ursi preparations. 

Analogues. 

Chloroformum, Chloroform., and the Chlorinated Ethers, are described under the title 
Chloroformum. 

Anesthetic Mixtures. 

Nussbaum's has — Ether 3 parts, Chloroform 1, Alcohol 1. 

Vienna General Hospital uses — Ether 9, Chloroform 30, Alcohol 9. 

The Vienna Mixture, — Ether 3, Chloroform 1. 

A.C.E. Mixture, — recommended by the Medico-Chirurgical Society of London in 1864, 
consists of Alcohol 1, Chloroform 2, and Ether 3 parts. 

M. S. Mixture, — has of Ether 56!, Chloroform 43^ parts by volume, and is said to be a 
true molecular solution, containing neither of its ingredients free. 

Meyer's Mixture, Anesthol, — has of the M. S. mixture (above) 83, Ethyl Chloride 17 parts 
by volume, and boils at 104 F. Dr. Meyer considers it a great improvement on the Schleich 
solutions, causing but slight general disturbance, no struggling, infrequent vomiting, rapid 
recovery, and no disturbance of the lungs or kidneys. 

Schleich' s Solutions — are three in number, and are made up by volume and not by weight, 
as follows: (No. 1), Ether 6, Chloroform i£, Benzin (Petroleum Ether) £. (No. 2), Ether 5, 
Chloroform i£, Benzin £. (No. 3), Ether 2§, Chloroform 1, Benzin £; or Ether 80 Cc, 
Chloroform 30 Cc, Benzin 15 Cc. The latter is adapted to major operations and has a boiling 
point of 1 07 .4° F. 

Physiological Action of Ether. 

Ether is anodyne, antispasmodic, diaphoretic and anthelmintic; a cardiac 
and cerebral stimulant, an anesthetic, and a narcotic poison. Given internally, 
it is a most powerful stimulant of secretion, acting especially on the secretions 
of the stomach, salivary glands and pancreas. On the cerebrum and the motor 
and sensory nerves its action is similar to that of alcohol, but more prompt 
and less protracted. It is eliminated rapidly, chiefly by the lungs. Externally 
it is a powerful refrigerant and local anesthetic; also rubefacient when rubbed 
into the skin. 

Ether when inhaled produces at first faucial irritation, a sense of stran- 
gulation and cough; then a stage of excitement (cerebral intoxication), in which 
the face is flushed and the respiration and pulse are accelerated. A tetanic 
convulsive stage generally follows, the face being cyanosed, the muscles rigid, 
and the respiration stertorous. This soon subsides, and complete insensibility 
is established, the muscles being then relaxed, the reflexes abolished, and the 
cerebral functions suspended, the lower centres in the medulla carrying on 
the processes of respiration and circulation. If the inhalation be continued, 
these also become paralyzed, death usually resulting from slow paralysis of res- 
piration, the heart pulsating long after breathing has ceased. If the inhalation 



84 iETHER. 

be discontinued before the lower centres are affected, the patient gradually 
emerges from the condition of insensibility, and, as the narcosis subsides, vomit- 
ing is usually experienced. 

Dr. Brunton found that in a hot climate Ether will decompose within a few hours, and 
hence, during his investigations for the Hyderabad Chloroform Committee, he found it im- 
possible to obtain pure ether. This may account for the preference for Chloroform as an 
anesthetic which is so universal in the Southern States. 

Ether is less irritant than Chloroform to the mucous membranes when 
swallowed, but its vapor is more irritant to the air-passages. The one grave 
danger following its administration is the subsequent development of a broncho- 
pneumonia, more rarely a lobar pneumonia. Acute mania has followed its 
inhalation for anesthesia, but only in a few cases. Ether is a cardiac and vaso- 
motor stimulant and raises the blood-pressure; Chloroform is a cardiac and 
vaso-motor depressant and lowers the blood-pressure. Ether has been often 
administered with safety in cases of organic heart disease. It does not clot the 
blood. Its vapor is very inflammable, less pleasant to inhale than that of Chlo- 
roform, is slower in action, has a longer stage of excitement, and a less profound 
narcosis, and causes a greater degree of vomiting. It is much less dangerous 
than Chloroform, death from the inhalation of Ether occurring slowly and usu- 
ally by paralysis of respiration — from Chloroform, it is almost always sudden, 
and is generally believed to occur by paralysis of the heart. Ether has un- 
doubtedly been the direct cause of a number of deaths, besides several which 
occurred some hours after the termination of its anesthesia ; but the sudden deaths 
produced by it have nearly all occurred in patients who had some lung disease or 
some enervating lesion, as intestinal obstruction, tumor of the brain, cancer 
or kidney disease. When bronchitis or renal disease exists Ether is positively 
dangerous. The mortality of ether-anesthesia is about i in 10,000 cases. 

Modes of Dying in Anesthesia. 

(1.) From sudden paralysis of the cardiac ganglia, early in the inhalation, by reflex action 
proceeding from some peripheral injury before complete anesthesia is produced. Thus, in 
the extraction of teeth, a small quantity of Chloroform having been administered, the heart is 
enfeebled, and the action of the cerebral hemispheres suspended, but not that of the basal or 
medullary ganglia. If at this stage the 5th nerve be irritated, by the intimate relation of its 
nucleus with that of the pneumogastric reflex inhibition may be transmitted over the latter, 
arresting the cardiac ganglia. The stage of incomplete anesthesia is always a dangerous one 
in which to perform any operation around the distribution of the 5th nerve. 

(2.) In the stage of rigidity, from tetanic fixation of the respiratory muscles, the blood 
backing up on the venous side, and arresting the heart's action, respiration ceasing before the 
cardiac action is stopped. 

(3.) In the stage of complete relaxation, by paralysis of respiration; or by paralysis of the 
tongue, causing obstructed respiration. 

(4.) In the same stage, by paralysis of the motor ganglia of the heart. 

(5.) From depression of the functions by chloroform narcosis, and from shock, — and may 
occur in the anesthetic state, or afterwards. 

Contraindications for Anesthesia are: fatty degeneration or dilatation of 
the heart, renal and pulmonary disease, fainting fits, status lymphaticus, cere- 
bral tumor, diabetes mellitus and chronic alcoholism — particularly the first and 
last named. 



.ETHER. 85 

Dangerous Symptoms should be met by withdrawing the vapor and invert- 
ing the patient head downward, drawing the tongue forward and applying a 
cold douche to the face and chest. Atropine hypodermically is an agent of great 
value in combating the cardiac failure. Artificial Respiration and faradization 
of the respiratory muscles if breathing ceases. Strychnine, hypodermically, as 
a cardiac and respiratory stimulant, has many advocates, and has done good 
service, especially in chloroform narcosis. Amyl Nitrite by inhalation, or 
Ammonia, hypodermically. Heat to the body and limbs. 

Physiological Action of Other Ethers. 

Hydriodic Ether is an antispasmodic and a general stimulant; also an an- 
esthetic if inhaled for a sufficiently long time. Its use as a medicinal agent 
is chiefly to bring the system rapidly under the influence of Iodine. It increases 
appetite, stimulates the action of the heart, gives vivacity to the general feelings 
and activity to the intellect. 

Ethyl Bromide has a pleasant odor, produces but little irritation of the 
air-passages, has very brief stages of excitement and rigidity, and but a short 
stage of insensibility, with prompt awakening and little of the mental confusion 
and excitement consequent on the use of the other anesthetics. It is not inflam- 
mable, acts quickly, and is a good local anesthetic. Its action in other respects 
corresponds with that of Ether. A number of deaths have been reported 
following its use and on this account is distinctly less desirable than other safer 
anesthetics. 

Nitrous Ether is a mild diaphoretic, a diffusible stimulant, a carminative, 
and an efficient diuretic. On the blood it acts similarly to Amyl Nitrite, di- 
minishing oxygenation, relaxing the peripheral vessels, accelerating the heart's 
action, and lowering arterial tension. Relaxing the renal and cutaneous ves- 
sels, it is diuretic and diaphoretic. 

Acetic Ether has a pleasant odor and taste, forming agreeable combina- 
tions with other carminatives as a stimulant and antispasmodic. 

Comparative Safety of Anesthetics. 

A comparison of these agents in respect to their safety has been made by Dr. Richardson, 
who considers Methylic Ether to be the safest of all, and the others as follows: 

Safe are — Ethyl Bromide, Ethyl Chloride, Ether. Ethene (olefiant gas), Ethene Chloride, 
Methyl Bromide, Methyl Chloride, Methene Chloride, Methane (marsh gas), Nitrous Oxide. 

Of doubtful value are — Amylene, Amyl Chloride, Butyl Chloride, Benzene (benzol), Carbon 
Disulphide, Carbon Dioxide, Carbon Tetrachloride, Methyl Alcohol, Methylal, Spirit^ of 
Turpentine. 

Dangerous are — Amyl Hydride, Butyl Hydride, Carbon Monoxide, Ethyl Hydride. 
Chloroform and Ethene bichloride are considered useful, but requiring care. 

Therapeutics. 

When diluted with alcohol Ether mixes readily with water, and may be ad- 
ministered internally with advantage in indigestion of fats, and to aid the 
digestion of cod-liver oil. It is given in hysteria to relieve the paroxysm and 



86 .ETHER. 

flatulence, and in heptatic colic from calculi, Ether with Turpentine (Durande's 
solvent remedy), which acts only as an anodyne and antispasmodic, is con- 
sidered valuable by some authorities. Subcutaneously Ether is used in the 
algid stage of cholera, sudden cardiac depression, neuralgia, and in the adyn- 
amia of hemorrhage, pneumonia and the eruptive fevers. Local anesthesia 
by the Ether spray affords great relief in neuralgia of superficial nerves, lum- 
bago, chorea, and spinal irritation. In minor surgical operations this is a val- 
uable method. 

As a General Anesthetic the vapor of Ether is less prompt in action than 
that of Chloroform, but is equally efficient and much safer. It should be in- 
haled in as concentrated a form as possible, and will then produce insensibility 
in from 5 to 10 minutes. It is the safest and most reliable anesthetic for major 
operations requiring complete relaxation and the expenditure of considerable 
time, and being the least depressant of all anesthetics should be preferred when 
shock is liable to be a prominent feature of the case. If a light be in the room 
it should be high above the patient, a grate-fire or gas-stove in the vicinity is 
very dangerous. [Compare the article on Chloroform.] Besides its surgical 
uses ether-anesthesia is employed in neuralgia, cancer, tetanus, chorea, colic, 
delirium, puerperal mania and convulsions, infantile convulsions, hystero-epi- 
lepsy, epileptic seizures, laryngismus stridulus, whooping-cough and asthma. 
The unpleasant after-effects may be greatly modified if not entirely prevented by 
the previous administration of Morphine, gr. J-J, and Atropine, gr. T ^-$, 
subcutaneously. It is contraindicated in cases of asthma, chronic bronchitis, 
pulmonary tuberculosis, and marked arterio-sclerosis. 

Intrathoracic Insufflation Anesthesia with the apparatus of Elsberg, has been used with 
great success, and has many advantages over the inhalation method of ether administra- 
tion in certain selected cases. It promises to be a favorite method of anesthesia. 

Schleich's Method is based upon the theory that the safest general anesthetic is one which 
has a maximum evaporation point slightly above the body-temperature of the patient, so that 
its elimination by the lungs during each act of expiration may be nearly, but not quite, as much 
as its absorption during the previous act of inspiration. Such an anesthetic is obtained by 
mixing Ether, Chloroform and Benzin in various proportions, the result giving true chemical 
solutions (mixtures according to some chemists), the evaporation points of which may be varied 
at the will of the anesthetist and adapted to the patient's body-temperature at the time of 
administration. Experience has however disproved the claims made for these solutions, cases 
of deep cyanosis, excessive vomiting, broncho-pneumonia, albuminuria, and alarming condi- 
tions of the respiration and circulation having frequently occurred under their use. 

Hewitt's Method, which is preferred in England, is to administer nitrous oxide gas first 
and follow with ether in a closed inhaler. This method is rapid and safe, the preliminary 
choking sensation of ether is avoided, and unconsciousness is quickly produced. 

Brownlee begins with Chloroform 1, Ether 3, and later develops full surgical anesthesia 
with Ether alone, dropped instead of poured on the inhaler. 

Intravenous Anesthesia, by injecting a 5 per cent, solution of Ether in physiological salt 
solution, was used in 30 cases with eminent success; is the safest and most pleasant of all 
methods of anesthesia (Burkhardt). 

Ethyl Bromide had a short period of popularity as an anesthetic, but fell 
into disrepute after a few cases of death under its influence, which were prob- 
ably not due to the agent used (Levis' and Sims' cases). Its action is less pro- 
longed than that of Ether, but it has many advantages, being non-inflammable, 



AGAR, AGAR. 87 

acting rapidly in small quantity, and being comparatively free from ill effects. 
It may be used as a primary inhalation before the use of ether, a method of 
inducing anesthesia which has given good results in many cases, being free from 
bronchial irritation, requiring less ether to maintain the effect than when ether 
is given alone, having less intoxication and muscular excitement, less tendency 
to vomiting, and a more rapid return to consciousness. It is considered an 
excellent anesthetic in obstetrics and gynecology, its inhalation has proved 
useful in hysteria, epilepsy, chorea and other spasmodic disorders; and it has 
been employed subcutaneously in place of Ether in the treatment of spasmodic 
affections such as whooping-cough and chorea. 

The Compound Spirit of Ether is an admirable agent in gastralgia, colic, 
flatulence, and syncope, also in the various paroxysms of hysteria. In com- 
bination with the camphorated tincture of opium it is often remarkably efficient 
in checking the simple diarrhea of hot weather. 

Spirit of Nitrous Ether is used as a diaphoretic, a diuretic and a carmina- 
tive; also in expectorant mixtures, as an antipyretic in febrile affections, and 
to relieve pain in angina pectoris, dysmenorrhea and asthma. When its diuretic 
effect is desired it should be administered in iced water, and the patient should 
be lightly covered: but when its diaphoretic action is required, it should be 
preceded by a hot drink, and the patient should be well covered. 

Hydriodic Ether may be obtained in glass capsules containing five minims 
each, and is used by inhalation in chronic pulmonary disorders, cardiac dyspnea, 
spasmodic affections of the bronchi and larynx, asthma, and catarrhal laryngitis. 
It is not employed as an anesthetic. 



AGAR, Agar, (Agar-Agar), — is the dried mucilaginous substance ex- 
tracted from gracilaria lichenoides and other marine alga? growing along the 
eastern coast of Asia. It is extracted usually by hot water and marketed 
mostly in the form of bundles of shreds, or as a powder. The bundles consist 
of thin, translucent, membranous, agglutinated pieces from 4 to 8 mm. wide, 
yellowish-brown in color, brittle unless damp, with a slight odor and muci- 
laginous taste. It is insoluble in cold water, but slowly soluble in hot water. 
When boiled with about 100 parts of water for ten minutes it yields a stiff 
jelly upon cooling. Dose, 5j~iv [av. 5ij-] 

Unofficial Preparations. 

Phenolphthalein Agar is a preparation in which agar-agar is impregnated 
with 3 per cent, of phenolphthalein for the purpose of augmenting the laxa- 
tive effect of the agar-agar. Dose, gr. xv once or twice daily. 

Regulin, a preparation of agar-agar containing cascara, and used for the 
same purpose as the preceding. Dose, 3 j — ij once or twice daily. 



88 agaricus albus — agaricus muscarius. 

Physiological Action and Therapeutics. 

When taken internally agar-agar is unaffected by the digestive juices and 
is not absorbed. It absorbs water from the stomach and intestines and 
swells, increasing the bulk of the feces. It is indicated in that form of chronic 
constipation in which the bulk of the feces is small and the moisture reduced 
as a result of overdigestion of food. The good results obtained in its use are 
dependent upon the increased bulk and increased moisture which act mechan- 
ically by stimulating peristalsis and facilitating the movement of the intes- 
tine contents. There are certain disadvantages which have been enumerated 
by Bastedo as follows: (i) it is an excellent culture medium favoring the 
growth of intestinal bacteria, (2) it mechanically retards absorption of food 
products, and (3) lessens the normal stimulation of intestines by food products 
because of its demulcent nature. 

AGARICUS ALBUS, White or Purging Agaric (Unofficial),— is the fungus Polyporus 
officinalis, which grows upon the European larch. It occurs in large, white, spongy pieces; 
and contains Agaricic otLaricic Acid, also from 40 to 70 per cent, of resins. The term A garicin 
was formerly applied to the impure Agaricic Acid containing about 3 per cent, of Agaricol, 
which is physiologically inert. 

The taste of Purging Agaric is first sweetish, then becoming very acrid and bitter. The 
powder inhaled causes violent sneezing, and taken internally in full doses it produces watery 
stools. Small doses check diarrhea and dysentery, and diminish the secretions of the bronchi 
and mammas. 

Agaricus Albus was formerly employed as a drastic purgative, in doses of gr. xxx to 5j. 
It has been used with much success, in 15-grain doses of the powder, or 3 grains of the alcoholic 
extract, to check the night-sweats of phthisis. Agaricic Acid has proved very valuable in 
checking persistent sweating from any cause, especially that occurring after influenza. The 
dose is gr. ^ to ^; it should not be given hypodermically. 

AGARICUS CHIRURGORUM, Surgeons' Agaric (Unofficial),— is the interior portion 
of the fungus Polyporus fomentarius, which grows on the trunks of beeches, birches, and oaks 
in Europe. It is prepared for use by boiling in weak lye and beating with mallets, and then 
occurs in light, thin, yellowish -brown pieces, soft and pliable, without odor or taste. It is 
almost pure cellulose. It was formerly used as a mechanical hemostatic, and for the purpose 
of moxa. When soaked in a strong solution of the Nitrate or Chlorate of Potassium and 
dried, it is very inflammable, and is called Spunk. 

AGARICUS MUSCARIUS, Amanita Muscaria, Fly- Agaric (Unofficial), 
— is a poisonous mushroom, of disagreeable odor and burning acid taste, used 
in infusion with milk for poisoning flies, and by the Tartars as an intoxicant. 
It contains an actively toxic alkaloid, Muscarine, C 5 H 13 N0 2 , of syrupy con- 
sistence, odorless and tasteless, soluble in water and alcohol, and readily dis- 
solved out by water and dilute acetic acid, so that a doubtful mushroom may 
be easily rendered innocuous. Muscarine is produced synthetically by the 
oxidation of choline, but it is doubtful whether the article so prepared is as active 
as the natural alkaloid. 

Muscarinas Nitras, Muscarine Nitrate (Unofficial), — a viscid, yellowish-brown liquid. 
Dose, gr. 3*5— rV (Merck); gr. £-§ (Ringer). It may be used hypodermically. 

Incompatible physiologically with Muscarine are Atropine, Digitalis, Physostigmine. 
Atropine exactly opposes it, and vice versa; no example of physiological antagonism being so 
complete in all particulars. 



ailanthus — albumin and albuminoids. 89 

Physiological Action and Therapeutics. 

Agaricus acts as an intoxicant to the cerebrum, producing more vertigo 
and delirium than Alcohol, followed by profound sopor with lowered reflexes, 
perhaps coma and death. The action of Muscarine is very like that of Pilo- 
carpine and almost completely opposed to that of Atropine. It is a powerful 
respiratory and cardiac depressant, paralyzing the respiratory centre and ar- 
resting the heart in diastole by depressing the motor ganglia while stimulating 
its inhibitory apparatus. It lowers the arterial tension, produces profound 
salivation, lachrymation and sweating, contracts the pulmonary vessels, caus- 
ing intense dyspnea, and increases the intestinal, hepatic and pancreatic secre- 
tions, but markedly diminishes the renal. It disturbs the gastro-intestinal tract, 
causing tetanic intestinal contractions, severe colic, vomiting and purging. 
It produces spasm of the accommodation and contraction of the pupil when 
given internally, but dilates the pupil widely when locally applied. [Gelse- 
mium does so also.] Under its action the body-temperature is decidedly re- 
duced, and the excretion of waste-products is lessened. It is eliminated un- 
changed by the kidneys. 

Muscarine has been as yet little used in medicine. It has been employed, 
with marked benefit, for the night-sweats of phthisis, given in doses of 5 
minims of a one per cent, solution, hypodermically. 

AILANTHUS, Tree of Heaven (Unofficial), — is the bark of Ailanthus glandulosa, a 
well-known shade tree, of the nat. ord. Simarubaceae, indigenous to China, but cultivated 
elsewhere. It contains an oleo-resin and a volatile oil, on which its properties probably 
depend. Dose, gr. x-5j. 

Fluidextrac turn Ailanthus, Fluidextract of Ailanthus (Unofficial), — Dose, TT£x-5j. 
Tinctura Ailanthus. Tincture of Ailanthus (Unofficial), — Dose, Ti£x-3ij. 

Ailanthus is a decided nauseant, and a drastic purgative, causing also vertigo, weakness, 
cold sweats, dull headache, pains in the back, numbness and tingling in the limbs. It para- 
lyzes the cerebrum and spinal cord of animals, impairment of motility beginning in their hind 
extremities. The cardiac action, at first increased, soon slows, the pulse becoming small and 
weak, and the respiration depressed, death occurring from paralysis of respiration. It is a 
good teniafuge. 

Ailanthus is used against tapeworm, a decoction of the fresh bark (5 j to Biv), or the oleo- 
resin in drachm doses, being very efficient. It has been well employed in malignant scarlatina, 
with dark and partial eruption, insensibility, delirium and other cerebral symptoms. 

ALBUMIN AND ALBUMINOIDS.— Albumin (albumen) is the typical 
member of a group of organic proximate principles which have the same gen- 
eral chemical composition but very different physical properties, and are called 
albuminoids, proteins, or nitrogenous principles. They all contain N, together 
with C, O, H, and Sulphur. The chief members of the group are Albumin, 
Fibrin and Casein, often termed the histogenetic bodies, because they are essen- 
tial to the building up of the animal organism. They are each resolved by 
caustic potassa and heat into Protein, which may then be thrown down by acetic 
acid. The albuminoids are originally formed in the vegetable kingdom, occur- 
ring in all parts of plants but especially in their seeds. When eaten by animals 
they undergo digestion into soluble compounds (peptones), which pass into the 



90 ALBUMIN AND ALBUMINOIDS. 

blood and are retransformed into serum-albumin before being built into the 
tissues. Albumin is the most important member of the group, as it forms the 
principal portion of all animal tissues, varying from i part per iooo in the cere- 
brospinal fluid to 383 per 1000 in the crystalline lens. The composition of 
its molecule is very complex and varies widely within certain limits in different 
organs and conditions, but C 72 22 H 112 N 18 S is given as its approximate formula. 

Albumin is amorphous, soluble in water, coagulated by heat, and occurs in three native 
forms, viz. — (1) Serum-albumin, which is yellow, elastic, transparent, soluble in water but 
precipitated by alcohol and by strong acids, and coagulated by heat at 104 F. (2) Egg- 
albumin, differs from the first by precipitating when shaken with ether, and in other respects. 
It is soluble in water and coagulated by heat. (3) Plant-albumin, occurs in nearly all vegetable 
juices and especially in the seeds of plants. It is coagulated by heat and strongly resembles 
egg-albumin. 

Incompatible with Albumin are: Acetic Acid (with heat), Alcohol, Alum, Ammonium Sul- 
phate, Camphor, Coniine, Collodion, Copper Sulphate, Ether, Ferric Chloride, Heat, Hydrogen 
Peroxide, Lactic Acid, Mercuric Chloride, Metallic Salts, Metaphosphoric Acid, Mineral 
Acids, Phenol, Picric Acid, Tannic Acid, Thymol, Volatile Oils. 

Gelatinum, Gelatin — is a derivative of the proteins ossein and collagen 
and is obtained from bones, tendons, cartilage, skin, and other fibrous animal 
structures, by prolonged boiling in water. It swells up in cold water, is soluble 
in boiling water, and its aqueous solution solidifies (gelatinizes) on cooling. 
Its composition is similar to that of albumin but it does not yield protein. Gela- 
tin is the basis of soup, beef-tea, and other preparations made from meat with 
boiling water. 

Gelatinum Glycerinatum, Glycerinated Gelatin, — is composed of equal parts of Gelatin 
and Glycerin. 

Ichthyocolla, Isinglass, (Unofficial), — the swimming-bladder of several species of stur- 
geon, occurs in horny, semi-transparent sheets, iridescent, soluble in 24 of boiling water, and 
forms on cooling a transparent jelly. It is the purest form of Gelatin known. 

Emplastrum Ichthyocollae, Isinglass Plaster, Court Plaster, (Unofficial), — consists of 
Isinglass 10, Glycerin 1, Alcohol 40, Water and Tincture of Benzoin, spread on taffeta and 
allowed to dry. 

Incompatible with Gelatin are: Alcohol, Alumnol, Chlorine water, Ferric salts, Formalde- 
hyde, Mercuric Chloride, Metaphosphoric Acid, Picric Acid, Platinum Chloride, Potassium 
Ferrocyanide, Tannic Acid, Tartar Emetic. 

Chondrus, {Irish Moss, Carragheen) — is a sea-weed, Chondrus crispus, 

dried and bleached. It contains mucilage 55^, water 19, mineral matter 14, 

albuminoids 9^, and cellulose 2 per cent. A jelly may be prepared by boiling 

2 oz. in a quart of water for an hour, then straining and adding 3 oz. of sugar 

while hot. The dose is indefinite, [av 3iv-] 

Irish moss is horny, translucent, pale yellowish-white, of sea-weed odor, and mucilaginous 
saline taste. It swells in cold water but does not dissolve. On boiling with 30 parts of water 
for 10 minutes it yields a solution which gelatinizes on cooling. It is a demulcent and nutrient 
of some slight value in bronchial and catarrhal affections; but as it contains no starch it is not 
as valuable as Iceland Moss (Cetraria) as a food for the sick. [See under the title Amylum.} 
Another member of the Algae is the Fucus Vesiculosus, which is described under its own title. 

Unofficial Analogues of Albumin. 

Fibrin is the proteid which causes the clotting of plasma, lymph, and the 
blood when shed. It does not exist in the living, circulating blood, but is formed 



ALBUMIN AND ALBUMINOIDS. 9 1 

by the mutual action of fibrinogen, fibrino-plastin and fibrin-ferment, which 
arise as products of the breaking up of white blood-corpuscles. In normal 
blood it occurs to the extent of 0.2 per cent., is increased in inflammation and 
diminished in hemophilia. 

Fibrin has the same general composition as albumin but contains more O and S. Its 
special characteristic is its power of spontaneous coagulation. It is insoluble in water and in 
ether, and is changed into syntonin (acid-albumin) by dilute hydrochloric acid. 

Casein is the protein contained in milk. Its composition is the same as 
that of albumin, but it differs therefrom in not being coagulated by heat and 
by being thrown down by organic acids which do not precipitate albumin. 
It is, by some authorities, supposed to be a combination of albumin and potash. 

Gluten is a nitrogenous constituent of the seeds of wheat and other cereals, 
the former containing it in the proportion of from 8 to 15 per cent. It is made 
up of a number of albuminous principles which differ but slightly from each 
other, the chief ones being gluten-fibrin, gluten-casein, gliadin and mucedin. 

Unofficial Albuminous Preparations. 

Albumen Ovi, Egg-albumen, — the liquid white of the egg of the domestic 
hen, was official in the B. P. It contains 12 per cent, of albumin, with 3 of 
mucus and salts, and 85 of water. 

Many writers use the spelling albumen for the name of the proximate principle albumin. 
Others distinguish between the white of egg (albumen) and its chief constituent (albumin). 

Vitellus, Yolk of Egg, — is the yolk (or yelk) of the hen's egg, and occurs 
as a viscid, reddish-yellow, opaque liquid, of bland taste and alkaline reaction, 
coagulated by heat and by alcohol. It may be regarded as a dense emulsion 
of oil suspended in water by means of albumin. It contains, in 100 parts, vitel- 
lin 16 to 18, cholesterin 0.4, lecithin 7, fat 21 to 31, also salts, etc., and from 
48 to 55 of water. Vitellin is described as a mixture of albumin and casein 
(Fowne), or as a protein related to casein mixed with about one-fourth of al- 
bumin (Nat. Disp.). 

Glyceritum Vitelli, Glycerite of Yolk of Egg, Glyconin (Unofficial), — consists of Vitellus 
45, Glycerin 55, rubbed together until thoroughly mixed. 

Beef, among meats, has the highest nutritive value. The average of 
many analyses shows its composition to be as follows: In 100 parts, total 
albuminoids, 2o{, fat 2J, extractives ij, salts 1^, water 73J, also a minute 
quantity of creatin. 

Extracts of Meat prepared by boiling down the flesh of animals, as Liebig's Extract, are 
stimulants, not nutrients, as they contain practically none of the nutritious (albuminous) con- 
stituents of meat but only the salts and flavoring matter (E. Smith). 

Meat-juices, prepared by a cold process of extraction and partial digestion, are claimed 
to retain the fibrin, gelatin and coagulable albumin. Many such are on the market, under the 
trade-names Bovinine, Bovril, etc. 

Chittenden, by analyses of various meat extracts, has shown that they possess very little 
nutritive value as compared with fresh lean beef. In most of them the fat is less than 1 per 



92 ALBUMIN AND ALBUMINOIDS. 

cent., and the total amount of available protein is far below i per cent. Some are even less 
nutritious than ordinary beef-tea. 

Beef Peptonoids is the trade-name of a powdered preparation which is claimed to consist 
of the nutritive constituents of beef with milk and wheat gluten, partially peptonized and 
containing Q5 per cent, of nutritious material. Liquid Peptonoids is intended to represent the 
same combination in liquid form, all the constituents being entirely digested and ready for 
assimilation. 

Milk contains all the elements necessary for the growth and nutrition of 
animal tissues in the most digestible form. Its chief albuminoid constituent 
is Casein, but it also contains fat, sugar, salts and water, which vary in pro- 
portion according to the animal and its food. Cow's Milk, of sp. gr. 1.030, 
averages, in 100 parts, of albuminoids 4, fat 4, sugar 5, salts \, and water 86£. 
Goafs Milk is very near to that of the cow in composition, but Asses' Milk 
has much less of casein and salts, very little fat, and more sugar and water. 
Woman's Milk contains about the same proportion of casein as asses' milk, 
more fat than cow's milk, more sugar than the others, and less salts than any 
except asses' milk. 

Buttermilk contains, in 100 parts, casein 4^, sugar 2\, fat \, salts £, lactic acid \, and 
water 92. 

Condensed Milk is prepared by adding refined sugar and an alkali to fresh cow's milk, 
then evaporating the mixture in vacuum pans until it has a thick, semifluid consistency. Desic 
cated Milk occurs in the form of a dry powder, and is highly esteemed in the armies of Europe. 

Peptonized Milk is prepared by adding to fresh cow's milk one-third part of water, in 
which, after boiling and cooling, there is dissolved a pinch of Sodium Bicarbonate, and 5 j or 
5ij of Liquor Pancreaticus is added to each pint. The mixture is then allowed to stand in a 
warm place for an hour, when it is ready for use. Pepto genie Milk Powder, containing 
the requisite proportions of the alkali and the pancreatic ferment, may be obtained in the 
drug-stores and will prove satisfactory. 

Cheese is obtained from the milk of animals, especially the cow, by coagulating the casein 
by means of rennet or an acid, and after separation submitting it to pressure. It contains, in 
100 parts, albuminoids (casein, etc.) 28 to 45,- fat 6 to 30, salts 4 to 5, and water 36 to 44; the 
proportions of each varying to the quality of the milk used. 

Kumyss, Koomiss, — is described under Lactic Acid, p. 71. 

Wolff's Formula, for its preparation in small quantity, is as follows: — Dissolve oss (a 
tablespoonful) of grape sugar in § iv of water. Dissolve gr. xx (a teaspoonful) of Fleischmann's 
compressed yeast or well washed and pressed out brew r er's yeast in oij of cow's milk. Mix the 
two solutions in a quart champagne bottle, and fill it within two inches of the top with good 
cow's milk. Cork well, secure the cork with wire, keep it in a cellar or ice chest, maintaining a 
temperature of 50 F. or less, and agitate twice daily. In three or four days it is ready for use, 
but should not be kept longer than four or five days. Draw it with a champagne tap. 

Kumysgen is a powder containing the elements necessary for the preparation of Kumyss, 
for which a special bottle and tap are also furnished by the manufacturers. It is a very con- 
venient manner of making this preparation, and the product tastes just as well as that made 
in the ordinary way. Whether it acts as well dietetically remains to be ascertained. 

Kefir is the name of a fermented drink prepared from the milk of a cow or mare by the 
addition of a mushroom-like ferment found near the snow-line in the Caucasian Mountains. 
It is used by the natives of the Asiatic plains as a remedy for struma, anemia, lung and stomach 
diseases. Kefir is richer in albuminoids than Kumyss, is less alcoholic and less acid. 

The following label shows the average composition of Milk, Kumyss and Kefir: — 



ALBUMIN AND ALBUMINOIDS. 93 

Cow's milk. Kumyss. Kefir. 

Albuminoids (casein, etc.), 4 1 4 

Butter, 4 2 2 

Sugar of milk, 5 2 \ 2 

Lactic Acid, — 1 1 

Alcohol, — i£ 1 

Water and salts, . . 87 92 90 

Physiological Action. 

The normal adult human organism, doing ordinary work, loses daily by 
its metabolism 4^ oz. of albuminous or protein matter, besides 14^ oz. of 
carbohydrates, 3 oz. of fat, 1 oz. of salts and 2 h, quarts of water, these quantities 
being largely increased during the performance of laborious work. A corre- 
sponding amount of these substances must be daily ingested in order to supply 
material for the repair of the tissues and for the production of heat and other 
forms of force. The albuminoids are most important alimentary principles, 
their chief office being the repair of the tissues, they being the only foods con- 
taining nitrogen, an essential element in the formation of every structure which 
manifests any form of energy. They can replace each other in supplying nutri- 
tion to the tissues, their composition is identical with that of the same sub- 
stances in the blood and other tissues, and they consist wholly of nutri- 
tive material in concentrated and digestible form. They undergo digestion in 
the stomach by the acid gastric juice, also in the intestine by the pancreatic juice, 
the respective ferments of which convert them into simpler compounds in 
which they enter the blood. The digestive changes through which they pass 
are— (1) protein, the albuminoid, as ingested; (2) acid-albumin in the stom- 
ach, alkali-albumin in the intestine; (3) propeptone or hemialbumose; and (4) 
peptone. The chief products arising from their oxidation within the body are 
CO2, H 2 and urea, the latter containing nearly all their nitrogen. They are 
mainly obtained by the ingestion of animal food, as flesh, milk, eggs, etc., but 
they are also contained in vegetable products, especially the seeds of certain 
plants, those of leguminous plants (peas, beans, lentils) containing more 
protein material than any kind of meat. 

The increased ingestion of protein food, by persons who have previously 
used it sparingly, improves the quality of the blood by increasing the number 
of the red corpuscles, and causes a rise in the sp. gr. of the urine and a greater 
excretion of urea and uric acid. Individuals who consume protein in ex- 
cess of their requirements are lean but muscular, irritable in temper and prone 
to excessive sexual appetite. The exclusive use of animal food develops a super- 
abundance of muscular force, so that a nation of meat eaters is usually one of 
hunters possessing a warlike and savage disposition. 

Disease may be produced by food of any kind through excess or deficiency 
in quantity, special characteristics of quality, or imperfect digestibility. If 
exercise is not taken at the same time, the proteins are imperfectly oxidized, 



94 ALBUMIN AND ALBUMINOIDS. 

and deleterious products are retained in the system, or the eliminating organs 
are irritated by the passage through them of material which they are not 
adapted to remove. A great excess of proteins, without other food, produces 
in a few days marked febrile symptoms, malaise and diarrhea; and if per- 
severed in albumin appears in the urine. Gout probably arises in the same 
way, partly from the use of alcohol, which delays metamorphosis, partly 
from using too much protein food, and partly from want of exercise. A diet 
which is deficient in proteins causes a lessening of bodily activity and the 
gradual oncome of an adynamic condition which predisposes the subject to 
infectious diseases and modifies the course" of many affections, typhoid fever 
running its course in such cases with less elevation of temperature than is 
usual and with less excretion of urea. Complete deprivation of proteins 
produces loss of muscular strength, mental debility and feverish and dys- 
peptic symptoms, followed by anemia and prostration. 

The advantages of a meat diet are: — its large amount of nitrogenous ma- 
terial, the presence in it of iron and important salts, and also much fat, the latter 
performing to great extent the office of the carbo-hydrates in supplying fuel to 
the body. It is easily cooked, is very digestible whether raw or cooked, and is 
more readily assimilated than any vegetable food. Its great disadvantage is 
that it contains neither starch nor sugar, hence it cannot supply all the carbon 
needed by the body unless so large a quantity of it be taken (4^ lbs. of beef 
daily) as would soon impair the digestive organs. 

Beef contains alimentary principles which are most important for the nu- 
trition of the body. When of good quality, neither too old nor too young, hav- 
ing the fat and muscle suitably proportioned and unaltered by disease, and 
properly cooked, it is the best of the animal foods. 

Milk is an excellent albuminous food, but its protein, casein, is coagulated 
by the acids in the stomach, even by the acid of the gastric juice, and is tolerated 
with difficulty by many persons, especially in the large quantity which must 
be taken to itself maintain the nutrition of the organism. As an exclusive diet, 
for anyone above the infant age, it soon palls upon the appetite, and causes a 
sense of emptiness at the epigastrium, a coated tongue and an unpleasant taste 
in the mouth. The subject of an exclusive milk diet is usually constipated, 
the stools being hard and of ochre-yellow color, but if diarrhea is produced it 
shows that the milk is not digested. The urine is greatly increased in quantity 
and the body-weight is gradually diminished to a certain point, where it remains. 
The pulse is quickened at first and arterial tension is lowered, but the pulse- 
rate falls as soon as the body ceases to lose weight. A sense of weakness is 
usually experienced, but many persons are greatly debilitated and some com- 
plain of vertigo. 

Kumyss has an acidulous and peculiar taste. In large quantity it can take 
the place of other food for a time, each quart equalling 4 oz. of solids. It is a 
powerful diuretic, especially in cold weather, and in warm weather it causes free 



ALBUMIN AND ALBUMINOIDS. 95 

perspiration. It is stimulant and tonic, increases the nutrition of the body and 
produces considerable somnolence. The stomach tolerates it well, even when 
it rejects all other food. It is easily assimilated and very nutritious. 

Eggs, like milk, constitute an almost complete food, as they contain all the 
elements required by the blood. According to Pavy an egg weighing 2 oz. has 
no grains of albuminous material, 82 grains of fat and n grains of saline matter. 
The white, consisting chiefly of albumin dissolved in water, contains the large 
proportion of nitrogenous material, and the yolk contains the greater quantity 
of fat. 

Gelatin is undoubtedly a food, as it increases vital action in the same direc- 
tion, if not in the same degree, as albumin (E. Smith). Like albumin, however, 
it must not be relied on alone, but should be mixed with a proper quantity of 
other foods. It is an efficient styptic and hemostatic. 

Therapeutics. 

The chief affections in which nitrogenous food is required are diabetes mel- 
litus, anemia, obesity, phthisis and other wasting diseases, and long-continued 
fevers. In fever there is an excessive consumption of the proteins of the body 
and the eliminative processes are very active, the discharge of urea being often 
enormous. All this increases the demand of the organism for albuminoid food, 
but the digestive power of the stomach is, at the same time, greatly reduced, 
the secretion of gastric juice being diminished. In carcinoma of the stomach 
and some other affections hydrochloric acid is absent from the gastric juice, 
and in many diseases gastric digestion is feeble or imperfectly performed. Hence 
it becomes important to furnish protein foods in such form that they may be 
assimilated with the least possible expenditure of digestive energy. Pre- 
digested proteins can be prepared outside the body and administered as food, 
but when artificially made they have little nutritive value, are unable to 
supply the need of the organism and are exceedingly disagreeable to the 
patient. Albumoses, the intermediate products, are readily absorbed, and 
being free from taste and not causing digestive troubles they are suitable foods 
for invalids and for subjects of weak digestion. 

Raw beef, scraped to a pulp, freed from fat and seasoned with salt and pep- 
per, is used in the treatment of chronic diarrheas, also in debilitated conditions 
from any cause wherein it becomes necessary to administer an easily digested 
nitrogenous aliment. Its chief objection is the liability of tape-worm following 
the use of uncooked meat. Beef -tea, when made with boiling water, contains 
less than one per cent, of gelatin, the only nutritive principle yielded by meat to 
a hot aqueous solution. The other extractives obtained by boiling (creatin 
and creatinin) are simply effete muscular material on the way to the formation of 
urea. Hence beef-tea, bouillon and similar preparations of meat contain little 
except stimulating salts and are almost wholly devoid of nutritive properties. 
Cold drawn infusions of meat have considerable food value, as they contain 
much albuminous material. 



1 



g6 ALBUMIN AND ALBUMINOIDS. 

Albumen Ovi (white of egg), besides being a valuable food, is used in medi- 
cine as an antidote in poisoning by corrosives and irritants, especially corrosive 
sublimate, copper sulphate, silver nitrate and the lead salts. Shaken with 
alum it coagulates and forms the so-called Alum Curd, which is highly es- 
teemed as an astringent and cooling application in acute conjunctivitis, also 
for burns and erysipelas. White of egg, diluted with water, sweetened and 
flavored, forms an agreeable and nutrious drink in gastritis. It is spread on 
silk or gold-beater's skin to make an adhesive plaster, which only requires 
moistening before application, i 

Yolk of Egg is more nutritious and digestible than the white, and is highly 
esteemed in dyspepsia. The yolk of a hard-boiled egg crumbles easily and 
is readily acted on by the gastric juice. It is a useful article of diet in exhausted 
conditions of the system, but its chief use in medicine is for emulsionizing oils 
and camphors. The Glycerite has the consistence of honey and forms an 
opaque emulsion with water. It is a good vehicle for cod-liver oil, and an ex- 
cellent protective application for burns, erysipelas, fissure of the nipples, and 
many cutaneous disorders. It is used as a cosmetic, and may be employed 
as an aliment. 

Gelatin is somewhat nutritious, but is usually employed as the basis of 
flavored jellies, which are esteemed rather as delicacies than as foods. It is 
highly praised as a styptic application in epistaxis and other hemorrhages. 
A normal saline solution containing 2 per cent, of gelatin is successfully used 
hypodermically or by rectal injection in hemoptysis, hematuria, and purpura 
hemorrhagica; while daily doses of § vj of a 10 per cent, solution internally have 
given satisfactory results in hemophilia. It has been efficiently used subcuta- 
neously by Lancereaux and Osier in the treatment of aneurisms, 250 Cc. of a 
1 per cent, solution in normal saline solution being injected every other day 
slowly into the thigh or abdominal wall. Isinglass has no advantage over any 
other form of gelatin. It is used for clarifying liquids and in solution as a test 
for tannic acid. The plaster, commonly called court-plaster, is a useful protective 
agent for cuts, sores, etc. 

Milk is the only proper food for infants up to the age of eight months, their 
digestive organs being unable to manage the farinaceous aliments. For those 
who are deprived of their natural milk the best substitute is cow's milk diluted 
with about one-third part of water and sweetened with sugar, which should be 
given at a temperature of ioo° F. and at intervals of about three hours. The 
addition of lime-water instead of ordinary water will make it more digestible. 
As an exclusive diet for older children and adults, milk is employed with great 
benefit in many gastric and intestinal disorders; also in albuminuria, diabetes, 
ascites, anasarca, eczema, gout, aneurism, and in irregular and tumultuous 
cardiac action due to valvular disease of the heart. Skimmed milk is better 
borne than unskimmed milk in many affections of the gastro-intestinal tract. 
Milk is the one food available in typhoid fever and may be wholly depended 



ALCOHOL. 



97 



on as aliment in that disease. It is especially useful in scarlet fever, both as a 
nutrient and a diuretic. In intestinal indigestion, cholera morbus, cholera 
infantum, and the ileo-colitis of children, it is necessary to supply 'only such 
foods as are digested in the stomach, in order to give the intestine rest, hence 
milk, eggs, meat-juices and meat-broths are the suitable articles of diet in these 
affections. 

Buttermilk contains lactic acid, which does not exist in ordinary milk, hence 
it is more easily digested than the latter. It is particularly useful in gastric 
disorders, albuminuria and diabetes. Lactic Acid Preparations (see page 71) 
have been described in a previous paragraph. 

Kumyss is an invaluable article of diet in many wasting diseases, especially 
phthisis. It is of great benefit in dyspepsia, the diarrheas of children, con- 
valescence from acute maladies, chronic affections of the kidneys, and other 
cachexias. In cases of feeble digestive power an ounce every hour is sufficient, 
but as its digestion and assimilation increase it may be given almost ad libitum, 
and when used with other food a half -pint may be taken after each meal. Each 
quart is estimated to contain four ounces of solid food, besides from 1 to 3 per 
cent, of alcohol. 

ALCOHOL, Alcohol, Ethyl Alcohol {Ethyl Hydroxide), C 2 H 5 OH. The 
official alcohol is Ethyl Alcohol, which is represented in the pharmacopoeia by 
the following three forms, viz. — 

Alcohol Dehydratum, Dehydrated Alcohol (Absolute Alcohol, U. S. P. VIII), 
C2H5OH, — is Ethyl Alcohol, containing not more than 1 per cent, by weight of 
water. A transparent, inflammable, colorless, mobile and volatile liquid, 
very hygroscopic, of characteristic, agreeable odor, and burning taste. Sp. 
gr. not higher than 0.790 at 25 C. Used in the manufacture of Chloroform. 

Alcohol, — a liquid composed of about 92.3 per cent, by weight, or 94.9 
per cent, by volume, of Ethyl Alcohol, and about 7.7 per cent., by weight, of 
water. It is a transparent, inflammable, colorless, mobile and volatile liquid, 
of agreeable odor and burning taste, sp. gr. 0.810 at 25 C. It is miscible with 
water in all proportions and without any trace of cloudiness; also miscible with 
ether or chloroform.- Obtained by the distillation of fermented saccharine 
fluids. Used in preparing tinctures and spirits, also in some liniments, liquors 
and mixtures. 

Alcohol Dilutum, Diluted Alcohol, — a liquid containing from 41 to 42 per 
cent., by weight, or from 48.4 to 49.5 per cent., by volume, of Dehydrated 
Alcohol. It is prepared by mixing together equal volumes of alcohol and 
distilled water. Sp. gr. about 0.936 at 6o° F. 

An Alcohol is a volatile organic compound, which contains no N, has a great affinity for 
water, and reacts with acids, forming therewith H 2 and ethers. Alcohols are therefore 
analogous to the metallic hydroxides, as are Ethers to salts. Methyl Alcohol is obtained by 
the destructive distillation of wood, Phenyl Alcohol (Phenol) by that of coal-tar, and the 



98 ALCOHOL. 

fermented Alcohols (Ethyl, Amyl, etc.) from any vegetable substance containing sugar (or 
starch and the ferment Diastase, which converts the starch into sugar), by fermentation 
through the agency of the yeast-plant, which splits the sugar into Alcohol and C0 2 . The 
product contains much water, and is then distilled in order to separate the alcohol, which 
passes over first, with a certain amount of water, the greater part of the latter being left behind. 
In this country Alcohol is so produced from grain (chiefly barley), and is termed High Wine 
being disposed of by the distillers to certain wholesale liquor dealers, many of whom proceed 
to "rectify" it by mixing and blending it with water, essential oils of corn, rye, etc., ethers, 
burnt sugar, and occasionally small quantities of genuine whisky, brandy, etc. The product 
is then labeled "Old Tom Gin," "Old Crow Whisky," etc., according to the requirements of 
the retail dealers. True Whisky is distilled from the mash of fermented grain (corn, wheat 
and rye, or a mixture of all three), and should be not less than four years old, to be official; 
Brandy from the fermented juice of fresh grapes, and should be not less than four years old. 
Wines are the product of the fermented juice of grapes, without distillation. 

Alcohol may be produced synthetically by shaking Olefiant Gas, C 2 H 4 , with strong Sul- 
phuric Acid, then diluting and distilling. Absolute Ethyl Alcohol, which is only used for 
Chemical testing and for the manufacture of Chloroform, is obtained by shaking Alcohol 
with Potassium Carbonate, decanting and distilling with slaked lime. 

Alcohol very slowly oxidized forms Aldehyde, C 2 H 4 0; if less slowly Acetic Acid, C 2 H 4 2 ; 
if quickly, as in burning, C0 2 and H 2 0, which are in all cases the ultimate products of its 
continued oxidation. 

An Aldehyde is obtained from an alcohol by removing therefrom two atoms of hydro- 
gen, hence its name — ,4/cohol dehydv ogena.t\im. Aldehydes He in chemical constitution be- 
tween the alcohols and the acids, and have the power of reducing silver salts in darkness, 
which is shared also by living protoplasm. The principal aldehydes are — 

Acetic Aldehyde, Aldehyde, Ethyl Aldehyde, Ethylidene Oxide, C 2 H 4 0, — a colorless, 
mobile liquid, antiseptic, locally irritant, anesthetic when inhaled, and a powerful depressant 
of the respiration, too dangerous for use. 

Formic Aldehyde, Formaldehyde, CH 2 0, — is a gaseous body prepared by subjecting 
methyl alcohol to oxidation. It is described under its own title. 

Paraldehyde. C 6 H 12 3 , — is a polymeric form of Aldehyde and a valuable hypnotic. It 
is described under its own title. 

A Ketone bears the same relation to an aldehyde that an Ether does to an alcohol, being 
an aldehyde in which the hydrogen has been replaced by a radicle. The most important 
Ketones are — 

Acetonum, Acetone, Dime thyl-ke tone, C 3 H p O. 

Hypnone, Phenyl-methyl-acetone, C 6 H 5 (CO)(CH 3 ) (Unofficial), — a hypnotic agent of 
moderate energy. 

Principal Unofficial Alcohols. 

Methyl Alcohol, • M ethyl Hydroxide, Wood-spirit, CH 3 OH, — also called 
Pyroxylic Spirit, Carbinol, Methol, Hydroxymetliane, is a non-fermented alcohol, 
obtained from the destructive distillation of wood. Ordinarily it contains 
many impurities, which give it a very disagreeable odor, and mixed with ethyl 
alcohol it renders the latter so disagreeable as to be unfit for drinking. Such a 
mixture is sold, under the name Methylated Spirit, for use as a solvent in the 
arts, as a combustible in lamps, etc. 

Amyl Alcohol, Amyl Hydroxide, Potato-spirit, Fusel Oil, C 5 H n OH, — is a 
fermented alcohol obtained from the potato, also occurring in the crude spirit 
produced by the fermentation of saccharine solutions with yeast, and separated 
by excessive distillation, passing over after the ethyl alcohol. It is oxidized 
into Valerianic Acid. From it is prepared Amyl Nitrite, by distilling with nitric 
and sulphuric acids and copper wire. It is an oily liquid, of penetrating and 
oppressive odor and burning taste: sparingly soluble in water, but soluble in 
all proportions in alcohol, ether and essential oils 



ALCOHOL. 99 

Unofficial Alcoholic Preparations. 

Spiritus Frumenti, Whisky, — obtained from the distillation of the mash of fermented 
grain; rye, wheat, corn or barley, and at least four years old. It should have a specific gravity 
of not more than 0.945, nor less than 0.924 at 6o° F., corresponding to an alcoholic strength of 
37 to 47.5 per cent, by weight, or 44 to 55 per cent, by volume. If contains Ethers developed 
by the action of acetic and butyric acids on the alcohol, and traces of Amyl Alcohol (fusel-oil) 
even in the best. Dose, 3ij-§ij. 

Spiritus Vini Gallici, Brandy, — obtained from the distillation of the fermented juice of 
grapes, and at least four years old. Sp. gr. 0.925 to 0.941. Has an alcoholic strength of 39 
to 47 per cent, by weight, and (Enanthic and other Ethers developed by age. Pale Brandy 
is colored by the cask, the dark has caramel to color it. Is often prepared artificially by adding 
to high wines Acetic or Nitric Ether, Caramel, and Logwood or Catechu for astringency. 
Dose, 3ij-§ij. 

Spiritus Rectificatus, Rectified Spirit (official in the B. P.), — is Alcohol 90 per cent, 
obtained by the distillation of fermented saccharine fluids. Sp. gr. 0.834. Is often spoken of 
as "56 over proof," meaning that to reduce 100 volumes of it to the strength of proof spirit 
requires 56 volumes of water. 

Vinum Album, White Wine, — should contain from 7 to 12 per cent, by weight of absolute 
alcohol, and is made by fermenting the unmodified juice of the grape, freed from seeds, stems 
and skins. California Riesling, Ohio Catawba, etc. Dose, o j-Siv. 

Vinum Rubrum, Red Wine, — should contain from 7 to 12 per cent, by weight of absolute 
alcohol, and is made by fermenting the juice of colored grapes in presence of their skins. 
Native Claret, Burgundy, etc. Dose, § j-giv. 

Rum, — is obtained by the distillation of fermented molasses, and has about 42 per cent, 
by weight of alcohol. 

Gin, — has about the same alcoholic strength as rum, and approaches very nearly to the 
official Spiritus Juniperi Compositus. It is usually distilled from rye or barley, and flavored, 
in Holland, with juniper berries and hops; in England, often with oil of turpentine, various 
cheap aromatics, acetate of lead, sulphate of zinc, cayenne pepper, etc. Pure gin is slightly 
diuretic, from the oil of juniper contained in it. 

Spiritus Odoratus, Perfumed Spirit, Cologne-water, — prepared by adding to 800 parts 
of Alcohol, Water 158, Acetic Ether 2, Oil of Bergamot 16, Oil of Lemon 8, Oil of Rosemary 8, 
Oil of Lavender Flowers 4, and Oil of Orange Flowers 4 parts. A perfume and ingredient 
of lotions. 

Vinum Aromaticum, Aromatic Wine, — consists of Stronger White Wine 94 per cent., 
with Lavender, Origanum, Peppermint, Rosemary, Sage and Wormwood, of each 1 percent. 
It was official in the U. S. P., 1880. 

Vinum Portense, Port Wine, — is not a natural wine, spirit being added during the proc- 
ess of manufacture, and the alcoholic strength raised to 30 or 40 per cent. 

Vinum Xericum, Sherry Wine, — a dry, spirituous white wine, generally made to order 
by the dealers, and having from 20 to 35 per cent, of alcohol. 

Sparkling Wines, as Champagne, Hock, Catawba, — are more or less sweet, and charged 
with carbonic acid, being bottled before fermentation is completed and the grape sugar all 
converted into alcohol. They contain 8 to 10 per cent, of absolute alcohol. 

Sweet Wines, as Burgundy, Tokay, Muscatel, Malaga, Angelica, Madeira, etc., — are 
of low alcoholic strength, 6 to 7 per cent, unless fortified. 

Light Red Wines, as Claret, Red Rhine, Concord,— have 5 to 7 per cent, alcohol, tannic 
acid, grape coloring matter, etc. 

Dry Acid Wines, as Rhine and Moselle, California Hock, Kelley Island Catawba, — in 
these fermentation is complete, and the alcoholic strength from 5 to 7 per cent. 

Beer, Ale and Porter, — are fermented liquors, made from malted grain, with hops and 
other bitters added. Beer is made by slow fermentation, the yeast sinking; Ale by rapid 
fermentation, the yeast floating. Their alcoholic strength is 2 to 3 per cent, in beer, 4 to 6 
per cent, in ale and porter, — and they also contain malt extract, carbonic acid, lactic acid, 
various aromatics, potassium and sodium salts, etc. 



100 ALCOHOL. 

Kutnyss, — is obtained by the fermentation of milk, that of the mare being used in Tar- 
tary, where it is employed as a food. It contains from i to 3 per cent, of alcohol, sugar, lactic 
acid, casein, fat, salts, carbonic acid and ethers. [See page 71.] 

Incompatibles. 

Incompatible with Alcohol are:" Acacia, Acids (mineral), Albumin, Bromine, Chlorine 
Chromic Trioxide, Mercuric Chloride, Potassium Permanganate, Salts (inorganic). Physio- 
logically incompatible are Cocaine, Caffeine, Strychnine. 

Physiological Action of Alcohol. 

The Alcohols of the series to which the above-mentioned belong are all 
narcotic poisons when taken in sufficiently large doses; and have the general 
effect of paralyzing the nerve-centres in the inverse order of their development. 
The symptoms produced may be divided into stages, — (a) stimulant, (b) anodyne 
and anesthetic, (c) narcotic, (d) paralytic; therein closely following the action 
of the volatile anesthetics derived from them, though wanting in the profound 
degree of anesthesia which the latter produce. Ethyl Alcohol, the effects of 
which are detailed below has the most typical action, and in poisoning by it 
these stages follow each other in regular order. In poisoning by Methyl Alcohol 
the excitement is greater, the subsequent stages succeed each other rapidly, 
and if the dose be insufficient to cause death, the effects pass off more quickly. 
They all lower the body-temperature. 

Methyl Alcohol is an active and dangerous poison, differing from ethyl 
alcohol in that it is only partly oxidized in the system, and forms within the 
organism the highly toxic formic acid. In many cases it has caused permanent 
blindness, even when taken in small quantities, and has frequently caused death. 
It was formerly extensively used as a substitute for ethyl alcohol in the manu- 
facture of extracts, spirits, bitters, and medicines, intended for human con- 
sumption, such as Jamaica ginger, essence of peppermint, and lemon extract. 
The consensus of opinion at the present time is that it should not be used 
internally or externally on the body. 

The post-mortem appearances, after acute poisoning by the alcohols, show changes in the 
blood, stomach, intestines, liver, lungs and kidneys; some of which are probably due to the 
asphyxiation resulting from the paralysis of respiration. The Blood is dark and clotted in 
the heart. The Stomach and Intestines are congested and softened, especially so if the in- 
gested alcohol has been undiluted. The Liver is very much congested, soft and friable. 
The Spleen is gorged with blood and softened. The Lungs are congested and show small 
extravasations of blood, and in the Kidneys also hemorrhages are found. 

Physiological Action of Ethyl Alcohol. 

Externally applied, Alcohol is refrigerant, astringent, anhidrotic, rubefacient, 
and slightly anesthetic. Pure alcohol is not germicidal to dry bacteria, but that 
of 60 to 70 per cent, alcohol strength is efficient against most forms, and is a 
good antiseptic and disinfectant. Applied to the skin it evaporates quickly, cool- 
ing the surface, temporarily contracting the superficial vessels, and checking per- 
spiration. If its evaporation is prevented, as by covering with a watch-glass 



ALCOHOL. IQT 

or a piece of rubber, or if the alcohol is rubbed in, it absorbs water from the 
tissue and hardens it. It coagulates the albumin of the part, but the coagulum 
is soon redissolved by the fluids of the tissues. It then dilates the vessels of the 
derma, producing a sensation of warmth and a rubefacient effect upon the 
skin. Upon the mucous membrane of the mouth and pharynx similar effects 
are produced by the same application. If the alcohol is concentrated, a burn- 
ing sensation is felt immediately; also an increased flow of saliva and quick- 
ened pulse, due to reflex action. Then follows a slight local anesthesia of the 
part, and if the alcohol be held there for some time, the mucous membrane 
becomes whitish and opaque, from coagulation of the albumin, abstraction of 
water from the tissue and congestion of its vessels. This soon disappears, as 
resolution of the albumin occurs. 

Internally in moderate quantity and single dose, Alcohol acts briefly as a 
cerebral, cardiac and general stimulant; in large doses as an anesthetic, an 
intoxicant and deliriant, and finally as a narcotic poison and paralyzant of the 
nerve-centres. It is somewhat antipyretic, also diuretic and antispasmodic, 
and is hypnotic in many cases. 

A single dose of a strong alcoholic preparation, for example an ounce of 
neat brandy, introduced into the stomach, immediately produces important 
and valuable reflex effects. The cardiac rate is quickened, and its force is in- 
creased; the vessels of the entire body are dilated, especially those of the skin; 
the blood-pressure is raised, and a sense of glowing heat is produced. These 
reflex effects are well seen in the prompt restoration of a fainting person by the 
administration of a single dram of whisky or brandy. By the same means 
the nausea, paleness and other unpleasant symptoms produced by tobacco are 
promptly counteracted. 

Internally, in small quantity diluted, Alcohol dilates the gastric vessels, 
reddens the mucous membrane of the stomach, produces a sense of warmth 
and comfort, stimulates the gastric glands to increased production of gastric 
juice, and increases the activity of the gastric movements. Taken moderately, 
immediately before or during meals, it promotes the appetite and assists diges- 
tion; lessens the elimination of waste-products (urea and C0 2 ), causes a sub- 
jective sensation of heat, and slightly raises the body-temperature. It briefly 
stimulates the heart, prolonging its systole and reducing the length of the dias- 
tole, and increases the functional activity of all the organs. The effects of large 
doses are very injurious; the vaso-motor nerves are partially paralyzed for a 
time, causing dilatation of the arterioles throughout the body; the pepsin of the 
gastric juice is precipitated, the gastric and hepatic vessels are congested, the 
walls of the stomach are rendered hyperemic, and the gastric glands and hepatic 
cells are over-stimulated to the production of pathological secretions. If the 
ingestion is continued, even in moderate quantities frequently repeated, chronic 
gastritis ensues, gastric mucus is poured out in large amount, the gastric glands 
soon atrophy, and the permanent dyspepsia of drunkards is set up, with morning 



102 ALCOHOL. 

vomiting of glairy mucus. The further effects of large doses are the total 
arrest of digestion, the production of intoxication, perhaps hallucinations and 
delirium, also great incoordination of thought and motion, depressed sensibility, 
depression of the heart and respiration, lowered arterial tension and body-tem- 
perature, abolished reflexes, stupor, and, if the dose be sufficient, coma and 
death. 

With regard to the value of alcohol as a food Bastedo has summarized the 
experimental evidence as follows: " When fat in the food is deficient, alcohol 
can entirely compensate for the deficiency, at least for a short period; it yields 
the energy that fat would yield, and so spares protein and prevents tissue 
waste. When alcohol and fat are administered together in quantities above 
the needs of the body, the alcohol is the more easily utilized to supply energy, 
so that the fat is spared and stored up in the body." The obesity in many 
persons who habitually consume large quantities of alcoholic beverages is 
explainable upon this basis. It has likewise been demonstrated that alcohol 
in moderate quantities can replace equivalent quantities of carbohydrates in 
a mixed diet for a short period. The energy value of alcohol is 7 calories per 
gram or equivalent to f gram of fat or 1 J gram of carbohydrate. 

Upon the Heart and Circulation the first effects of Alcohol are those of slight 
and brief stimulation by reflex action. After its absorption the same effects 
are exhibited in a more marked degree. The pulse becomes fuller, the action 
of the heart is quickened and its force increased, due mainly to direct stimula- 
lation of its accelerator nerves. The vaso-motor system is inhibited, causing 
dilatation of all the vessels of the body, especially those of the periphery, and 
producing a sense of increased body-heat. The blood-pressure is raised, the 
great increase of cardiac action overcoming the results of the vascular dilatation. 
The mental and bodily functions are all stimulated for a time, the subject feels 
better for the dram, his muscular power seems to be increased, more urine is 
passed, and perspiration is freer. But these effects are very transitory, and 
after a brief period of stimulation reaction sets in, and the entire organism is 
depressed to a lower point than where it was before the ingestion of the alcoholic 
stimulant. Large doses do not stimulate the heart at all, but immediately de- 
press it, both by reflex action and by direct paralysis after their absorption. 
A toxic dose may paralyze the heart almost immediately by direct depressant 
action, but usually, after a very brief period of excitement, insensibility is pro- 
duced, also stertorous breathing, dilated or contracted pupils, complete mus- 
cular resolution, and death by paralysis of the heart and respiration. The 
action of alcohol upon the heart clearly exemplifies two therapeutic laws: (1) 
that excessive stimulation is necessarily followed by depression, and (2) that 
drugs which in moderate doses excite a function are very apt in large doses to 
paralyze it. 

The extremists, who find no good whatever in alcohol, hold that it is a fallacy to apply 
the term "stimulant" thereto, that alcohol is a paralyzant from first to last, that its apparent 



ALCOHOL. 



103 



cardiac stimulation is in reality the result of its narcotism of cardiac inhibition, and that every 
special sense is blunted by even small doses of this poison. They calmly ignore the fact that 
their premises apply to every stimulant in its special field of action as well as to alcohol in its 
sphere, and forget that their conclusion (that alcohol has no place in medicine except as a 
poison) applies by the same reasoning to every other stimulant. Hence, to be consistent, 
they should advocate the banishment of all stimulant drugs from the materia medica. 

On the Skin and Kidneys Alcohol is mildly diaphoretic and diuretic, act- 
ing partly by its vascular dilatation, partly by stimulation of glandular activity. 
On the Intestines it has a slightly astringent effect at first, but in those who use 
it habitually to excess the bowels are always very loose, and the evacuations 
watery. 

Upon the Nervous System Alcohol has specific and selective action. By 
a moderate dose this entire system is briefly stimulated, chiefly as a result of 
increased blood supply due to the vascular dilatation and cardiac elevation. 
Reaction, however, soon occurs, and if the dose be very large, the period of 
exaltation quickly passes into one of profound cerebral depression, but this is 
usually preceded by marked incoordination of thought and of muscular move- 
ment, shown by incoherency of language, difficult speech, and staggering gait. 
The reflex activity of the spinal centres is abolished next, the urine and feces 
are discharged involuntarily; the depression extends to the respiratory centre, 
breathing becomes difficult and the face cyanosed; profound coma supervenes, 
respiration and the heart are paralyzed, and the patient dies. 

The reflex depression occurs early in the case, and accounts for the im- 
punity with which a drunken man will often bear an injury which would cause 
death by shock to a sober one. 

The action of Alcohol upon the nervous system illustrates well, in the order of its events, 
the physiological fact that excessive stimulation is followed by depession; as well as the law 
that drugs which affect the functions progressively exhibit their earliest powers upon those 
functions which are highest in development (being those latest acquired by the individual and 
last to appear in the species), and influence next the next lower, and finally the lowest, those of 
respiration and circulation. The primary stimulation and subsequent depression of function 
proceeds, in a descending scale from the highest or least firmly fixed and latest acquired func- 
tion, to the lowest or most firmly fixed one. Thus, by Alcohol, the intellect is affected very 
early and the judgment abolished very soon, even though the imagination, the emotions and 
the powers of speech remain stimulated. Soon these follow the same course, imagination is 
abolished, the patient loses command over his emotions, cries and laughs immoderately and 
without reason; next loses control over his organs of speech, talking incoherently and thickly, 
and then can only make a noise. At the same time other delicate and lately developed move- 
ments, as those required for writing, feeding, etc., are incoordinately performed and soon 
paralyzed. General muscular movements, being less highly and earlier developed, are next 
to become implicated, being first incoordinated, and soon abolished. The paralysis of reflex- 
action follows, though lowered earlier in the case, then paralysis of respiration and finally 
paralysis of the heart. 

The antipyretic action of Alcohol is due chiefly to the dilatation which 
even moderate doses produce in the vessels of the surface. This dilatation 
subjects the warm blood from the interior of the body to the cooling influence 
of the atmosphere, also to the cooling due to evaporation from the skin; and if 
kept up by repeated drams in a freezing temperature will soon so chill down 
the blood as to kill the subject. 



104 ALCOHOL. 

Under ordinary conditions the contraction of the cutaneous vessels, in a person exposed 
to cold, prevents the warm blood from approaching the surface in any great quantity and 
becoming cooled; but this mechanism is temporarily paralyzed by every dose of alcohol, 
admitting the hot blood to circulate freely over the surface, and to be rapidly cooled down 
until the patient may be absolutely frozen to death as a result of repeatedly taking "some- 
thing to keep him warm." This fact is well known to Arctic travelers and to the lumbermen 
of the northern forests, who have been taught by bitter experience to let alcohol alone when 
exposed to severe cold. 

Delirium Tremens occurs after an alcoholic debauch, usually in cases where 
the stomach is to deranged as so prevent the ingestion or assimilation of food. 
So long as the toper can eat and digest his food he is practically not liable to 
this affection. It generally begins in from two to four days after the patient 
has lost his appetite and commenced to reject or vomit his food; and is marked 
by great restlessness, obstinate insomnia, a peculiar tremor of the tongue and 
limbs; also delusions connected with the sense of sight, the patient imagining 
that he sees animals around him (dogs, rats, snakes, beetles, etc.). The delir- 
ium is constant and active, may become violent and pass into mania, or the 
patient may die suddenly while in this state, without any warning symptoms. 
In several cases observed by the writer the delirium appeared four and five days 
after the last alcoholic dose was taken, though the patient was eating, sleeping, 
and working during the interval, apparently convalescent. Under treatment, 
and especially if sleep is brought on, the delirium usually subsides gradually,' 
and the patient recovers. 

Chronic Alcoholism is the result of the ingestion for a considerable length 
of time of an excessive quantity of alcohol, even though perhaps never suffi- 
cient to cause acute intoxication. One of the earliest symptoms usually ob- 
served is the vomiting of watery fluid or glairy mucus in the morning after ris- 
ing. The bowels are generally loose, and the evacuations watery. The skin 
has a greasy look and a satiny feel, and the cutaneous capillaries on the face 
may become permanently dilated, giving to the cheeks a characteristic, dusky- 
red hue, and a flaming red color to the nose. In old drunkards, the latter 
organ often becomes covered on its tip with dusky-red tubercular enlargements, 
making it a very unsightly appendage. The stomach and liver are in a state 
of chronic congestion, the food is not digested and often to a great extent aban- 
doned, the patient, in fact, living upon alcohol. Eructations of gas and flatu- 
lence are constant and distressing; the body is usually puffed and bloated, the 
eyes bleary, red and watery. One of the most graphic descriptions of the drunk- 
ard's personal appearance is that by Trollope, in "Orley Farm," chapter 57. 

After a time the connective tissue of the liver increases (hyperplasia), its 
parenchymatous structure atrophies or undergoes fatty degeneration, the organ 
contracts (sclerosis), the portal circulation is impaired, the veins of the ab- 
dominal integument become prominent, and soon ascites ushers in the final stage. 
Sclerosis of the kidneys may accompany that of the liver. The general 
impairment of function extends early to the nervous system, the mental 
powers are dulled, the temper becomes irritable, and tremor appears in the 



ALCOHOL. 105 

tongue, lips and hands. As a result of the prolonged use of alcohol very 
serious pathological changes take place throughout the organism. It exerts 
its essential and most injurious influence on the vital organs by its pres- 
ence in the circulation, being thus brought into direct contact with the 
cellular tissue of the vital organs. It sets up hyperplasia of the connec- 
tive tissue, resulting in sclerosis, especially in the stomach, brain, liver and 
kidneys; produces fatty degeneration of the arterial walls and the parenchyma 
of the various organs, depresses the brain, the heart and the arterial tension. 
Chronic disease of the heart, the arteries and the mucous lining of the stomach 
and intestines, gout, diabetes, Bright's disease of the kidneys, paralysis, 
ataxia, peripheral neuritis, epilepsy, amaurosis, and insanity may result from 
the continued use and abuse of alcohol. The malt liquors (beer, ale, etc.) are 
less prone than spirits to affect the brain, but are even more apt to set up 
fatty degeneration of the heart and liver. The heart is very liable to undergo 
gradual hypertrophy, partly by reason of the constant whipping up it receives 
from every dram of alcohol taken, and partly as a result of renal sclerosis. 
Several of the largest hearts ever seen by the writer at autopsies, some of 
which were veritable instances of cor bovinum, occurred in subjects of chronic 
alcoholism associated with employment involving exposure and great anxiety, 
as in masters of steamships, superintendents of 'mines, etc. 

Impurities in Alcohol increase greatly its toxic action; so that inferior brandy 
from a public liquor shop has a lethal action nearly one-half greater than that 
of pure ethyl alcohol. (Dujardin-Beaumetz.) 

Alcoholic Coma may be easily confounded with that of apoplexy, opium narcosis, con- 
cussion of the brain, acute pneumonia, uremia and epilepsy, the differential diagnosis being 
almost impossible to make with accuracy when the coma is deep. The pupils afford no 
trustworthy indication, as they may be either dilated or contracted in alcoholism. They are 
often unequally contracted in apoplexy, and in apoplexy of the pons varolii they may be equally 
and minutely contracted, as in opium-poisoning. The difficulty of diagnosis is increased by 
the common practice of giving a dram of whisky as a reviver, so that a stranger found insensible 
on the street and brought to a hospital may smell of alcohol without having been the subject of 
alcoholism. When no accurate history of the case can be obtained the diagnosis is impossible 
in many cases. 

Alcohol is rapidly diffused throughout the organism, which oxidizes a por- 
tion of it, about an ounce and a half for the adult in 24 hours, the oxidation 
yielding force, which is utilized as nervous, muscular, and glandular power. 
A large quantity is decidedly poisonous, as it sets up structural changes in the 
various organs, and lowers the power of resistance to morbific influences. It 
renders its victims particularly liable to phthisis, and has frequently caused 
directly an intractable form of that disease, pulmonary sclerosis. It makes 
patients bad subjects for withstanding any severe illness, especially pneumonia, 
or to successfully undergo severe surgical operations. 

The portion not oxidized is excreted unchanged by the lungs, the skin and 
amounts have been ingested. The very old bear more alcohol relatively than 
the adult. It has been proven to exist normally in the human organism, and 



Io6 ALCOHOL. 

within the limit above stated it is undoubtedly a food, as is shown by the fact 
of its retention and combustion in the body, supplying the place of other 
foods, so that the quantity of food which without it would be insufficient, 
with its aid becomes sufficient to maintain the body-weight. 

Researches as to the action of alcohol upon vital resistance to infection, by Drs. Abbott 
and Delearde, seem to show that it has a decidedly injurious influence upon animals inocu- 
lated with cultures of the germs of certain infectious diseases. Alcoholized rabbits died when 
inoculated with Streptococcus pyogenes and Bacillus coli communis in attenuated cultures which 
did not kill non-alcoholized control ones. Animals vaccinated against tetanus and afterwards 
alcoholized, soon lose their immunity; and those vaccinated against tetanus and at the same 
time alcoholized, do not readily acquire immunity. Similar results were obtained with regard 
to rabies and anthrax. The conclusion is drawn that strong doses of alcohol should not be 
administered to persons suffering from certain infectious diseases, as pneumonia, or from 
certain intoxications, as that produced by snake-venom, during which an increase in the number 
of leucocytes appears to be a necessary part of any process leading to the cure of the patient 

Therapeutics of Alcohol. 

The external and local use of alcohol in medicine includes many applications 
of its antiseptic, astringent, refrigerant and rubefacient qualities. Diluted, in 
the proportion of four parts to one of water, it makes an excellent lotion for 
bruises, sprains, and other slight injuries, where it is desired to cool the part 
and check impending inflammation. A perfumed spirit, as Cologne-water, is 
commonly used as a lotion to the forehead for the relief of headaches. Alcohol 
does good service as an application to prevent bed-sores and cracked nipples, 
as it hardens the inflamed skin by abstracting water therefrom and coagulating 
the albumin temporarily. Diluted alcohol is applied on the surface of the 
body in fevers, to cool the skin and check excessive sweating. Alcoholic lini- 
ments (linimentum camphors, etc.) are rubbed into the cutaneous tissue for 
their rubefacient effect, to aid the absorption of inflammatory products and to 
relieve pain, in chronic rheumatism, lumbago, and myalgia. As a gargle or 
spray, diluted alcohol is one of the very best local agents in tonsillitis, pharyn- 
gitis, and other inflammatory affections of the throat, especially diphtheria, 
in which disease it fulfills several important purposes, acting as an efficient local 
antiseptic, astringent and anesthetic. Among miners, hunters, frontiersmen 
and others, lotions of whisky or brandy are in common use as applications to 
wounds and sores, and they could not find a more efficient agent for the pur- 
pose, when conjoined with thorough cleanliness of the lesions. 

Internally, in small quantities taken just before or during a meal, alcohol 
is an efficient aid to digestion, especially in the aged and feeble, or persons who 
are greatly exhausted by overwork. In the atonic indigestion of nervous and 
depressed subjects and in cholera infantum, good brandy is beneficial. Care 
must be taken, however, not to exceed the amount which agrees with the case, 
for large quantities precipitate pepsin, paralyze the gastric secretions, and set 
up a substitute gastritis, which will become a chronic one if the indulgence is 
persisted in, with eventual atrophy of the gastric glands. Many cases of gout 
have their origin in the habitual use of alcoholic beverages, especially the malt 



ALCOHOL. 107 

liquors and heavy red wines; and all forms of alcohol should be avoided by 
subjects of the uric acid diathesis. 

In the form of a sparkling wine, as champagne, or as brandy and soda- 
water, alcohol may control vomiting from many causes, especially that of yellow 
fever and sea-sickness. A single full dose of strong whisky or brandy is often 
a very efficient combatant of fainting or of collapse, by its prompt reflex stimu- 
lation of the circulation. Diarrhea of simple form may be checked by a dram 
of good brandy, acting as a tonic astrigent to the intestines. An attack of 
acute coryza, or a cold from exposure beginning with a chill, may frequently 
be aborted by a full dose of spirits in hot water taken just before going to bed, 
for the purpose of relaxing the perpipheral vessels and thus promoting diapho- 
resis and restoring the disturbed balance of the circulation. In anemia and 
chlorosis good red wines are almost indispensable, also in convalescence from 
acute diseases, sudden and profuse hemorrhages, and many other morbid con- 
ditions. In phthisis alcohol does good service if it promotes assimilation and 
assists digestion, shown by increase of the body-weight during its employment. 
It is invaluable in poisoning by cardiac depressants and snake-venom, and im- 
pending cardiac failure from any cause. It is the most efficient antidote in 
poisoning by Phenol (carbolic acid), as besides diluting the poison, it has de- 
hydrating and astringent action on the tissues which prevent the absorption of 
the phenol to a great extent. 

In fevers Alcohol is often very serviceable, but may do harm if used with- 
out discrimination. Its powers of supplying energy, of being itself oxidized 
in the body and acting as a food, of reducing body-temperature and promot- 
ing perspiration and sleep, are all indications for its beneficial employment 
in many febrile conditions; while its stimulant action on the heart may be 
available in such diseases as typhoid fever, and lobar pneumonia, to tide that 
organ over a brief period of depression or a condition of impending collapse. 
Furthermore, for some unexplained reason, it often slows the pulse in fever, 
and when it does so its moderate use will be of general benefit to the patient. 
The danger is that if continuously given in such affections it may fail to make 
the required impression when an emergency calling for it occurs. The best 
rule to observe for its administration in typhoid, diphtheria, pneumonia and 
other fevers is to withhold it until the first sound of the heart becomes feeble 
and dull, and then to use it boldly but not excessively. It is an absolute 
necessity in the treatment of acute lobar pneumonia, if the patient has been 
accustomed to its daily use as a beverage; but in other subjects of this disease 
it is best given at the crisis only, to tide the patient over a brief period of 
extreme danger. 

The use of alcoholic beverages in moderate quantity by healthy persons is 
violently condemned by extreme total abstinence advocates, and allowed with 
apparently as reasonable argument by others. Some physicians agree with 
Mr. Lawson Tait, who declared himself "fully persuaded after thirty years of 



IOS ALETRIS ALOE. 

life, as hard in work and as full of responsibility as well could be, that the 
moderate use of alcohol is a necessity in our modern life." Dr. Robert Far- 
quharson sums up the case for moderate drinking as follows. "All stimu- 
lant is unnecessary for the young and for people living perfectly healthy lives. 
But, under the stress and struggle of modern civilization, few of us beyond 
middle age are placed under normal physiological conditions, and a little 
alcohol helps us to round the corners, and to plane away the asperities of 
existence. In turns it may be a stimulant, or a sedative, or a tonic, or a 
digestive, or an actual food; and unless we run on into excess, no physical 
damage can possibly be done to our tissues. The argument in its favor, 
when wisely and prudently used, seems complete. It does us good, and can 
do us no harm." On the other hand, quite as many physicians believe that 
the healthy man does not require alcoholic beverages, and that many of the 
ills of the body directly and indirectly would be lessened by restricting its 
use to conditions in which either as a food or as a medicine it is particularly 
indicated. 

ALETRIS, Colic-root (Unofficial), — is the rhizome of Aletris farinosa, the Starwort, an 
indigenous perennial plant which grows in grassy places and in sandy woods. It contains 
starch, and a bitter principle, but no tannin. This plant was formerly official, and is now 
widely advertised by the proprietors of an Aletris Cordial, as being tonic, emetic, purgative, 
diuretic, carminative, sialogogue and anti-rheumatic, also " the most powerful of uterine stimu- 
lants," a specific for dysmenorrhea and a wonderful remedy for colic, dropsy, and chronic 
rheumatism. It is little more than a simple bitter in small doses, though in very large ones it 
may prove emeto-cathartic. Dose, of the powdered root, gr. x; of the infusion (§ j to the pint), 
oss. 

ALLIUM, Garlic (Unofficial), — is the bulb of Allium sativum, a plant of the nat. ord. 
Liliaceae, indigenous to Asia, but cultivated in Europe and America. Its odor is pungent and 
disagreeable and its taste warm and acrid. It contains a Volatile Oil, which consists mainly 
of the Sulphide of Allyl (C 3 H 5 ) 2 S, on which its qualities depend. Allied species are Allium 
Cepa, the Onion, and Allium Porrum, the Leek. 

Syrupus Atlii, Syrup of Garlic (Unofficial), — contains 20 per cent, of Garlic, Sugar and 
Dilute Acetic Acid. Dose, 3j-iv, according to age. 

Garlic, Leeks and Onions are stimulants to the digestion and to the nervous system, and 
are supposed to have a special influence upon the bronchial secretion. Garlic is also thought 
to be emmenagogue and anthelmintic. It promotes diaphoresis and diuresis, and acts as a 
tonic and carminative. Many persons use it as a condiment. Large doses will often pro- 
duce gastric irritation, flatulence, hemorrhoids, headache and fever. In domestic practice 
it is frequently employed as an external application in the cutaneous eruptions of children, 
and as a poultice or liniment in infantile disorders of many kinds. Internally it is of real 
benefit in feeble digestion and flatulence, chronic catarrhal affections of children, nervous 
and spasmodic coughs, and nervous vomiting. 

ALOE, Aloes, — is the inspissated juice of the leaves of Aloe vera, Aloe 
ferox, Aloe Perryi, or other species of Aloe, a plant of the nat. ord. Liliaceae. 
It occurs in masses of yellowish-brown color, fragrant odor and bitter taste, 
soluble in alcohol and in boiling water. It contains a peculiar volatile oil, a 
resin, snidSoaloin, C 15 H 16 7 , a variety of the principle Aloin, which is common 
to all varieties of aloes, — also Aloetic and Chrysammic Acids. Dose, gr. j-vj, 
[av. gr. iv.] 



ALOINUM — ALTH.EA. 109 

Aloinum, Aloin, — is a neutral principle obtained from Aloes, chiefly pre- 
pared from the Curacao variety, and varying in composition and properties 
according to the source from which it is obtained. It is soluble in about 65 
of water, n of alcohol, 21 of acetone, 664 of ether, at 77 F. Dose, gr. ss-j 
[av. gr. }.] 

Preparations. 

Tinctura Aloes, Tincture of Aloes, — has of Aloes 10, Glycyrrhiza 20, Diluted Alcohol to 
100 parts. Dose, TT£x-3j, [av. ttj^xxx.] 

Pilulae Aloes, Pills of Aloes, — each has Aloes and Soap, 2 grains of each. Dose, ij. 

Aloes is a constituent of Extractum Colocynthidis Compositum, Pilulae Rhei Compositae 
and Tinctura Benzoini Composita (which see, under Colocynthis, Rheum and Ben- 
zotnum respectively). 

Incompatibles. 

Incompatible with Aloes are Mercury Nitrate, Silver Nitrate; with Aloin are Alkaline 
Hydrates, Bromine-water, Ferric Chloride, Lead Acetate (basic), and Tannic Acid. 

Physiological Action and Therapeutics. 

Aloes is a tonic-astringent and resin-bearing purgative, an emmenagogue 
and an anthelmintic against the thread-worm. As a cathartic it acts chiefly 
on the lower half of the large intestine, doses of 1 to 4 grains producing in about 
10 hours copious soft evacuations with some griping pain. This effect is pro- 
duced whether the drug be taken internally or absorbed from an exposed sur- 
face, so that it probably diffuses into the blood and is eliminated by the mucous 
membrane of the colon. It is a stomachic tonic in small doses, a stimulant 
of the hepatic functions, and an excitant of the pelvic circulation. It may 
cause abortion in the female and priapism in the male, and is said to have fre- 
quently produced hemorrhoids, which if existing it will aggravate. Given to 
nursing mothers it imparts a purgative quality to their milk. 

Aloes is chiefly used in combination with iron, myrrh, and nux-vomica, for 
amenorrhea and chronic constipation with atonic dyspepsia and hypochondriasis. 
It is curative in certain forms of hemorrhoids especially those occurring after de- 
livery and where the condition is not one of active pelvic congestion. It is also 
used internally and as an injection in gonorrhea, and for simple atonic jaundice. 
It must be avoided in irritable rectum, hemorrhoids of active form, menorrhagia 
and pregnancy, unless given in small doses and with care. The Pil. Aloes et 
Ferri [aa gr. j] is perhaps the most generally used agent in the anemia, amen- 
orrhea, and constipation of girls at the period of puberty. 

ALTHiEA, Marsh-Mallow, — is the root of Althcea officinalis, a European plant of the 
nat. ord. Malvaceae. It contains about 35 per cent, each of vegetable mucus and starch, 
with 2 per cent, of Asparagin, also pectous matter, sugar, fixed oil, but no tannin. It is a 
constituent of Massa Hydrargyri and Pilulae Phosphori, and is much used as an excipient in 
extemporaneous pharmacy. Dose, indefinite. 

Althaea is one of the best mucilaginous drugs, but has no active medicinal properties. It 
is used in Europe to make pectoral teas and syrups, and is extensively employed as a mucilagi- 
nous demulcent. The powdered root makes a good emollient poultice. In the Phar. Ger. 
a Compound Althaea Tea is official, which under the common name, "German Breast Tea," 
is a popular demulcent drink in bronchial affections, coughs, etc. 



HO ALUMINUM. 

Asparagin (Unofficial), — is an organic principle, occurring in large rhombic crystals, and 
found in many other plants, as in the shoots of asparagus, vetches, potatoes, licorice, the 
sweet almond, the root of the locust, etc. It is considered a derivative of Succinic Acid, and 
has diuretic properties, besides being sedative to the circulation. It may be used in ascites, 
especially in children, in the anasarca of Bright's disease, and in gout. Dose, gr. ij-iij, in 
water. 

ALUMINUM, Al. — This metal is widely distributed in nature, chiefly in 
the form of the silicate, constituting clay, kaolin, and many common rocks. 
Its official salts are the following-named: — 

Alumen, Alum, (Potassium Alum, Aluminum and Potassium Sulphate), AlK(SOJ 2 + 
12H0O, — occurs in large, octahedral crystals, or cubes, of sweetish astringent taste and acid 
reaction, soluble in 9 parts of water and in 0.3 of boiling water, insoluble in alcohol. The 
Ammonia-alum (Alumini et Ammonii Sulphas) was formerly official, and is still sold and 
dispensed as Alum. Dose, gr. v-x, [av. gr. viij.] — as an emetic 5 J for a child. 

Alumen Exsiccatum, Exsiccated Alum, — is a white, granular powder, slowly soluble in 
20 parts of water at 25 C, and quickly soluble in 1.5 of boiling water. Dose, gr. j-v. 

Alumini Hydroxidum, Aluminum Hydroxide (Hydrated Alumina), Al 2 (OH) 9 , — is a 
white, light, amorphous, tasteless powder, insoluble in water or alcohol, but soluble in strong 
alkaline or acid solutions. Dose, gr. iij-xx in powder or mixture. 

Incompatibles. 

Incompatible with Alum are: Alkaline Hydrates, Borax, Carbonates, Galls, Kino, Lead 
Acetate, Lime-water, Magnesia, Magnesium Carbonate, Mercury salts, Phosphates, Tartaric 
Acid, Potassium Chlorate. 

Unofficial Compound. 

Alumnol, — is the trade name of an aluminum salt of naphthol-sulphonic acid, and is 
readily soluble in cold water. It is markedly antiseptic and astringent, and though precipi- 
tating gelatin and albumin, the precipitate is soluble in an excess of either, so that when it is 
used on purulent discharges they do not clog up cavities, and desirable penetration below the 
surface is accomplished. Incompatible with it are Albumin, Alkalies, Gelatin, and Silver 
Nitrate. 

Kaolinum, Kaolin, — is a native Aluminum Silicate, powdered and freed from gritty 
particles by elutriation. It is a fine white clay, derived from the decomposition of the felspar 
of granitic rocks. It is used as an excipient for the easily reduced metallic salts, and as an 
ingredient of — 

Cataplasma Kaolini, Cataplasm of Kaolin, — contains Kaolin, Glycerin, Boric Acid, 
Thymol, Methyl Salicylate, Oil of Peppermint. It is identical with the trade preparation 
known as Antiphlogistine. 

Physiological Action and Therapeutics. 

Alum is an astringent, coagulating albumin and stimulating muscular con^ 
traction. At first it excites the flow of saliva and then markedly diminishes 
it. It coagulates pepsin and arrests digestion, stops peristalsis, and usually 
causes constipation, though sometimes inducing diarrhea. Although coagulat- 
ing albumin, even in weak solution, it enters the blood, constricts the capillaries, 
arrests secretions, especially those of mucous surfaces, and stops capillary hemor- 
rhage. In teaspoonful doses it is an efficient and non-depressant emetic. In 
large doses it is a gastro-intestinal irritant, one ounce and five-eighths of dried 
Alum having caused the death of an adult in eight hours. 

Alum is used locally as an astringent in chronic catarrhs, leucorrhea, gonor- 
rhea, hemorrhoids, bed-sores, ulcers, relaxed throat, colliquative sweats, catar- 



AMMONIUM. Ill 

rhal ophthalmia and granular lids. The dried powder is escharotic, destroying 
granulations and warty growths, and is used by insufflation in chronic nasal 
catarrh. Internally it is beneficial in gastric catarrh, gastralgia, enteralgia, 
passive hemorrhages, lead colic and constipation. As an emetic it is employed 
in croup, and it is a good antidote in lead-poisoning. Alum is best administered 
alone, as it forms precipitates with a large number of drugs. 

Aluminum Hydroxide is a feeble astringent and dessicant, occasionally used 
as a local application in inflammatory skin affections, and internally in diarrhea. 
The Sulphate is antiseptic and astringent, and is chiefly employed in 5 per cent, 
solution locally for ulcers, and in 8 to 10 per cent, solution for foul mucous 
discharges. A saturated solution is mildly escharotic, and may be used as a 
daily application for enlarged tonsils, nasal polypi, ulceration of the os uteri, 
and various chronic enlargements. 

Alumnol does not irritate or cause pain, and is employed dry and in solu- 
tion as a dressing for wounds and ulcers, acute inflammatory diseases of the 
skin, and acute and chronic inflammations of mucous membranes. In 1 to 3 
per cent, solution it makes a good injection for gonorrhea, and a 4 per cent, 
solution is used to check the lachrymal discharge during an examination of 
the eye. 

Earth, in the form of clean, yellow clay, was used by Dr. Hewson as a sur- 
gical dressing for wounds, and as an application for erysipelas, but has been 
abandoned since the introduction of antiseptics and the discovery of soil infec- 
tion by pathogenic organisms. 

AMMONIUM, NH 4 , — is a hypothetical compound radicle, which does not 
exist in the free state, but in combination with acids forms salts which closely 
resemble those of the elements Potassium and Sodium. Many of its salts are 
official, as well as the aqueous solutions of the gas Ammonia, NH 3 , which is 
produced during the putrefaction of all organisms and many organic nitrogen- 
ous compounds. Ammonia exists free in the air and the soil, and is contained 
in the products of the dry distillation of many nitrogenated compounds. The 
so-called " gas-liquor,' ' a by-product in the manufacture of illuminating gas, 
when neutralized by hydrochloric acid, yields Ammonium Chloride, NH 4 C1, 
and from this salt are derived all the other ammonium compounds employed 
in medicine. 

Ammonium Salts and their Preparation. 

' Liquor Ammonii Acetatis, Solution of Ammonium Acetate, {Spirit of Mindererus), is 
prepared by neutralizing dilute acetic acid with ammonium carbonate. It contains about 
7 per cent, of the acetate and is an ingredient of Liquor Ferri et Ammonii Acetatis. It should 
be freshly made as it soon deteriorates. Dose, 5 j-5 j, [av. 3iv.] 

Ammonii Benzoas, Ammonium Benzoate, NH 4 C 7 H 5 2 , — minute four-sided laminar 
crystals, soluble in 10 of water and 35 of alcohol at 25 C. Dose, gr. v-xx, [av. gr. xv.] 

Ammonii Bromidum, Ammonium Bromide, NH 4 Br, — prismatic crystals or a gianular 
salt, soluble in 1.3 of water and 12 of alcohol at 25° C. Dose, gr. ij-xx, [av. gr. xv.] well 
diluted. Children bear it well if epileptic from reflex causes; a child 1 year old will tolerate 
gr. v every 4 hours (Barton). 



1 



112 AMMONIUM. 

Ammonii Carbonas, Ammonium Carbonate, C 2 H u N 3 5 , — occurs in white' masses con- 
sisting of both the acid carbonate and carbamate, which on exposure to air become a white 
pOwder. Soluble in 4 parts of water. Dose, gr. iij-x, [av. gr. v.] For children small doses, 
gr. J-ij, frequently repeated. 

Ammonii Chloridum, Ammonium Chloride, {Sal-ammoniac), NH 4 C1, — a white, crystalline 
powder, of saline taste, and slightly acid reaction; soluble in 3 of water and very sparingly 
in alcohol. Dose, gr. j-xx, [av. gr. v.] , « 

Trochisci Ammonii Chloridi, Troches of Ammonium Chloride, — each contains ij 
grains of the Chloride. Dose, j-x troches. 

Ammonii Iodidum, Ammonium Iodide, NH 4 I, — a deliquescent, granular, white salt, 
soluble in water and in alcohol. Dose, gr. ij-x, [av. gr. v.] 

Ammonii Salicylas, Ammonium Salicylate, NH 4 C 7 H 5 3 , — colorless prisms or plates, or 
a white powder, soluble in 1 of water, and in 3 of alcohol at 25 C. Dose, gr. j-x, [av. 
gr. viii.] 

Ammonii Valeras, Ammonium Valerate (Valerianate), NH 4 C 5 H 9 2 — white, quad- 
rangular plates, deliquescent, very soluble in water and in alcohol. Dose, gr. j-x, [av. gr. 
viij.] 

Preparations of Ammonia. 

Aqua Ammoniae, Ammonia Water, — is an aqueous solution of Ammonia, containing 
9.5 to 10.5 per cent, by weight of the gas. It is a colorless liquid of pungent odor, acrid 
taste and strongly alkaline reaction. Dose, tt#v-5ss, [av. itjjxv.] well diluted. 

Aqua Ammoniae Fortior, Stronger Ammonia Water, — contains 27 to 29 per cent, by weight 
of the gas. 

Spiritus Ammoniae, Spirit of Ammonia (Unofficial), — is a 10 per cent, solution of the gas 
in alcohol. Sp. gr. about 0.810. Dose, tt£x-3J, diluted, [av. irjjxv.] 

Spiritus Ammoniae Aromaticus, Aromatic Spirit of Ammonia, — contains Ammonium 
Carbonate, Aqua Ammoniae, Oils of Lemon, Lavender, and Nutmeg, Alcohol and Water. 
Used in the Tinct. Guaiaci Ammoniata and the Tinct. Valerianae Ammoniata. Dose, tt^xv- 
3j, [a v. itjjxxx.] 

Linimentum Ammoniae, A mmonia Liniment, — has of Aqua Ammoniae 25 parts, Sesame 
Oil 75 parts. 

Raspail's Eau Sedative (Unofficial), — consists of Aqua Ammoniae §ij, Sodii Chloridum 
§ij, Spiritus Vini Camphorat. §iij, Aqua §xxxij. For local use. 

Incompatibles. 
Incompatible with Ammonia preparations are Acids, Acid salts; with the Aromatic Spirit 
are Acids, Acid salts, Lime-water, Aqueous fluids; with the Acetate are Alkaline Carbonates, 
Potassium and Sodium Hydroxides; with the Benzoate are Acids, Liquor Potassae, Ferric 
salts; with the Carbonate are Acid salts, Alkaloids, Alum, Salts of Copper, Iron, Lead and 
Silver, Magnesia, Magnesium Sulphate, Mercurous and Mercuric Chlorides, Potassium 
Bitartrate and Bisulphate, Tartar Emetic, Zinc Sulphate; with the Chloride are Alkalies and 
their Carbonates, Alkaline earths, Lead and Silver Salts. 

Physiological Action. 

':■ The gas Ammonia is intensely alkaline and irritant to mucous membranes; 
inhaled it causes spasmodic cough and a sense of suffocation. Its prolonged 
inhalation will produce violent inflammation of the air-passages and edema 
of the glottis. It stimulates the nasal branch of the fifth nerve, exciting the 
vaso-motor centre By reflex action, and thus raising the arterial tension. Ap- 
plied to the skin and allowed to evaporate, it has a slight rubefacient effect, but 
if evaporation be prevented it penetrates the epidermis, and has a powerfully 
vesicant action. The Aqua, swallowed undiluted, may cause death quickly by 
suffocation from the action of its vapor upon the air-passages; if not, it may 
excite gastro-enteritis accompanied by coma, differing in the latter respect from 



AMMONIUM. 113 

/ ... ' } 

potassium or sodium poisoning. After absorption it stimulates both the respi- 
ration and the circulation by direct action on their respective nerve-centres. 
It is a powerful irritant to muscular tissue, causing tetanic contraction and 
subsequent rigor mortis when directly applied. 

All Ammonium Salts stimulate and finally paralyze the spinal cord, motor 
nerves and muscles in animals, but the order and intensity of the action vary 
with the salts employed, some having a predominating influence on the cord, 
others on the motor nerves. In general they may be said to form a series, of 
which the members at one end stimulate the cord, and those at the other paralyze 
both the cord and the motor nerves. At the stimulant end are Ammonia and 
the Chloride; at the paralyzant end the Iodide; the Bromide, Phosphate and 
Sulphate lying between (Brunton). In medicinal doses they act on man as 
stimulating expectorants, in large quantity they injure the structure of the red 
blood-corpuscles, and if long continued they produce rapid emaciation by im- 
pairing digestion and increasing tissue-waste. 

The Chloride has decided cholagogue powers, increases the excretion of 
urea, in 20-grain doses is purgative, and is considered to have a selective action 
upon the gastric mucous membrane. The Carbonate is a powerful and very 
diffusible stimulant; when administered internally in moderate doses it is prob- 
ably decomposed by the HC1 of the gastric juice, nascent ammonia being set 
free and absorbed. It stimulates the respiratory centre, acts as a stimulating 
expectorant, and in very small doses stimulates the secretion of the gastric juice. 
It is also emetic, and has been supposed to prevent iodism when administered 
conjointly with potassium iodide. The Solution of the Acetate is an active 
diaphoretic if the body be warm, or a diuretic if it be cold. In wineglassful doses 
it will counteract many of the immediate effects of alcohol. The Benzoate is 
diuretic, and like benzoic acid it passes out of the system in the urine as hippuric 
acid. It stimulates the liver, and acidifies the urine where there is a phosphatic 
tendency thereof. The Nitrate and Sulphate are only used for the preparation 
of other salts, while the Iodide, Bromide and Valerate correspond in action to 
that of their bases, and are described under the respective titles, Iodum, Bromum 
and Valeriana. 

Therapeutics. 

. The stronger Water of Ammonia may be used as a rubefacient and vesi- 
cant, and its vapor, by cautious inhalation, in syncope and the results of shock. 
Locally, it is a good application to bites of the less venomous reptiles and to the 
stings of insects. The Carbonate is used internally in the eruptive fevers, de- 
lirium tremens, continued fevers, and pneumonia, when much depression exists; 
as a stimulating expectorant in chronic bronchitis, in the broncho-pneumonia 
of children, and in cardiac asthma. It is highly recommended in scarlet fever 
in doses of 3 to 5 grains every one, two, or three hours, all acid drinks or fruits 
being prohibited while it is being administered. With ten-minim doses of 
8 



I 



114 AMYGDALA. 

tincture of capsicum in an ounce of some bitter infusion it is exceedingly effi- 
cient, in 5- to 10-grain doses, for the sinking sensations and craving for stimu- 
lants experienced by subjects of alcoholism. It may be used as an emetic in 
bronchitis, when the tubes are choked with mucus and the circulation of the 
patient is weak. It may also be employed by inhalation, and administered in- 
ternally, for similar purposes as Aqua Ammoniae. In doses of 5 grains, ad- 
ministered hypodermically in the vicinity of wounds caused by poisoned arrows, 
it was employed by Parke in Africa, with entire success in saving life when used 
immediately after injury, though those so wounded at too great a distance for 
treatment invariably died within a short time. 

The Chloride has high repute in catarrh of the stomach, with anorexia, bad 
taste in the mouth, flatulence, coated tongue, etc., in short, the symptoms of 
so-called " biliousness " ; also, in chronic congestion of the liver, jaundice from 
catarrh of the bile-ducts, nervous and sick headaches, myalgia, amenorrhea, 
muscular rheumatism and neuralgia. In the latter affection it should be given 
in 30-grain doses several times a day. It is also efficient in bronchial catarrh 
without fever, and in chronic bronchitis when the secretion is scanty and tough. 
It is remarkably efficient in straightening up a victim of acute alcoholism; ad- 
ministered to one on the verge of delirium tremens, in dose of J drachm in half 
a pint of water, swallowed at one draught, it is said to restore the patient's facul- 
ties so quickly as to astonish those who have never seen it so employed. Locally, 
in solution, it has been well employed as a lotion for inflammatory swellings, 
as sprains, inflamed joints, orchitis; also to allay itching in prurigo, to remove 
ecchymoses and glandular enlargements. Eau Sedative is often a good local 
application for headaches. 

The Solution of the Acetate is especially beneficial in the exanthemata, 
influenza, coryza, anomalous febrile conditions of children, acidity and vomit- 
ing; also in acute alcoholism and in erysipelas when there is feeble circulation, 
cyanosis and delirium. It is frequently combined with spirit of nitrous ether, 
as a diuretic and diaphoretic in febrile affections. The Benzoate is useful 
in cystitis with alkaline urine and phosphatic deposits, as it acidulates the 
urine, at the same time stimulating and disinfecting the mucous coat of the 
bladder. 

The therapeutics of the Iodide, Bromide and Valerate are stated under 
the titles Iodum, Bromum and Valeriana, respectively. 



AMYGDALA, Almond. — The seeds of one variety of Prunus Amygdalus 
nat. ord. Rosaceae, namely Amygdala dulcis, is official. Amygdalin, C20H27- 
NOn, is a crystalline glucoside, existing in Amygdala amara but not in Amyg- 
dala dulcis; while the ferment Emulsin is common to both varieties. The 
reaction which occurs between these two substances in the presence of water 
produces Hydrocyanic Acid. (See ante, page 68). 



AMYGDALA. 115 

Amygdala Amara, Bitter Almond (Unofficial), — is the ripe seed of Prunus 
Amygdalus, var. amara, a tree of the nat. ord. Rosaceae, indigenous to Asia, 
but cultivated in many other parts of the world, especially in Spain and the 
Balearic Islands. The seed has an embryo of bitter taste, which, when 
triturated with water, emits the odor of hydrocyanic acid. 

Amygdala Dulcis, Sweet Almond, — is the ripe seed of Prunus Amygdalus, 
var. dulcis, a tree of the nat. ord. Rosacea. The bitter and sweet almond trees 
are identical botanically, and the fruits and seeds of the two varieties resemble 
each other closely, only differing in taste and the presence or absence of amyg- 
dalin (see above) . The sweet almond is largely cultivated about Malaga and 

in California. 

Preparations. 

Oleum Amygdalae Amarae, Oil of Bitter Almond, — is a volatile oil, of peculiar and aro- 
matic odor, bitter, burning taste, and neutral reaction; soluble in 300 of water, but freely in 
alcohol and ether. Dose, m_ \-), in mixture, [av. rn_ ss.] 

This essential oil should yield not less than 85 per cent, of Benzaldehyde, and not less 
than 2 per cent, and not more than 4 per cent, of Hydrocyanic Acid which may be removed 
by distillation with caustic potash. Nitrobenzol, Oil of Mirbane, closely resembles the oil of 
bitter almond, and like it is used for flavoring. It contains no Hydrocyanic Acid, but is a 
dangerous poison, producing toxic effects when inhaled, even in small doses. 

Oleum Amygdalae Expressum, Expressed Oil of Almond, — is the fixed oil expressed 
from Bitter or Sweet Almond. Used in Unguentum Aquae Rosas, and as a bland local appli- 
cation in skin affections. 

Aqua Amygdalae Amarae, Bitter Almond Water, — is a weak solution of the Oil in Dis- 
tilled Water (1 to 1000). Is only a flavored water. Dose indefinite, [av. 3 j-] 

Spiritus Amygdalae Amarae, Spirit of Bitter Almond, {Essence of Bitter Almond), has of 
the Oil 1, dissolved in Alcohol 80, and Water added to 100 volumes. Dose, ttjj v-x, [av. 
m viij.] 

Emulsum Amygdalae, Emulsion of Almond, — has of Sweet Almond 6 per cent., with 
Acacia, Sugar and Water. A demulcent drink, much used as a vehicle for cough mixtures. 
Dose, Sj-vj, [av. §iv.] 

Benzaldehydum, Benzaldehyde, C 7 H s O, — an aldehyde, produced artifically or obtained 
from natural oil of Bitter Almond or other oils; soluble in alcohol, ether, and oils, and in 300 
of water. Dose, tt£ |-j, [av. ttjj ss.] 

Physiological Action and Therapeutics. 

The bitter and sweet varieties of the species Prunus Amygdalus differ in 
action only through the agency of the principle Amygdalin contained in the 
former. The Sweet Almond is demulcent and nutritive, while the fixed oil 
expressed from either variety is a bland application, having the same action as 
olive oil. The action of the Bitter Almond and its oil is due to the hydrocyanic 
acid contained in them. 

The Oil of Bitter Almond must not be used as a flavoring agent, and may 
be employed locally or internally in lieu of hydrocyanic acid. The spirit is 
somewhat sedative, and the emulsion is used in catarrhal affections and as a 
vehicle for cough-mixtures. The poisonous character of the Bitter Almond 
and its essential oil should be kept in mind when prescribing them. Of 39 
cases of poisoning by bitter almond preparations, the oil caused 28, the 
spirit 4, the almonds themselves 4, the water 2, and the emulsion 1. 



I 



Il6 AMYLIS NITRIS. 

The Expressed Oil of Almond js a good demulcent, also laxative in doses 
of 5 j to oij- It is used externally for excoriations, chapped hands and inflam- 
matory affections of the skin, and may be applied in the external auditory canal 
for earache. Almond Bread is made from the cake remaining after the fixed 
oil is expressed from the sweet almond. The cake is ground into a meal or 
flour, and is an excellent substitute for wheat bread in the diet of diabetics, as 
it contains no starch. 

AMYLIS NITRIS, Amyl Nitrite, — is a liquid containing about 80 per 
cent, of Amyl Nitrite, C 5 H n N0 2 , together with variable quantities of undeter- 
mined compounds. It occurs as a clear, yellowish liquid, of ethereal and fruity 
odor, aromatic taste, and neutral or slightly acid reaction, extremely volatile, 
insoluble in water but freely soluble in alcohol, ether, chloroform and benzin. 
It is produced by the action of nitric acid upon amylic alcohol, and when impure 
may contain nitric or hydrochloric acid. Dose, — internally Tnj-j dissolved in 
alcohol, — by inhalation TTlij-v; but larger doses are probably safe, [av. 1T|nj-] 

Analogous Compounds. 
Spiritus Glycerylis Nitratis, Spirit of Glycerl Trinitrate {Spirit of Nitroglycerin, Spirit 
of Trinitrin, Spirit of Glonoin), — is an alcoholic solution, containing 1 per cent, by weight of 
Glyceryl Trinitrate. Dose, TTRss-ij, [a v. ngj.] 

Tabellae Trinitrini, (B. P.), Tablets of Nitroglycerin (Trinitrin), — are tablets of choco- 
late, each containing gr. T £o of pure Nitroglycerin. Dose, j-ij. 

Sodii Nitris, Sodium Nitnte, NaN0 2 , and Potassii Nitris, Potassium Nitrite (the latter 
unofficial), — are used as substitutes for Amyl Nitrite and Nitroglycerin. The former is a 
white, crystalline powder, deliquescent in the air, in which it gradually oxidizes to sodium 
nitrate; has a mild, saline taste, but no odor; very soluble in water, slightly in alcohol. Dose, 
gr. ss-iij, [av. gr. j.] according to individual susceptibility. 

jEthylis Nitris, Ethyl Nitrite, C 2 H 5 N0 2 , — constitutes about 4 per cent, of Spirit of 
Nitrous Ether (See page 82). 

Tetranitrin, Erythrol Tetranitrate (Unofficial), — occurs in large scales, which are soluble 
in alcohol, insoluble in water, and explode on percussion. Dose, gr. ss-j. 

Incompatibles. 
Incompatible with Amyl Nitrite are Alcohol, Antipyiine, Potassa; with the Nitrites are 
Acetanilid, Antipyrine, Chlorates, Chromates, Gold Chloride, Hypophosphites, Iodates, 
Iodides, Mercurous and Mercuric salts, Permanganates, Sulphites, Tannic Acid, and vege- 
table astringent preparations; with Nitroglycerin are Alkalies, Carbonates, Hydrochloric 
Acid, Hydriodic Acid. Physiologically incompatible are Chloroform, Cocaine, Morphine, 
Strychnine, Ergot, Digitalis, Atropine, Picrotoxin, and all other agents which increase the 
functional activity of the spinal cord and sympathetic, though by reason of their slower rate 
of diffusion this antagonism may not be always available. 

Physiological Action. 

Amyl Nitrite and the other Nitrites agree closely in their general action, 
producing great vascular dilatation by paralyzing either the sympathetic system, 
the vaso-motor centre or the muscular coat of the arterioles, — which, is yet 
undecided. They cause tumultuous action of the heart by relaxing its inhibi- 
tion; deep and rapid respirations due to stimulation of respiratory centre, or 
depression and asphyxia from overdose; diminution of sensation, motility, 



AMYLIS NITRIS. II 7 

and reflexes; a sense of heat, but lowered body- temperature; also throbbing 
pain in the head, beating carotids, quickened pulse, flushed face and vertigo. 
The effect of an ordinary inhalation of Amyl Nitrite on man is very transi- 
tory, excepting the headache, which may last several hours. Of all the 
nitrites it is the most prompObut least enduring in action, and is best admin- 
istered by inhalation. It causes sugar to appear in the urine and increases 
the quantity of urine voided. Mixed with blood it forms methemoglobin, 
which is not so readily deoxidized as hemoglobin. This does not occur, 
however, in the therapeutic use of the drug even in large doses. 

Nitroglycerin acts similarly, but less promptly, and its action is more en- 
during. Its headache is of intensely frontal character, and persists for hours 
after the other effects have passed off. It is more suitable than amyl nitrite 
for internal administration. Sodium Nitrite is also slower in action than amyl 
nitrite, and does not cause so much throbbing headache as nitroglycerin. It 
may be given in solution with water. The action of these agents is probably all 
due to the nitrous acid contained in them. Tetranitrin is a vasodilator, acting 
as such by reason of its nitrate constituents. 

Therapeutics. 

The inhalation of Amyl Nitrite is a useful palliative in angina pectoris, 
epilepsy, tetanus, and many of the respiratory neuroses, as spasmodic asthma, 
whooping-cough, laryngismus stridulus, etc. It is indicated in migraine of the 
pale-face form, and in the cold stage of intermittents and pernicious remittents, 
to prevent internal congestion, — also in convulsions of various kinds, including 
the puerperal form. It has been sometimes used in threatened death from 
chloroform anesthesia, and in poisoning by strychnine. 

Nitroglycerin is employed with benefit in neuralgic dysmenorrhea and sea- 
sickness. It promptly relieves hiccough, also migraine of spasmodic char- 
acter, and has afforded immediate relief in neuralgia of the fifth and in 
sciatica. Its administration in angina pectoris, though not producing such 
prompt results as that of Amyl Nitrite, gives excellent and much more lasting 
effects. It is useful in the weak heart of the aged, or that from fatty degen- 
eration, or when, as in B right's disease, the arterial tension is above normal; 
also in irritable and overacting heart, which it relieves by rapidly dilating the 
arterioles and thereby lowering arterial tension. It is employed with benefit 
in epilepsy, in alternation with bromide treatment. 

Sodium Nitrite has been successfully used in angina pectoris, in hemicrania, 
and in asthma of purely bronchial and neurotic origin. It has proved decidedly 
beneficial in association with the iodides in the abnormally high arterial ten- 
sion of chronic nephritis, especially when complicated with a weakened and 
dilated heart. Disagreeable symptoms caused by it may be prevented by 
prescribing it with spirit of chloroform or ammonia water and small doses of 
morphine. 



I 



Il8 AMYLUM. 

Tetranitrin is highly recommended in asthma, angina pectoris, arterio- 
sclerosis, interstitial nephritis, gout, and lead-poisoning, for the purpose of 
reducing high arterial tension. Brunton prefers a mixture of Potassium Nitrite 
gr. ss, with Potassium Nitrate, gr. xviij, and Potassium Bicarbonate gr. xxv, 
once daily in a glassful of water. It acts less promptly and less intensely than 
Tetranitrin, but its effects are more enduring. 

AMYLUM, Starch, C 6 H 10 O 5 , — is the fecula of the seed of Zea Mays, the 
Maize or Indian Corn, a plant of the nat. ord. Gramineae. Though corn-starch 
is the only official kind, any other might be properly used, as the starch occur- 
ring in wheat, barley, oats, arrow-root, sago and tapioca, all of which were offi- 
cial in the U. S. P. of 1870. The last three are almost entirely composed of 
starch; wheat contains about 70 per cent., and rice nearly 90 per cent. The 
B. P. recognizes the starches from Maize (Zea Mays), Wheat (Triticum sativum) 
and Rice (Oryza sativa) ; the Ph. Ger. recognizes that from wheat alone. 

Starch occurs in distinct grains (granules) which form irregular, angular masses, white, 
odorless and tasteless, of neutral reaction, easily pulverized and insoluble in alcohol, in ether 
and in cold water. In boiling water they swell, burst and form a mucilage which gelatinizes 
on cooling and gives a deep blue color on the addition of Iodine, the color disappearing on 
warming and returning on cooling. Under the microscope the granules are seen to be len- 
ticular in form and differing somewhat in size and shape according to the plant from which 
they are derived. Those from wheat are large and small mixed and show concentrated striae 
formed around a nearly central spot (hilum). Those from maize are smaller, have a hilum 
but no striae. Those from rice are very minute, polygonal in shape, with a small hilum but 
no striae. 

Starch is converted into grape-sugar (glucose) by the action of diastase, 
ptyalin and pancreatin, also by boiling it with a dilute mineral acid, Dextrin 
being formed as an intermediate product. [See the article entitled Pepsinum.] 
By hot, concentrated nitric acid it is converted into oxalic acid, but cold, fum- 
ing nitric acid dissolves it, forming an explosive compound. By the action 
of ferments it is finally converted into alcohol and carbon dioxide. C 6 H 10 O 5 = 
2C 2 H 5 OH+2C0 2 . 

Glyceritum Amyli, Glycerite of Starch, — has of Starch 10 parts, Water 10, Glycerin 80, 
triturated and heated to a jelly. A vehicle for external applications. 

Maltum, Malt, — is the grain of one or more varieties of Hordeum sativum (nat. ord. 
Gramineae), caused to enter the incipient stage of germination by artificial means and dried. 
The germination is allowed to go far enough to develop the maximum amount of Diastase, 
the peculiar ferment by which the starch of the grain is converted into glucose. Malt is 
the source of beer, ale and whisky, and is composed of the germinated, dead grains with 
their acrospires and radicles. It should be fresh, not darker in color than a pale amber, 
and of agreeable odor and sweet taste. 

Extractum Malti, Extract of Malt, — is a liquid of the consistence of thick honey, con- 
taining all the soluble principles of malt in permanent form. It consists chiefly of diastase 
and glucose. Dose, 3j-§j, [av. oiv.] 

Unofficial Derivatives and Analogues. 
Dextrin, — is produced by the action of dilute acids on starch, and is an intermediate 
product in the conversion of starch into glucose. It is a transparent, brittle solid, soluble in 
water and in dilute alcohol, is not fermentable, and is not colored bv Iodine. 



AMYLUM. II9 

Cetraria, Iceland Moss, — is the lichen Cetraria islandica found in northern latitudes. It 
contains Lichenin or lichen starch, which forms as a jelly when the plant is boiled in water; 
also Cetraric Acid. 

Decoctum Cetrariae, Decoction of Cetraria, — 5 per cent, strength. Dose, % ij-iv. 

Horlick's Food, — is, like Mellin's and many other foods for childien, a gianulated extract 
of malt. Hoff's Malt Extract is another such preparation in fluid form, containing alcohol, 
and corresponding to a concentrated beer. 

Cellulose, C 6 H 10 O 5 , — forms the basis of all vegetable fibre, and is isomeric with starch. 
It exists almost pure in cotton and in Swedish filter paper. Pyroxylin, Gun-cotton, is dinitro- 
cellulose. 

Glycogen, Animal Starch, — closely resembles starch in its properties, being converted 
into glucose by the same agents which so act on starch. It exists in the liver of all animals. 

Incompatibles. 
Incompatible with. Starch in solution are: Acids, Alkalies, Alcohol, Diastase, Iodine, Lead 
Subacetate, Lime-water, Tannic Acid. 

Physiological Action. 

Starch and its derivative grape-sugar are the chief members of the non- 
nitrogenous group of alimentary principles designated hydrates of carbon or 
carbo-hydrates, so called because in them the constituent elements H and O 
exist in multiples of the same proportions as in water. Starch is met with 
only in the vegetable kingdom, occurring in the form of granules in many seeds, 
roots, stems, and in some fruits. It is formed by plants from inorganic ma- 
terial under the influence of light, and is stored up in their seeds as food for 
the young seedlings. In order to be absorbed by the animal organism starch 
must undergo digestion by the action of the secretions of the pancreas and 
intestinal glands, which convert it first into soluble dextrin and then into grape- 
sugar, in which form it passes into the blood. 

Food is required by the animal organism for two purposes, (1) to generate 
heat and other forms of force, (2) to repair the waste of the tissues. Both are 
essential to continued life, but the first is even more important than the second, 
for though the body may live a long time while wasting, it dies rapidly when 
the source of heat is removed or greatly lessened. The doctrine taught by 
Leibig — that the nitrogenous principles (albuminoids) are exclusively con- 
cerned in tissue repair, and the non-nitrogenous (starches, sugars and fats) 
in heat-production, — though not strictly accurate, still holds good as describing 
the leading office of each group. 

The carbo-hydrates (starches, sugars, etc.) represent in vegetable food the 
same office which the hydrocarbons (fats) represent in animal food, namely — 
the maintenance of heat-production and other forms of force. The glycogen 
in the liver and in the muscles is a store of insoluble fuel for emergencies, and 
is given up in the form of soluble grape-sugar as required. Any surplusage of . 
carbo-hydrates goes to form fat, the adipose tissue of the body, another reserve 
of body-fuel. Being devoid of nitrogen the carbo-hydrates cannot enter into 
the actual structure of the tissues, the instruments of energy, but their oxidation 
supplies the motive power, they being the fuel of the body. When they are 
entirely burnt up and no more supplied the organism perishes of exhaustion. 



I 



120 AMYLUM. 

The adult human body of average size and weight requires according to its 
activity from 12 to 18 ounces of water-free carbo-hydrate material daily in 
some form of food. 

Starch and sugar occur in vegetable foods in from three to five times greater 
amount than protein material. The latter exists in greater proportion in the 
leguminous vegetables (peas, beans, lentils) than in meat, but in other vegetables 
the protein is much less. Cereal grains are by far the most important vegetable 
foods, and among them Wheat is the one most generally used. Its constituents 
correspond with the requirements of the human organism more closely than 
those of any other grain; in fact both life and health can be maintained on 
wheat alone for a very long period. As ordinarily used, however, it is deprived 
of much of its nutritive value, white bread being made from wheaten flour from 
which not only the indigestible cellulose has been removed but part of the starch 
and sugar and a large proportion of the gluten, which is the protein material 
of the grain. Brown or Graham bread contains nearly all the nutritive ele- 
ments of wheat and is much more nutritious than white bread. Rye is a valuable 
grain, containing nearly the same proportions of starch, sugar, fat and protein 
as wheat. Rice contains more starch than the others and its starch is very 
digestible, but it has practically no fat and only the smallest quantity of pro- 
tein. Its nutritive value is small, and it requires an oil and some albuminoid 
to be taken with it in order to make it a suitable diet. Maize is more nutritious 
than rice, but is less digestible. It contains much starch and some fat, but is 
deficient in protein material (gluten). Oats are rich in fat but contain less 
starch than the other grains, and require prolonged cooking to render them 
digestible. Barley ranks about as wheat, contains rather more protein and is 
rich in phosphates and iron. It is highly nutritious and was the principal diet 
on which the Grecian athletes were trained. The Potato contains about 20 
per cent, of a very digestible starch, is rich in salts and its juice is highly acid. 
It is an excellent antiscorbutic and is extensively used for food. Arrow-root, 
Sago and Tapioca consist almost entirely of starch, without fat or protein, and 
are readily digested. Peas and Beans contain about 50 per cent, of starch and 
sugar, also 22 per cent, of legumin or vegetable casein, albumin, etc. — a very 
large proportion of protein material, more in fact than exists in any kind of meat. 
They are rich also in fat and salts, and form the best vegetable substitute for 
animal food. They are somewhat indigestible and require prolonged cooking 
before being eaten; but they are an excellent food, alone nourishing both men 
and beasts for a long time. 

The excessive consumption of starchy food delays tissue-metamorphosis, 
produces a superabundance of adipose tissue, and often causes acidity and 
flatulence. Undigested starch passes into the feces and the urine becomes 
saccharine in many cases. Profound disease does not necessarily follow, but 
if decided corpulence is produced the muscular fibres of the heart and many 
voluntary muscles decrease in size, the cardiac action becomes enfeebled and 



ANIMAL EXTRACTS. 121 

the usual results thereof are manifested. The deprivation of starch can be borne 
well for a long time if fat is taken with the food, but if both starch and fat are 
excluded and nitrogenous material is alone supplied, illness results in a few 
days. [See the article entitled Albumin, page 89.] 

Therapeutics. 

The principal affections in which the carbo-hydrates are imperatively re- 
quired are gastric disorders, diarrhea, dysentery, excessive secretion of bile and 
other hepatic disorders, Bright's disease, alcoholism, gout and rheumatism. 
In acute and continued fevers there is often an almost complete inability to 
take and digest any kind of food. This may last for weeks, the result being 
that the patient dies from so-called exhaustion, in reality starvation due to want 
of fuel-food, the human fire going out in the absence of material to feed it. In 
such cases the need of soluble carbo-hydrate food must be supplied. ' Well- 
baked flour which contains much soluble dextrin, also milk-sugar or grape- 
sugar, should be added to the beef-teas which are so much used in the sick- 
room. Grape-sugar is digested starch and a very soluble carbo-hydrate; it 
may therefore be administered in lemonade or any other drink which the patient 
fancies. In gastric disorders accompanied by much acidity an uncrystallizable 
sugar like grape-sugar is preferable to cane-sugar or beet-sugar, the latter be- 
ing crystallizable sugars and readily undergoing the acetous fermentation. In 
diarrheal conditions the proper food is milk with some digestible carbo-hydrate, 
as arrow-root, sago, or tapioca. Rice-water makes an excellent drink in diar- 
rhea and dysentery, and has often arrested these conditions without medicinal 
aid. In the treatment of Bright's disease and chronic alcoholism a diet of carbo- 
hydrates should be inculcated and animal food reduced to a very small quantity. 
The same rule is imperative in the management of gout, especially when this 
disease occurs in persons of sedentary habits. In acute rheumatism the diet 
should be wholly non-nitrogenous, except for broken-down and debilitated 
subjects, or where serious nervous or cardiac complications exist. 

Starch is medicinally inert. It is employed as a vehicle for medicated 
enemata, as an antidote in poisoning by iodine or bromine, and as a protective 
and absorbent powder applied by dusting over the skin. Mixed with glue it 
makes an excellent stiff bandage for surgical purposes. 

Malt Extract, containing good food elements, is directly nutritive, and indirectly so from 
the presence of the ferment Diastase, which converts the starch of bread or other farinas into 
sugar. It is usefully employed in wasting diseases, and mixed with milk or oleaginous foods 
it aids their digestion and assimilation. It may be used to form a syrupy mixture with prepa- 
rations of Iron or Cinchona. 

Cetraria is nutrient, demulcent and feebly tonic. It has a popular reputation in pul- 
monary affections and is of value in chronic catarrhs, chronic bronchitis, purulent discharges 
from mucous surf aces generally, also in chronic diarrhea and dysentery. 

ANIMAL EXTRACTS. — The organs, tissues and secretions of animals 
were extensively employed as medicinal agents in ancient times, and many of 



I 



122 ANIMAL EXTRACTS. 

them were official in the pharmacopoeias of the last century. At present the 
only ones recognized in the U. S. Pharmacopoeia are the digestive ferments, 
(pepsin and pancreatin), ox-gall (fel bovis), the secretion of the preputial fol- 
licles of the musk-ox (moschus), and the suprarenal, thyroid and pituitary 
glands of animals. The first definite attempt in recent regular practice to 
apply animal tissues to the cure of disease was made in 1852 by Dr. Jackson of 
Philadelphia, who used as a tonic the blood of bullocks carefully dried in vacuo, 
giving 5 to 10 grains thereof at a dose. Raw meat was administered as a rem- 
edy for diabetes at St. Bartholomew's Hospital in London in 1874. The pow- 
dered Russian cockroach (Blatta orientalis) was used as a diuretic in dropsies, 
and preparations of the bodies of various spiders and toads, also bee and ser- 
pent venoms, are recognized remedies in homeopathic practice. 

The use of glandular extracts as remedies in disease is very old. It was 
revived in 1889 by Brown-Se'quard's advocacy of orchitic (testicular) extract 
for impotence and several nervous affections, and was profoundly stimulated 
by the results of Dr. Murray's suggestion in 1891 of thyroid extract for the cure 
of myxedema. According to the theory promulgated by Brown- Sequard, all 
glands, in addition to their ordinary secretions, elaborate certain materials of 
unknown chemical composition, which pass into the blood and perform therein 
definite functions of some kind. We now know that such is the case with the 
thyroid gland, we suspect that it is equally true of the thymus, the spleen and 
the adrenals, and we have reason to believe it highly probable that the other 
glands of the body exert influences heretofore unsuspected over distant parts 
of the organism. 

The effect of the entire removal of the thyroid, the pancreas or the adrenal 
glands is to produce the symptoms of characteristic and fatal disorders; but 
if a portion of either gland be left behind these toxic symptoms do not develop, 
and the same is true of the thyroid and pancreas if, after their entire ablation, 
a portion be engrafted upon the peritoneum. It is evident therefore that the 
disorders so produced are of auto-toxic origin, the result of chemical poisons 
in the blood which were previously neutralized, destroyed or eliminated by the 
removed gland or some of its secretions. It has also been shown that the sub- 
cutaneous injection of an aqueous extract of the dead gland will dispel the 
toxic phenomena which follow the removal of that gland, proving that the active 
principle thereof is a chemical substance existing in the gland itself, and that 
the previous immunity was not due to any action of its living cells other than 
that required to produce the active agent. The discovery that ablation of the 
testicles causes retrogression of the hypertrophied prostate, and that removal 
of the ovaries will cure osteomalacia, as also the long-known facts that castrated 
individuals usually grow very obese and develop massive skeletons, while giants 
are generally endowed with atrophied testicles, — clearly point to the same 
conclusion. 

The animal extracts form a group of active medicinal agents which are 



ANIMAL EXTRACTS. 1 23 

worthy of careful investigation both physiologically and clinically. The study 
already given to them has yielded much new knowledge, and has shown in- 
dubitably that their employment as therapeutic agents rests on a scientific 
basis; but most of them are as yet on trial, and the limits of their utility in 
medicine are by no means defined. They contain leucomai'nes, extractives and 
other chemical substances, all of which possess physiological powers, many 
proving distinctly poisonous when their excretion is prevented. Excepting thy- 
roid extract and perhaps some others, the animal extracts are active medicinally 
only when injected subcutaneously as most of them are destroyed or altered 
in the stomach, or prevented by the liver from entering the general circula- 
tion. Physiological chemists are endeavoring to separate their active prin- 
ciples, a line of research which promises more accurate and positive results. 
It is already demonstrated that some of their principles are the most power- 
ful of all alteratives, and that others possess the most energetic action upon 
the muscular fibres in the walls of the arterioles. 

The initial doses of many animal extracts should be very small, in order 
to avoid the possible systemic disturbance which has been frequently noticed 
by clinical observers as following on their administration. 

Thyroid Gland and its preparations are the most efficient as medicinal 
agents of the entire class, especially in the treatment of myxedema, which a 
few years ago was classed among the incurable diseases, but is now considered 
curable by thyroid feeding, or by the use of an extract of the thyroid gland of 
the sheep. Myxedema is a combination of symptoms due to thyroid absence 
or inadequacy, and occurs as a result of the removal of the gland or of disease 
impairing its functional activity. It is characterized by imperfect oxygenation 
of the blood, lowered body-temperature, impairment of intellect, memory and 
speech, also increase and subsequent mucoid degeneration of fibrous tissue, 
with thickening of the skin, drying of the surface and shedding of the epithelial 
structures. When caused by ablation of the thyroid the disease is fatal to cats 
and dogs in a very few days, but their life has been saved by engrafting a por- 
tion of the removed gland in other situations, and also by intravenous injections 
of thyroid extract. This treatment of the idiopathic form of myxedema was 
suggested and commenced by Professor George R. Murray, of the University 
of Durham, in 1891, and has since proved remarkably successful. At first the 
remedy was administered hypodermically, but it was soon found that the raw 
gland fed to the patient was equally efficient, or that a dry extract may be used. 
The latter represents the entire thyroid, divested only of its water, is easily ad- 
ministered and proves very efficient, improvement being usually noticed within 
a few days, and going on steadily to apparent perfect recovery if the remedy 
is continued. The thickening of the skin disappears, the normal body heat 
returns, and speech, memory and intelligence are restored. In mild cases re- 
covery is effected in a few weeks, but in severe ones several months of treat- 
ment are necessary; and in most cases the symptoms of the disease return when 



( 



124 ANIMAL EXTRACTS. 

the thyroid treatment is stopped, disappearing again when it is resumed. It 
is probable that the subjects of this disease will require to take a certain quan- 
tity of the remedy regularly and continuously for many years, perhaps for life. 

A large dose of thyroid extract gives rise to marked constitutional symp- 
toms, and several cases are recorded in which it has caused death. Nausea, 
vomiting, neuralgic pains in the back and limbs, cardiac irritability and weak- 
ness even to syncope, slight pyrexia, dyspnea, progressive emaciation, head- 
ache, diarrhea, nervousness, tremor, pruritus, and insomnia, are the principal 
manifestations of thyroidismus produced by its excessive use. It powerfully 
stimulates metabolism and elimination, increases largely the secretion of urine 
and the excretion of urea and other urinary constituents, and acts as a specific 
vaso-dilator, thus inducing perspiration and lowered blood-pressure. In one 
case all the symptoms of diabetes developed under its continuous administra- 
tion for psoriasis (James). In another instance a typical attack of gout came 
on, but subsided when the extract was stopped, and reappeared when it was 
again administered (Harris). 

Thyroid extract has produced great amelioration in cretinism (congenital 
myxedema) which is a thyroid disease, and the improvement has been steady 
and progressive in many cases while the remedy was used, but ceased as soon 
as it was discontinued. In psoriasis, eczema, ichthyosis, pityriasis rubra, lupus, 
universal alopecia and some other skin affections, it has been employed as a 
stimulant of the cutaneous functional activity with most satisfactory results; 
several cases of psoriasis treated with this remedy alone recovering completely 
in the course of a few weeks (Bramwell). In the insanity of the adolescent, 
climacteric and puerperal periods, the thyroid treatment has seemed to be espe- 
cially beneficial (Bruce) ; but in several cases of insanity where there was par- 
enchymatous (not cystic) enlargement of the thyroid, the extract was used with- 
out result upon the mental affection though it diminished the size of the goitre 
and caused a marked loss of weight (Reinhold). It is beneficial in simple 
goitre, but is contraindicated in the exophthalmic form. In many cases its 
continued administration has produced emaciation, which fact suggested its 
employment for the reduction of obesity, and it has been successfully used for 
this purpose in many cases (Guttmann). A loss of weight at the rate of from 
2 to ii pounds per week is produced in some cases; but after a time a limit is 
reached, beyond which further loss does not occur. Thyroid extract has given 
satisfaction in several other affections, including lupus, ozena, obstinate ulcers 
of the leg, progressive myopathy, endometritis, menorrhagia, uterine fibroma 
and carcinoma, and some forms of syphilis. It has been successfully used to 
promote union in ununited fractures, having well-recognized effects in dis- 
ordered nutrition of osseous tissue (Gauthier). It has seemed to act as an 
efficient galactagogue in some cases, increasing both the flow and the quality 
of the milk (Stawell). It is contraindicated in diabetes mellitus, also in cases 
presenting much emaciation. 



ANIMAL EXTRACTS. 1 25 

Thyroiodine or Iodothyrine is a protein substance existing in the gland, and is 
probably the chief active principle, though not the only one. It contains iodine 
in varying amount and a large proportion of nitrogen, also sulphur and phos- 
phorus. It appears to represent the physiological and therapeutic powers of 
the gland. It is given in tablet form and in doses of gr. j-x thrice daily. 

Preparations. 

Thyroideum Siccum, Dried Thyroids, — the thyroid glands of animals, freed from con- 
nective tissue and fat, cleaned, dried and powdered, containing not less than 0.17 or more 
than 0.23 per cent, of Iodine in thyroid combination. Dose, gr. j-iv, [av. gr. jss.] 

Thyroid Extract (Unofficial), — one grain equals ten grains of the crude gland, or one- 
sixth of a desiccated thyroid. Dose, gr. ss, thrice daily, gradually increased to gr. v. 

Thyroid Tablets (Unofficial), — each tablet contains two grains of desiccated thyroid 
equal to ten grains of the fresh gland. Dose, j to ij thrice daily. 

Iodothyrine, Thyroidine, (Unofficial), — a milk sugar trituration of a substance, or 
mixture of substances, representing, to a considerable extent, the activity of the thyroid 
gland. One Gm. of this trituration is said to represent 1 Gm. of fresh gland containing 
0.0003 Gm. of iodine. Dose, adults, 10 to 30 gr.; children 5 to 15 gr. per day. 

Parathyroid Gland. — Is used in tetany following accidental removal 
or injury at operation of the parathyroid glands. It has been used in 
paralysis agitans and a number of nervous conditions in adults with ques- 
tionable results. 

Preparations. 
Desiccated Parathyroid Gland, (Unofficial) , — the exterior parathyroids of the ox freed 
from fat, cleaned, dried and powdered, without the addition of preservative or diluent. 
Dose, jo grain 4 times a day. 

Adrenal Extract. — Ablation of the suprarenal glands in guinea-pigs and 
frogs is followed by serious nervous disturbances, shown by lowering of the 
body-temperature and progressive paralysis, and culminating in convulsions 
and death by failure of respiration. Brown- Se*quard made these observations 
in 1856, and later showed that the subcutaneous injection of extracts of the 
healthy glands in such cases restored the animals to almost a normal state for a 
time. In 1895 Schafer and Oliver demonstrated that the secretion of these 
glands strongly stimulates the muscular system by direct action, especially 
affecting the vaso-motor apparatus and the cardiac muscle, causing contraction 
of the arterioles and an extraordinary rise of blood-pressure, followed by slowing 
and strengthening of the heart's action through the vagus and the cardiac motor 
ganglia. These effects are of short duration and are produced by a very small 
quantity, the -^th of a grain of the dried gland causing a maximal result on 
the heart and arteries in a dog of twenty pounds weight. The rise of blood- 
pressure is greater than that produced by any other known substance. Locally, 
the extract is a powerful constrictor of the blood-vessels. The active principle 
is rapidly eliminated by the kidneys, and is largely oxidized in the liver. 

Epinephrine, a principle isolated by Abel, is found only in the medulla of 
the gland, and in very small quantity, but it is very active, the ^Vo 0I * a grain 
per kilo of body-weight producing a distinct effect on the blood-pressure. In 
1898 von Fuerth discovered Suprarenin, a principle which he claimed to be 



126 ANIMAL EXTRACTS. 

different from epinephrine. In 1901 Takamine isolated another principle, 
named Adrenalin, which is said to manifest all the properties of the gland sub- 
stance in greater concentration, being the most powerful hemostatic and as- 
tringent known, and a cardiac stimulant of great energy. It is claimed to be 
600 to 1,000 times more powerful than the extract, the 2 1 of a gramme 
(ttwo of a grain), administered intravenously, producing a distinct effect 
upon the adult man; and the fraction of a drop of a solution of 1 in 10,000 
blanching the normal conjunctiva within 30 to 60 seconds. Its intravenous 
administration acts powerfully on the muscular system, especially the muscle 
of the heart and blood-vessels, causing an enormous rise of blood-pressure. 
It is non-irritant, non-toxic, non- cumulative, devoid of injurious properties, 
and has little or no effect upon the cerebrum. It has no anesthetic power in 
itself, but when used in connection with cocaine, holocaine, etc., it prolongs the 
duration of the anesthesia produced by them. 

By local administration this extract has given good results in nasal and 
gastric hemorrhage, bronchial asthma, congestion and edema of the lungs, 
edema of the glottis. Internally and locally it has proved of very great 
benefit in the treatment of hay-fever. Its use in Addison's disease has been 
discouraging, although temporary improvement has been notedly a number 
of observers. 

By local application the angiostenotic properties of suprarenal extract have 
been successfully utilized in the treatment of local congestions, inflammations 
and hemorrhages, especially those of the eye, ear, nose and throat. It is an 
excellent hemostatic for hemorrhage following operations on the nose, and is 
used as an application to inflamed tissues prior to their being anesthetized by 
cocaine, also to the mucous membrane of the turbinated bodies in ulceration 
or hypertrophy thereof. 

Epinephrine has been employed with great satisfaction in all affections to 
which adrenal extract is applicable. Its powerful angiostenotic properties 
are utilized for bloodless operations on the nose and throat, in epistaxis, men- 
orrhagia, and other forms of hemorrhage, in asthma, laryngitis, conjunctivi- 
tis, coryza, and many other affections. Its prompt and powerful stimula- 
tion of the heart and vaso-motor system will be found invaluable in collapse 
during anesthesia and surgical shock, before cocainization to prevent cocaine 
intoxication, in opium and morphine poisoning, and in sudden failure of the 
circulation from any cause. Added to solutions of local anesthetics, it pro- 
duces local anemia and localization of the anesthetic action. 

Preparations. 

Suprarenalum Siccum, Dried Suprarenals, — the suprarenal glands of animals which 
are used for food by man, cleaned, dried, freed from fat, and powdered, and containing not 
less than 0.4 per cent, nor more than 0.6 per cent, of epinephrine, the active principle of 
the suprarenal gland. One part of Dried Suprarenals represents approximately 6 parts of 
fresh glands, free from fat. If assayed biologically one gram of Dried Suprarenals contains 
the equivalent of ten milligrammes of lasvo-ethanol-catechol. Dose, gr. ij-v, [av. gr. iv.l 



ANIMAL EXTRACTS. 1 27 

Adrenalin Chloride (Unofficial), — is not stable in its dry form, but is so in solution, if 
protected from heat, light, and oxidation. It is marketed in a 1 to 1,000 solution, containing 
0.65 per cent, of sodium chloride, and 0.5 per cent, of chloretone. This solution is diluted 
for local medication, to 1 in 5,000, or 1 in 10,000. Dose, internally, njv-x, every 4 hours; 
equal to gr. g&tf ^i oo of the chloride itself. There are other preparations of epinephrine 
under various proprietary names. These are obtained from the suprarenal gland of the 
sheep or other animals, or are prepared synthetically. 

Orchitic Extract, Didymin, Testicular Juice, (Unofficial) — was the sub- 
ject of a communication to the Socie*te de Biologie at Paris, in 1889, from Pro- 
fessor Brown- Sequard, in which the aged and distinguished writer declared 
that he himself had experienced a wonderful degree of rejuvenescence after its 
use, and recommended it as a general tonic for the aged and for subjects of 
impotence or a debilitated nervous system. In subsequent communications 
made to the Academie des Sciences by Brown-Se"quard and his assistant 
D'Arsonval, it was claimed that general paralysis, locomotor ataxia, contrac- 
tures, and certain forms of insanity, also affections due to organic lesions of 
the nervous system or impairment of its functions, are cured or ameliorated 
by injections of testicular juice; and that organic or constitutional diseases 
due to defective nutrition of the organs, as anemia, glycosuria and tuberculosis, 
may be arrested by this procedure. Unfortunately observations by a large 
number of physicians have failed to verify its value in these conditions. At 
the present time it has fallen largely into disuse because of uncertainty and 
lack of results in its application. 

Testicle Extract is fully noticed in the "Seplasium or the Druggist's Shop Opened," by 
W. Salmon, published about 1685. In this book the author describes the testicles taken 
from man or beast as consisting of "a Flegm, Spirit, Sulphur and Volatile Salt joined with 
some Earthy Particles; the chief used are from Bull, Horse, Goat, Ram, Boar and Buck," 
which were cut out, carefully dried, and used to make a tincture, a spirit, an oil and a volatile 
salt. Salmon further says that "their virtues are very great, for they refocillate the Spirits, — 
Natural, Vital and Animal, — comfort the Head, Brain and Nerves, and resist all Diseases 
afflicting them, .... they restore in Consumptions, .... are also good against 
the ColHck, and particularly strengthen the Instruments of Generation and provoke Lust." 
The same extract was also recommended by J. Fr. Leaulte, who wrote in 17 17. According to 
Pliny the ancient Greeks and Romans ate the testicle of the ass for the purpose of curing 
impotence. 

Brain Extract, Cerebrinin (Unofficial), — is obtained from the gray matter 
of the sheep's brain by digestion in 5 times its weight of pure glycerin and then 
adding an equal quantity of a 12 per cent, solution of common salt. It was 
recommended in locomotor ataxia, neurasthenia and allied affections, nym- 
phomania, perverted sexual habits of cerebral origin, hysteria, melancholia, 
insomnia, the general debility of malaria, chlorosis and even more profound 
anemias (C. Paul) ; also in cases of defective development of the spinal appa- 
ratus, as Friedrich's ataxia. Its use has not met with favor because of the 
uncertainty of its action and the lack of results. 

The dose is 16 minims (1 Cc.) once daily or every other day, administered 
subcutaneously. 



128 ANIMAL EXTRACTS. 

Bone Marrow Extract (Unofficial). — Red bone marrow has been long 
known to be one of the sources of the red blood corpuscles, and it is probable 
that it contains chemical ingredients which may stimulate the production of 
blood cells by other blood-forming organs in which such natural stimulus may 
be lacking. Recent studies would seem to indicate that such action is due 
largely to the iron and lecithin present in the bone marrow. In pernicious 
anemia the marrow of the long bones shows characteristic changes, which fact 
suggested the administration of red bone marrow as a remedy for that disease. 
This treatment has proved successful in some cases which were apparently 
hopeless. It was first suggested by Dr. Dixon Mann, who administered a 
glycerin extract thereof in cases of hemophilia, chlorosis, profuse hematemesis 
and anemic affections, with good results. It has been used in leucocythemia, 
with no great success; but it is indicated in disorders of the blood, from 
whatever cause ; and it may render good service in any debilitating or blood- 
impoverishing affection, and in convalescence after severe osteitis. The raw 
marrow, freed from spicules of bone, may be administered to the amount of 
about 3 ounces daily in divided doses; or it may be given as a paste made with 
wine, glycerin, and gelatin. Tablets, containing from i| to 5 grains each of 
the dried marrow, are on the market and may be used if preferred. 

One of the most striking cases of pernicious anemia recorded is that of the gardener 
patient of Professor Fraser of Edinburgh. Under the use of raw bone marrow by the stomach 
his blood corpuscles increased in number from less than 900,000 to over 4 millions per cmm., 
the proportion of hemoglobin rose from 18 to 35 per cent., and the man became well enough to 
resume his occupation. 

Splenic Extract (Unofficial). — Excision of the spleen, or its serious impair- 
ment by disease, is usually followed by marked tissue changes and great suscep- 
tibility to alterations of temperature, especially in malarial subjects. Excision 
of the spleen in animals is followed by moderate anemia of a secondary type 
with slow recovery. Austin and Pearce found that splenectomy does not 
entail any constant or important changes in normal iron metabolism. It has 
been suggested that the splenic substance of animals naturally immune 
against certain diseases, be employed as a remedy in tuberculosis, malaria, and 
typhoid fever, and it has been used with benefit. The intra-peritoneal injec- 
tions of splenic extracts produce in animals a distinct increase of hemoglobin 
and corpuscles lasting for several days. This action results apparently from 
stimulation of the bone marrow. Krumbhaar and Musser found the feeding 
of spleen was ineffective. Some relation between the spleen and the thyroid 
body is suggested by the frequent enlargement of the former organ in myx- 
edema and cretinism. Splenic substance has been used medicinally in various 
disorders of the blood, with the idea of supplying to that tissue some material 
which may be necessary to its health; and Dr. H. C. Wood has used the 
extract in exophthalmic goitre with results which indicate that it is worthy of 
trial in this intractable disorder. Given by the mouth in sufficiently large 



ANIMAL EXTRACTS. 1 29 

doses it is apt to cause nausea, and when used hypodermically it frequently 
produces local abscesses. 

Thymus Gland (Unofficial). — The thymus gland is active only during 
the developmental period of life, and becomes atrophied about the age of two 
years. The suggestion has been made that an extract thereof may prove 
useful in diseases characterized by defective development, as rachitis and 
pseudo-hypertrophic paralysis. It has been used with reported benefit in 
leucocythemia, chlorosis, idiopathic and pernicious anemia, and in Paltauf's 
so-called "status thymicus." It appears to be useless in exophthalmic goitre, 
but beneficial in the other form. Of 30 cases of goitre treated with it 20 were 
improved but only 2 were cured (Kinnicut). The dose of the desiccated 
thymus gland of the calf is 2 to 4 gr. three times daily. 

Pineal Gland (Unofficial) . — The pineal gland is present during the entire 
life of the individual, and its removal has been followed in animals by struc- 
tural changes in the central nervous system. It is thought that the sub- 
stance of this gland exerts an influence upon growth and development. Al- 
teration in the function is associated with adiposis and interference with 
physical, mental and sexual development. The experimental administra- 
tion of pineal substance seems to favor development, although the clinical 
observations of pineal tumors would seem to indicate that in some instances, 
at least, a perverted secretion inhibits the mental and sexual development. 
The dose of desiccated pineal gland of normal young cattle is -^0 to tV gr. 
three times a day. It is purchasable in powder or tablet form. 

Pituitary Gland (Hypophisis). — The complete removal of the pituitary 
body (or gland) gives rise to symptoms which occur in a definite order, begin- 
ning with lowered temperature and loss of appetite, then twitchings, tremors 
and nervous phenomena, and finally dyspnea and death. The anterior lobe 
is essential to life and its removal produces death. When partially removed it 
results in a disturbance of growth characterized as infantilism with obesity. 
Hyperactivity of this lobe leads to excessive growth, as acromegaly and 
gigantism. The posterior lobe exerts an influence upon smooth muscle 
fibres, especially of the blood-vessels and of the uterus. This organ has been 
found enlarged in cases of myxedema in which the thyroid was functionally 
absent. Internally administered extracts of the posterior lobe cause a tem- 
porary increase of the cardiac force, and' a rapid rise of blood-pressure due 
to direct contraction of the vessels and slowing of the pulse; also increased 
elimination of phosphates without corresponding increase of the nitrogenous 
elements. It induces diuresis and stimulates contraction of the intestines and 
bladder. It has been used to hasten labor, in which, however, it should not 
be used unless the os uteri is fully dilated and the contractions weakening. 
The careless use of pituitary extracts in this group of cases has given rise to 
9 



I30 ANIMAL EXTRACTS. 

precipitate labor, extensive tearing and in some instances, rupture of the 
uterus. It has been recommended in uterine hemorrhage after labor due to 
relaxation. There is some experimental evidence to indicate that the secre- 
tion of milk in animals is favored by the use of pituitary preparations, but 
the clinical effect has not been satisfactorily demonstrated in human subjects. 
Wiggers believes it may be of some use in pulmonary hemorrhage. It has 
been recommended intravenously in shock. All preparations of the drug 
should be physiologically standardized. Of 13 cases of acromegaly treated 
with pituitary preparations 7 showed varying degrees of improvement, 5 
none, and 1 became worse. In 2 cases the violent headache and neuralgic 
pains in the limbs were diminished, and in one case decrease of the affected 
extremities occurred (Kinnicut). 

Official Preparations. 

Hypophysis Sicca, Desiccated Hypophysis, — the posterior lobe obtained from the pitui- 
tary body of cattle, cleaned, dried, and powdered. It is a yellowish or grayish, amorphous 
powder, having a characteristic odor. It is only partially soluble in water. Dose, gr. 
j-iv [av. gr. ss.] 

Liquor Hypophysis, Solution Hypophysis, — a solution containing the watersoluble- 
principle or principles from the fresh posterior lobe of the pituitary body of cattle. Ex- 
tract the finely minced material with slightly acidulated water, boil the solution for ten 
minutes and filter it. Sterilize this filtrate and preserve it in a sterile condition in glass 
containers. It is a transparent liquid, colorless or nearly so, having a faint, characteristic 
odor. One mil of Solution of Hypophysis, diluted 20,000 times, has the same activity on 
the isolated uterus of the virgin guinea-pig as a 1 to 20,000,000 solution of beta-iminazolyl- 
ethylamine hydrochloride when tested as directed by the United States Hygienic Labora- 
tory. Dose, TTgxv. 

Parotid Extract (Unofficial). — An extract of the parotid gland has been employed by 
Dr. Robert Bell of Glasgow with good results in ovarian disorders, particularly enlarged and 
tender ovaries associated with dysmenorrhea, metrorrhagia, chronic endometritis and sub- 
involution of the womb. 

Ovarian Extract (Unofficial). — The internal secretion of the ovary exerts an influence on 
the function of the uterus and also upon the nervous system and metabolism. The re- 
moval of the ovaries or the reduction in their function, as occurs at the menopause, results 
in a variety of nervous symptoms. The active principle of the internal secretion is supposed 
to have its origin in the corpora lutea, which substance has been used for the same indica- 
tions as the entire gland. Ovarian extracts have been administered therapeutically for 
the relief of symptoms following the natural or artificial menopause, and in cases of amenor- 
rhea with chlorosis. It does not seem to have any effect, although recommended, in 
dysmenorrhea and irregular bleeding. The ovarian preparation may be administered in 
powder or in tablet form. Although ovarian extracts are not official, there are three 
preparations which have been included in "New and Nonofficial Remedies," as follows: — 

Preparations. 

Ovarian Substance. — The entire fresh ovaries (including the corpora lutea) of the hog, 
cleaned, dried and powdered, without the addition of either preservative or diluent. Dose, 
1 to 3 gr. three times daily. 

Desiccated Corpus Luteum. — The fresh substance from the corpora lutea from cows' 
ovaries, removed, dried and powdered without the addition of preservatives or diluent. 
Dose, I to 1 gr. twice daily. 

Lutein Tablets. — Each tablet is said to represent 1.3 Gm. (20 gr.) of fully developed 
corpora lutea of pigs. Dose, one tablet, three times a day. 

Mammary Gland Extract (Unofficial), has given satisfaction in menorrhagia, dysmenor- 
rhea and enlarged and sensitive womb (Bell). It is administered in the form of the clean, 
dried and powdered mammary gland of the sheep. Dose, 2 to 5 gr. three times daily. 



ANIMAL EXTRACTS. 131 

Nuclein (Unofficial), — is a protein substance, possessing a large propor- 
tion of Phosphorus in the form of Nucleinic Acid, which is combined with a 
highly complex base, the latter being different in the various tissues. Nu- 
cleins are the chief chemical constituent of cell nuclei, and their number is 
limited only by the varieties of the cells. They are found in both animal and 
vegetable tissues; wherever there is a nucleus we find a nuclein. They are 
generally insoluble in dilute acids, but are soluble in dilute alkalies, and resist 
peptic digestion. Their functions in the organism are supposed to be (i) that 
of a natural antiseptic, to destroy toxic products which may accumulate through 
faulty elimination, and (2) that of a natural bactericide, to resist microbic in- 
vasion. Two nucleins only have been clinically studied in this country, that 
obtained from yeast-cells and that from the thyroid and thymus glands. 

Nuclein is harmless, causing no functional derangement when administered 
by the stomach or subcutaneously, even in very large doses. When injected 
hypodermically its principal effect is to produce a very marked increase of 
leucocytic activity (an artificial leucocytosis), both in healthy and in tuberculous 
subjects. The increase is observed to affect chiefly the polynuclear leucocytes; 
it varies in degree with the individual, appears within three hours after ad- 
ministration of the nuclein, and disappears after forty-eight hours or there- 
abouts (Huber). The effect is to energize any existing inflammation, or to 
awaken such when comparatively quiescent, as in latent tuberculosis (See). 

Nuclein was introduced into medicine by Professor Vaughn of the Univer- 
sity of Michigan. Its employment as a therapeutic agent is based on the as- 
sumption that for immunity against and the cure of bacillary diseases we should 
look to non- toxic germicides of cellular origin, and to substances which stimu- 
late the activity of those organs whose function it is to protect the body against 
such invasion. As the nucleins apparently fulfil these requirements they have 
excited considerable attention among the advocates of animal extracts. Nu- 
clein has been successfully used in diphtheria, suppurative tonsillitis and other 
suppurative disorders, also in chronic rheumatism and malaria, chronic bron- 
chial catarrh and neurasthenia, and has been employed in tuberculosis with 
encouraging results (Vaughn). In one case an ulcer of twenty years' standing 
was cured in four months by the local application of nuclein. A physician 
reports his own case, one of genito-urinary tuberculosis, as apparently cured 
by nuclein injections. In simple anemia, chlorosis, typhoid fever, debility 
from any cause, and convalescence from acute diseases, such as pneumonia 
and influenza, the beneficial results of nuclein medication are prompt and 
permanent (Aulde). Recent observations would seem to indicate that the 
evidence on which these claims are based is not convincing and the use of the 
nucleins therapeutically is no longer in vogue to any great extent. As bac- 
tericides the nucleins may prove useful by reason of their harmlessness to the 
human subject. 

Nucleins are prepared from separate animal tissues and glands, as the thy- 



I32 ANISUM. 

roid, thymus, liver, spleen, animal nucleins; also from all the tissues and glands 
combined, protonuclein, and from yeast cells, vegetable nuclein. Vaughn uses 
a solution of yeast nuclein, containing i per cent, of nucleinic acid. The dose 
of this solution is 30 minims, administered hypodermically, and increased daily 
as long as no unfavorable symptoms appear. Tablets of nuclein are on the 
market, for administration by the mouth, the dose being 1 grain or more, as 
may be deemed advisable. 

Sodium Nucleinate (Unofficial), — by injection into the muscles, in doses of gr. v once or 
twice daily in acute infections, produces a temporary leucolysis, followed by an enormous 
leucocytosis, especially of the polynuclear elements, and is asserted of value in acute 
infections or the acute exacerbations of chronic conditions, especially in appendicitis, 
peritonitis, acute and puerperal phlebitis, pyosalpinx, and general septicemia. 

Protonuclein (Unofficial), — is the trade-name of an extensively advertised product 
which is said to be a combination of nucleins obtained from all the available lymphoid struc- 
tures of bullocks and pigs, including the entire brain, the pancreas, liver, spleen, salivary 
glands, thyroid, thymus, gastric and intestinal glands, etc. The manufacturer claims that 
it is "the true tissue-builder of the organism" and its "natural antitoxic agent," and publishes 
the usual florid literature, which includes clinical reports of the theiapeutic efficacy of pro- 
tonuclein in some forty- five different affections. It is sold in tablets and powder; also in a 
special powder containing no milk-sugar, and intended for inhalations and injections. The 
dose is 3 grains every 3 or 4 hours. 

Lymphatic Extract (Unofficial). — An extiact prepared from the lymphatic glands of 
animals has been employed in exophthalmic goitre, lymphadenoma, and other glandular 
swellings, but there are no trustworthy reports as to the results. 

ANISUM, Anise, — is the ripe fruit of Pimpinella Anisum, a European 

plant of the nat. ord. Umbelliferae- It occurs in ovate bodies, J inch long, hairy, 

of grayish color, aromatic ordor, and sweet, spicy taste, resembling conium 

fruit in appearance. Dose, gr. v-x, [av. gr. viij.] 

Oleum Anisi, Oil of Anise, — is a volatile oil distilled from Anise, and represents the 
medicinal qualities of the plant. It contains Anethol, C10H12O, or Anise-camphor, congeals 
at 50 to 59 F., is soluble in an equal part of alcohol, and is an ingredient of Tinctura 
Opii Camphorata, and the two following preparations. Dose, ttj7j-v, [av. Trgiij.] 

Aqua Anisi, Anise Water, — has in 500 parts 1 of Oil of Anise triturated with Talc, and 
mixed with distilled water. Dose, indefinite, [av. 5iv.] 

Spiritus Anisi, Spirit of Anise, — is a 10 per cent, solution of the oil in alcohol. Dose, 
iTRxv-5ij, [av. TT£XXX.] 

The Volatile Oil is the active constituent of Anise. It has a slightly stimu- 
lant action on the heart and the digestive organs, and liquefies the bronchial 
secretion, being probably excreted in part by the bronchial mucous membrane. 
It is a favorite flavoring ingredient of cough-mixtures, and relieves slight in- 
testinal colic and flatulence in children. In full doses it has weak narcotic 
power. 

ANTHEMIS, Chamomile, — the flower heads of Anthemis nobilis, a European perennial 
of the nat. ord. Composite, collected from cultivated plants. They contain a volatile oil, a 
camphor and a bitter principle, but no alkaloid. Dose, gr. xx-5j [av. gr. xxx.] There are no 
official preparations. An infusion (3iv to Oj) may be given in doses of o j-ij. 

Oleum Anthemidis, Chamomile Oil (Unofficial), — the volatile oil, is of a dark blue or 
green color, and is composed of various ethers, the Angelates and Valerates of Butyl predomi- 
nating. Dose, rrjjij— x, on sugar. 



ANTIMONIUM. 1 33 

Incompatible with Anthemis are: Cinchona infusion, Gelatin, Iron and Lead salts 
Mercuric Chloride, Silver Nitrate. 

Chamomile is a stomachic tonic. It improves the appetite and aids digestion by increasing 
the vascularity of the gastric mucous membrane. In large doses the warm infusion is emetic, 
and perhaps diaphoretic, though the latter action is chiefly due to the hot water. The oil 
is remarkably efficient in reducing reflex excitability in frogs, even after its excitation by 
strychnine or brucine. 

Chamomile is popular in domestic practice. An infusion is used internally for many 
infantile complaints, and externally as a fomentation to relieve pain, as in colic. The oil 
is very efficient in reflex cough, pulmonary catarrh, acute dyspepsia, diarrhea of children, 
spasmodic asthma, whooping-cough, colic, and the spasmodic and pseudo-neuralgic affections 
of hysterical women. 

The Chamomilla of the homeopaths is the Matricaria Chamomilla, or German Chamo- 
mile, official in the U. S. Pharmacopoeia as Matricaria, which see. 

ANTIMONIUM, Antimony, Sb— Metallic antimony is not official, and 
is not used in medicine. It is represented, however, by the following official 
salt and preparations, viz. — 

Antimonii et Potassii Tartras, Antimony and Potassium Tartrate, (Tartar Emetic), 
2KSbOC 4 H 4 6 .H 2 0, — small white crystals or a granular powder of sweet, disagreeable 
metallic taste, soluble in 1 2 of water, and in 3 of boiling water, insoluble in alcohol. It is 
decomposed by alkalies, and by Lead salts. _ Dose, gr. T y- i, [av. expectorant,gr. T V, emetic, 
gr. \] but after tolerance is established as high as gr. ij may be given. It is an ingredient 
of the two following, viz. — 

Mistura Glycyrrhizae Composita, Compound Mixture of Glycyrrhiza, Brown Mixture, — 
contains Extract of Glycyrrhiza 3, Syrup 5, Acacia 3, Paregoric 12, Spirit of Nitrous Ether 
3, Tartar Emetic .02, water q. s. 100. Dose 5HJ- 

Syrupus Scillae Compositus, Compound Syrup of Squill, Cox's Hive Mixture, Hive 
Syrup (see under Sctlla), — contains about 1 grain of Tartar Emetic to the 5, with Squill, 
Senega, etc. Dose, ttjjj— 3 j, cautiously in children, [av. tijxxx.] 

Incompatibles. 

Incompatible with Tartar Emetic are: Acacia, Acids (mineral), Albumin, Alcohol, Alkalies, 
Ammonia, Ammonium Carbonate, Antipyrine, Bicarbonates, Carbonates, Calcium Chloride, 
Gelatin, Lead salts, Lime-water, Mercuric Chloride, Metallic salts, Sulphides, Tannic 
Acid, and astringent vegetable preparations. 



Physiological Action. 

Tartar Emetic in its action represents the antimonial preparations, and 
is a cardiac, arterial and general depressant, a protoplasmic poison, a systemic 
and local emetic, a specific gastro-intestinal irritant, an expectorant and a dia- 
phoretic. Like aconite, arsenic, hydrocyanic acid and potassium salts, it is 
destructive to protoplasm, destroying function in all nitrogenous tissue, and 
paralyzing the spinal cord, the motor nerves, the muscles and the sensory nerve 
terminations. It is especially depressant to the heart-muscle and the cardiac 
motor ganglia; it combines with the red blood-corpuscles, lessening their oxid- 
izing power, lowering the blood-pressure and reducing the body-temperature. 
Its taste is styptic and one of its earliest effects is the production of constric- 
tion of the fauces. It promotes waste and rapid excretion of waste products, 
carbonic acid and urea being especially increased. Being eliminated by all the 



134 ANTIPYRINA. 

excretory organs, including the skin, it excites follicular inflammation at the 
points of elimination; resulting in an eruption which is papular at first, then 
becomes vesicular, and finally pustular, the pustules being umbilicated like 
those of variola. This same eruption is also produced by the application of 
the drug to the skin with friction. Aphthous ulcerations, extending from the 
mouth to the stomach, with salivation and painful deglutition, may also result 
from its continued use. 

In small doses Tartar Emetic stimulates secretion in the bronchial and sali- 
vary glands, the stomach, intestinal canal, liver and pancreas. In larger doses 
it excites nausea, vomiting and purging, with evacuations like the "rice-water 
discharges" of cholera, and great prostration of the vital powers. Toxic 
doses produce similar symptoms, besides epigastric pain, cyanosis, delirium, 
cramps, motor and sensory paralysis, suppression of urine and collapse, — the 
same phenomena as in Asiatic cholera. 

Therapeutics. 

Tartar Emetic was formerly much employed as an antiphlogistic on account 
of its power to cut short acute inflammations of sthenic type, but its use was 
greatly abused, so that it has now gone out of fashion as a remedy. The contra- 
stimulant treatment of pneumonia and other inflammatory diseases, by large 
doses of this salt after tolerance was established, is only worthy of reference as 
an historical fact. The same may be said of its external use as a counter- 
irritant as well as of its employment as an emetic, in both of which capacities 
it is too severe, while its emesis is too tardy in action to be of any value in poi- 
soning. It is, however, a very efficient agent in many grave affections, if used 
in small doses (gr. -gV^V); being highly efficacious in acute inflammatory 
affections of the respiratory tract, especially pneumonia, broncho-pneumonia, 
feverish and catarrhal colds, bronchitis, laryngitis and tonsillitis. In many 
respects it acts like Aconite in these and kindred affections, producing copious 
diaphoresis, slowing the pulse and allaying restlessness. It is considered a 
good remedy in puerperal peritonitis, mammitis, and orchitis, in lumbago and 
other muscular rheumatisms, also in photophobia and in gastric indigestion 
after beer-drinking. In still smaller doses (gr. tto" hourly) it is particularly 
efficient in catarrhal inflammations of the respiratory mucous membrane in 
children, accompanied by rattling breathing and much mucus, which is ex- 
pelled with difficulty. Such cases often simulate asthma, the attacks being 
marked by cough, wheezing, and difficult respiration, with sibilant rales in the 
chest, and usually follow on severe colds or on measles. The Compound 
Syrup of Squill is commonly used as an expectorant and nauseant in the treat- 
ment of bronchitis and croup, but the quantity of tartar emetic in it (gr. j to the 
5) should be remembered when administering it to children. (See under 
Scilla.) 

ANTIPYRINA, Antipyrine, Phenyl-dimethyl-pyrazolon, C n H 12 N 2 0- offi- 
cial in the B. P. under the name Phenazonum, Phenazone, — is a crystalline 



ANTIPYRINA. 135 

substance obtained from phenyl -hydrazine, and prepared by a patented and 
complicated process. It is a synthetical base, forming salts which are analo- 
gous to those of Ammonium; and occurs as white and inodorous crystalline 
powder, with a bitter taste, freely soluble in water, alcohol and chloroform, 
less soluble in ether. It gives a deep red color with ferric chloride, a deep 
green with nitrous acid, and with nitric acid a yellow color which deepens to 
crimson on warming. Dose, gr. j-x [av. gr. v.] 

Dose and Administration. 

The B. P. gives the dose as gr. v-xx. For children the dose is gr. J per year of age 
between 2 and 10 years, not exceeding gr. iv for any child under 15 years. It has but little 
flavor, is not unpleasant to the taste, and is readily taken by children. It is best given in 
aqueous solution with one-half its quantity of Sodium Bicarbonate. In capsule or powder 
it frequently irritates the stomach. It may be used hypodermically, in half its weight of 
hot water, but sphacelus is liable to follow on this method. 

Incompatibles. 

Incompatible with Antipyrine are: Alum, Ammonia-water, Amyl Nitrite, Benzoates, 
Beta-naphtol, Bromine, Butyl-chloral Hydrate, Calomel, Chloral Hydrate, Copper Sulphate, 
Chromic Acid, Cinchona alkaloids, Euphorin, Ferric Chloride, Ferric salts in solution, Ferro 
Sulphate, Hydrocyanic Acid, Iodine, Iodides, Lead Subacetate, Mercuric Chloride, Nitrites, 
Orthoform, Phenol, Potassium Permanganate, Pyrocatechin, Pyrogallol, Resorcin, Sodium 
Bicarbonate, Sodium Salicylate, Spirit of Nitrous Ether, Tartar Emetic, Tannic Acid, Thymol, 
Urethane; also Tinctures of Catechu, Cinchona, Hamamelis, Iodine, and Rhubarb; and 
Infusions of Catechu, Cinchona, Rose-leaves, and U va Ursi. 

Antipyrine and Euphorin liquefy when rubbed together. Antipyrine may be decomposed 
when brought into contact with Nitrous compounds, a new and poisonous substance being 
supposed to be formed, of uncertain composition, but resembling the Aniline greens. The 
mixture of this drug with Spiritus ^Etheris Nitrosi is therefore highly dangerous if this sup- 
posed reaction is at all likely to occur. 

Unofficial Preparations and Derivatives. 

Ferropyrin, — is a compound of 3 molecules of Antipyrine with 1 molecule of Ferric 
Chloride, and contains of Antipyrine 64 per cent., of Ferric Chloride 36 per cent. It occurs 
as an orange-red, impalpable powder, soluble in 5 of water, freely in alcohol, insoluble in 
ether. Incompatibles are Alkalies, Carbonates, and Bicarbonates. Dose, gr. v-viij internally; 
as a styptic a 20 per cent, aqueous solution. 

Pyramidon, Dimethyl-amido-antipyrine, — is a derivative of Antipyrine by a substitution 
process, and is highly praised as an antipyretic and analgesic. It occurs as a yellowish- 
white, crystalline powder, soluble in 10 parts of water. Its applications are the same as 
those of Antipyrine, but it is less soluble, slower in action, more lasting in effect, and the same 
results may be produced by it with about one-third the dose. Dose, gr. iv-viij, thrice daily. 

Pyramidon Acid Camphorate, — an acid salt of pyramidon and camphoric acid. It is 
claimed that this combination exerts the antipyretic effect of pyramidon and antihydrotic 
action of camphoric acid. It is said to be especially useful in the fever of tuberculosis 
associated with profuse sweating. Dose, gr. xij-xv. 

Pyramidon Neutral Camphorate, — a neutral salt of pyramidon and camphoric acid. 
In this neutral salt the antipyretic effect of pyramidon predominates in contrast to the acid 
salt above in which the antihydrotic effect of the camphoric acid predominates. Uses and 
dose, same as acid salt. 

Pyramidon Salicylate, — a salt of pyramidon and salicylic acid. It is useful in gouty 
and rheumatic affections. Dose, gr. v-x. 

Salipyrin, Antipyrine Salicylate, — is formed by combining Salicylic Acid 57.7, and Anti- 
pyrine 42.3 parts; and is the only salt of the base which has much therapeutic importance. 
Described under Salicinum. 



136 antipyrina. 

Physiological Action. 

Antipyrine is a powerful antipyretic, a local anesthetic, and a general anal- 
gesic, also possessing diaphoretic, mydriatic, antiseptic, hemostatic and slight 
hypnotic powers. After the ingestion of a large medicinal dose (gr. xx), there 
is a stimulant stage of short duration, in which the heart's action is increased, 
and a subjective sense of heat is experienced, with flushing of the face. This 
is soon followed by profuse sweating, coldness of the surface, slowed pulse, 
considerable depression, and by lowered temperature if fever be present; the 
latter effect coming on within half an hour after taking the drug, and its degree 
being in direct ratio to the quantity, administered, as also its continuance, — the 
former usually from. 3 to 5 degrees, and the latter from 1 to 10 hours, a fair 
average being about 2 hours. In one case a fall of i2°F. was observed. When 
given with Kairine, the mixture of the two drugs has been found to produce a 
much greater fall of temperature, with longer continuance down, than that 
produced by an equal quantity of either drug given alone. After the anti- 
pyretic effect of the dose has passed off, the temperature in fever commences 
to rise again, — the onset being usually preceded by a chill, which is of slight 
degree when compared with the severe rigors and dangerous depression occur- 
ring under the action of kairine, chinoline and other members of the group. 

In health the administration of *a full dose gives rise to slight nausea, sing- 
ing in the ears, and a reduction of the body-temperature of scarcely any extent, 
about iV F. It sometimes induces vomiting and may cause such a degree of 
depression as to almost amount to collapse. It has little or no effect upon 
the respiration, but acts as a sedative upon the cerebrum, leaving a somew T hat 
depressant influence on the brain. In some persons a single dose of ten 
grains produces an urticarial eruption on the skin, and this is occasionally 
accompanied by swelling and irritation of the mucous membrane of the 
respiratory tract, the subject feeling as if the nose and throat were swollen so 
that breathing becomes difficult. 

In toxic dose Antipyrine probably acts as a primary stimulant and a second- 
ary depressant of the spinal cord, paralyzes both the motor and sensory nerve 
trunks, decreases the arterial tension, and exerts a poisonous influence on the 
blood, altering the shape of the red corpuscles, separating the hematin, and 
causing decomposition of that tissue. A peculiar livid discoloration of the 
surface is one of the most characteristic symptoms of antipyrine poisoning, and 
is probably due to the formation in the blood of methemoglobin or some similar 
compound. 

As an antipyretic, Antipyrine acts by increasing heat dissipation and 
decreasing heat production. Its action is largely central by " increasing the 
resistance of the heat regulating centre to the disease poisons" (Bastedo). 
In health no influence is exerted on the temperature of the body. As an 
analgesic it has considerable power, especially in the pains of neuralgia, neu- 



ANTIPYRINA. 137 

ritis or disease of the central nervous system. It acts by depressing sensory 
nerves and pathways concerned with the perception of pain, which action is 
frequently obtainable with small doses. In general anodyne action, it is 
not to be compared with the derivatives of opium. Its hemostatic power is 
claimed to be superior to that of ergot. It is rapidly absorbed and slowly 
eliminated, so that it should not be administered in frequently repeated doses. 

Therapeutics. 

One of the most popular of the modern antipyretics, Antipyrine deserves 
high rank in professional esteem, being an excellent analgesic and one of the 
most certain and most powerful depressants of temperature, though somewhat 
dangerous, and devoid of any other influence upon the course of febrile dis- 
orders. Its principal applications are as follows: As an antipyretic it has been 
employed in all diseases with high temperature, and it may be used in asthenic 
fevers, as it has little effect upon the circulation. It has held a high place for 
several years in the treatment of acute rheumatism, and affords valuable aid 
in the pyrexia of intermittent fever, a stage in which the slow action of quinine 
prevents that drug being available for immediate relief. As an analgesic it is 
highly efficient except when the pain is dependent upon a local inflammation, 
in which case it is of no value for this purpose. It is often remarkably effi- 
cient in migraine and other headaches, in the fulgurant pains and pain-crises 
of locomotor ataxia, and in other paroxysms of suffering dependent on disease 
of the nerve centres, or having the character of nerve storms. It is very service- 
able in neuralgia, neuritis and other painful affections, especially when of rheu- 
matic origin, as lumbago, sciatica, hemicrania, supra-orbital neuralgia, in which 
ten-grain doses are generally sufficient and may be given hypodermically. It 
often relieves dysmenorrhea, also the painful affections of hysteria, pain from 
cerebral tumors, and that due to cardiac disease. In acute gout, a preliminary 
dose of 25 grains, followed by 10-grain doses every two hours, promptly relieved* 
the pain and shortened the duration of the paroxysms in one very carefully ob- 
served and thoroughly reported case. In chronic gout, very remarkable results 
are reported as due to it, indicating a specific and curative influence on that 
disease. For the relief of pain, the conjoint administration of Antipyrine and 
Morphine is said to be much more efficient than the use of either agent alone. 
To allay nervous irritation; it has been used with extraordinary success in nervous 
urticaria, and is often employed with benefit in the restlessness of hysterical 
subjects. In the urticaria-like eruptions of children its action is so promptly 
efficient as to indicate for it a direct influence upon the vascular nerves; and 
as a symptomatic remedy against itching it is equally efficient in nervous pruri- 
tus, true prurigo, urticaria, erythema, pemphigus vulgaris and lichen ruber. To 
antagonize excitability of the motor nerve centres, as in laryngismus stridulus, 
whooping-cough, tetanus, epilepsy and chorea. In the latter disease Anti- 
pyrine is held in high esteem as a curative remedy, and although it often fails 



138 APIOLUM. 

entirely in epilepsy, it sometimes acts therein with extraordinary power, espe- 
cially when given in combination with ammonium bromide. As a preventive 
remedy for whooping-cough it ranks high among the remedies used for that 
purpose. To affect secretion, as in infantile diarrhea, in which it has rendered 
signal service, administered in doses of J to i£ grain; and as an antigalactagogue, 
when it is desired to arrest the secretion of milk, doses of gr. iv every two hours 
will prove efficient. It has also been employed with benefit in both forms of dia- 
betes, and has been found remarkably effective in promoting the absorption of 
pleuritic effusions. As a local anesthetic it is" equal if not superior to cocaine, 
if applied to the mucous membranes in a 30 to 50 per cent, solution (St. Hilaire). 
As a local hemostatic, it is highly efficient in 15 per cent, solution as a spray 
for epistaxis, and hemorrhages of almost any kind are checked by the applica- 
tion of stronger solutions. It has the advantage of constricting the small ves- 
sels without causing any external clot which may break down. As an anti- 
septic though feeble it possesses properties which compare favorably with those 
of the aniline and coal-tar derivatives. 

Antipyrine has rendered good service in bronchial asthma, in sea-sickness, 
in cerebro-spinal meningitis, and in croupous pneumonia. In the latter affec- 
tion it has been employed in combination with camphor and small doses of 
morphine with excellent results. In erysipelas it is thought to be contraindi- 
cated, as when administered in that disease it has usually caused anuria and 
a profound fall of temperature. In doses of gr. vij, up to a daily maximum of 
3j, it has rendered good service in puerperal septicemia. The profuse sweat- 
ing caused by it may be prevented by giving in advance a small dose of 
atropine. 

Ferropyrin is used as a styptic in 20 per cent, aqueous solution on cotton 
tampons, or applied directly in the form of the powder. It has given satis- 
faction in severe epistaxis, puerperal and other hemorrhages. Internally it 
has been used with benefit in anemic conditions accompanied by headache 
and gastralgia, and in the dyspepsia of chloranemia. 

APIOLUM, Apiol, (Unofficial), — is an oily liquid, of green color, acid 
reaction and pungent taste, soluble in alcohol, ether, chloroform, and in glacial 
acetic acid. It is extracted from the fruit of Petroselinum sativum, Parsley, 
a biennial plant of the nat. ord. Umbelliferae, which also contains a gelatinous 
substance named Apiin, and a Volatile Oil which is by some considered to be 
the true emmenagogue principle of the plant. Liquid Apiol is official under 
the name Oleoresina Petroselini, Oleoresin of Parsley Fruit, prepared by ex- 
tracting Parsley Fruit with ether, recovering the ether distillation and spon- 
taneous evaporation. Dose, TUv-xv [av. Tfl.viij]. 

A camphor, also named Apiol or Apiolum Crystallisatum, is obtained from the same 
source, and occurs in white needles, of a feeble parsley odor, insoluble in water, but freely- 
soluble in alcohol or ether. Dose, gr. xv as an antiperiodic, gr. ij-v against dysmenorrhea. 



APOCYNUM— AQUA. 1 39 

In small doses (nxiij— v) Apiol is carminative, diuretic, diaphoretic, expector- 
ant, and stimulant to the circulation. In full doses (rn_xv) it is decidedly em- 
menagogue and feebly antiperiodic, but produces headache, tinnitus aurium, 
intoxication, and giddiness, its action generally resembling that of quinine. 
Large doses (rt|Xxx-5 j) are decidedly narcotic. 

Apiol has had some reputation in intermittents and in malarial neuralgiae, 
but is most frequently employed in amenorrhea and dysmenorrhea, being of 
especial advantage in the amenorrhea of anemia, also when the menstrual 
discharge is fetid. It is becoming fashionable as a supposed abortifacient, 
but is useless for this purpose, and if freely used may produce decided narcot- 
ism, especially if the preparation employed should happen to be an active one. 
Cases of poisoning by Apiol are seldom seen, as the French preparation in cap- 
sules sold in this country over the counters of drug-stores to any applicant are 
generally inert for either good or evil, though an important source of revenue 
to the druggists. 

APOCYNUM, Canadian Hemp (Unofficial), — is the root of Apocynum cannabinum, 
the Dog-bane, an indigenous perennial plant of the nat. ord. Apocynaceae, and is inodorous, 
but of bitter, disagreeable taste. It contains the glucosides apocynin and apocynein. 
Dose of the powdered root, gr. v-xxx, [av. gr. xv.] A decoction (§ss to the pint) may be 
given in doses of 5 j-i j thrice daily. 

Apocynum is powerfully emetic and cathartic in full doses, also diaphoretic, expectorant 
and actively diuretic. It lowers the pulse-rate and raises arterial pressure similar to that of 
Digitalis. It should not be confounded with the Indian and American Hemps (Cannabis 
sativa), which have entirely different qualities. 

The only condition in which Apocynum has proven of much value is dropsy, especially 
ascites and the anasarca of B right's disease, in which 15-grain doses are indicated. A 
fluidextract was formerly official in the dose of ttjjx-xxx, 

Apocynum Androsaemifolium (Unofficial), — is said to act chiefly on the liver and the 
mucous coat of the gastro-intestinal canal. It is reported to be an ideal cholagogue and to 
have proved almost specific in the so-called "bilious" condition. 

AQUA, Water, H 2 0, — is potable water, in its purest attainable state; a 
colorless limpid liquid, devoid of odor or taste, and of neutral reaction. Be- 
sides entering into the composition of most of the official extracts, fluid extracts, 
and many other pharmaceutical preparations, from it are prepared the 18 offi- 
cial Waters (Aquae), and also the following: — 

Aqua Destillata, Distilled Water, — H 2 0, — 1000 parts of water are distilled, the first 
100 parts obtained being thrown away, 750 parts are preserved. It is as near chemically 
pure water as can be obtained. 

Aqua Destillata Sterilisata, Sterilized Distilled Water, — is as its name implies distilled 
water collected in sterile container, and boiled for thirty minutes. 

Aqua Carbonata, Carbonated Water, Soda Water (Unofficial), — is described on p. 201. 

Incompatible with Water are: Alcoholic extracts and tinctures, Alkaloids generally (not 
their salts), Collodion, Fats, Oils, Resins, Resinous extracts and tinctures, Gum-resins. 

Mineral Waters. 

Natural Water differs from distilled water in containing saline and other 
constituents in varying proportions, — from common water (aqua communis), 
in which they are so small in quantity as not to alter the taste, color, etc., up 



140 AQUA. 

to sea-water, having 3^ per cent., and that of the Dead Sea with 26^ per cent. 
Spring waters, impregnated with foreign substances so as to have a decided 
taste and a marked action on the human system, are called Mineral Waters, 
which may be subdivided into various groups, according to their prevailing 
constituents, as Carbonated, Alkaline, Saline, Sulphuretted, Silicious, etc. Full 
analyses of all the principal mineral waters of Europe and America are given 
in Squire's Companion to the British Pharmacopoeia, also in the 15 th edition 
of the United States Dispensatory, but a few of the most prominent will be 
mentioned here. 

Alkaline Mineral Waters. 

Ems, Germany. Bladon Spring, Ala. Hot Spring, Va. 

Salzbrunn, Germany. Congress Spring, Cal. Warm Spring, Va. 

Gleickenberg, Austria. Seltzer Spring, Cal. Berkeley Spring, Va. 

Vichy, France. St. Louis Spring, Mich. Bethesda Spring, Wis. 

Vals, France. Buffalo Lithia Spring, Va. Gettysburg Spring, Pa. 

These waters are generally cold, those of Vichy and Ems being warm. They contain 
a considerable amount of Sodium Carbonate, also Sodium Chloride and Sulphate, and various 
other Chlorides, Carbonates and Sulphates, with Carbonic Acid gas in varying quantity. 
Vichy and Vals waters depend for their efficacy almost wholly on the quantity of Sodium 
Carbonate contained in them, which is for Vichy from 26 to 50 grains and for Vals about 
60 grains to the pint. 

Saline Mineral Waters. 

Friedrichshall, Germany. Seidlitz, Bohemia. Kreutznach, Prussia. 

Hunyadi Janos, Germany. Marienbad, Bohemia. Saratoga Springs, N. Y. 

Baden-Baden, Germany. Cheltenham, England. Ballston, N. Y. 

Wiesbaden, Germany. Kissingen, Bavaria. Hot Springs, Arkansas. 

Carlsbad, Bohemia. Reichenhall, Bavaria. St. Catherine's, Ontario, 

Piillna, Bohemia. Adelheidsquelle, Bavaria. Canada. 

These waters are of more complex composition, the various waters of Saratoga contain- 
ing more than thirty constituent salts. Those usually present are the Sulphates and Car- 
bonates of Sodium, Calcium, Magnesium, etc. (Magnesian waters); Chlorides of Sodium, 
Potassium and Lithium (Chlorinated waters); Ferrous salts (Chalybeate waters), with Iodine, 
Bromine, Manganese salts, and Phosphates in some few. Carbonic Acid gas is present in 
all. Most of them are purgative, some are considered alterative, and many are warm (ioo°- 
160 F.). 

The most powerful member of the saline group is Hunyadi Janos, which contains about 
150 grains each of Magnesium and Sodium Sulphates to the pint, and is, therefore, effectively 
purgative. Nearly as strong is Piillna water, with 124 grains of Sodium Sulphate and 93 
grains of Magnesium Sulphate to the pint. Friedrichshall is less powerful, but perhaps a 
better aperient water in doses of 6 to 10 fluid ounces. Marienbad contains no Magnesium 
Sulphate, but has 36 grains of Sodium Sulphate, 9 of Sodium Carbonate, 11 of Sodium Chloride, 
and a small quantity of Ferrous Carbonate to the pint; in transportation, however, it loses its 
Carbonic Acid and deposits the Iron. It is not aperient in ordinary doses. Carlsbad water 
contains 20 grains of Sodium Sulphate and 9 each of Sodium Carbonate and Chloride to the 
pint. The so-called "Carlsbad Salt" is simply Sodium Sulphate with a trace of the Carbon- 
ate. Hartnack gives the following formula for its artificial preparation; Sodium Sulphate 100 
parts, Sodium Bicarb. 80, Sodium Chloride 40; a dessertspoonful in water as a mild saline 
purgative. These waters are imported into, and made in the United States in large quantities, 
and may be ordered through any druggist. 

Sulphurous Mineral Waters. 

Aix-la-Chapelle, Prussia. Llandrindrod, Wales. Sharon Spring, N. Y. 

Bareges, S. France. Harrowgate, England. Yellow Sulphur Spring, Va. 

Eaux-Bonnes, S. France. Blue Lick Spring, Ky. White Sulphur Spring, W. Va. 

These waters all contain Sulphuretted Hydrogen gas, also Carbonic Acid gas and Car- 
bonates, Chlorides and Sulphates of Sodium, Potassium, Magnesium and Calcium; some- 
times Carbonate and Oxide of Iron, Iodide and Bromide of Sodium. 



AQUA. 141 

Carbonated Mineral Waters. 
These waters are cold, contain generally Carbonates of Calcium, Magnesium and Sodium 
(in some, Iron), which are held in solution by the excess of Carbonic Acid, also Chlorides 
of Sodium and Potassium, Sulphates, Phosphates, etc. They are described under Carboneum. 

Silicious Mineral Waters. 
Hot Springs, Iceland. Geysers of Yellowstone Park. 

The constituents of these waters are chiefly alkaline Silicates. 

Physiological Action of Water. 

Water is an essential constituent of all the tissues of the body, forming from 
0.2 per cent, of the enamel of the teeth to 77 per cent, of the ligaments. In 
the liquids of the organism it is contained in the proportions of 78 per cent, 
of the blood to 93 of the urine, and 99 of the tears. 

Cold water applied externally, as by a bath (4o°-6o° F.), abstracts a por- 
tion of the body-heat, lowering the surface temperature and depressing the cuta- 
neous nerves, producing spasmodic breathing and a quickened pulse. If the 
temperature of the water is not too low and the bodily vigor is good, reaction 
soon occurs, and the general effect is tonic to the muscular power, to the circu- 
lation and the respiration. If this does not take place a secondary chill occurs, 
and serious depression may result. Internally in moderate quantity during 
meals it is necessary to digestion, but in large quantity it impairs digestion by 
diluting the gastric juice so much as to weaken it. Ice-cold water, if freely 
used, suspends the action of pepsin, depresses the nerves of the stomach, and 
lowers its blood supply. The free use of water internally produces increased 
cutaneous and renal excretion, and promotes the elimination of some of the 
products of tissue-change, as urea and phosphoric acid. In some subjects it 
favors the deposition of fat, and with many persons a glassful of water taken 
before breakfast will act as a laxative. 

Warm water (95°-ioo° F.) applied to the surface of the body, as by baths 
of water or steam, packing, etc., acts in the opposite manner at first, increasing 
the circulation in the skin, the rapidity of the pulse and respiration and the 
body-temperature. Rapid tissue-change occurs, the waste products being elim- 
inated chiefly by the skin and the pulmonary mucous membrane. If long con- 
tinued, precordial oppression, giddiness and muscular debility are experienced. 
Warm water internally often causes nausea and vomiting, but hot water, sipped 
in small quantity frequently, will alleviate these symptoms in many cases. 

Hot water (iio°-ii2° F.) at first dilates the vessels of the part to which 
it is applied, and soon afterwards contracts them. It is a valuable means of 
relieving congestion and inflammation, and is a most effective hemostatic when 
the bleeding is from small vessels or of capillary character. Whether generally 
or locally applied it is one of the most reliable means of relieving spasm. Hot 
vapor applied to the surface accelerates the circulation and produces profuse 
sweating. Its general action is similar to that of warm water. 

Mineral waters taken internally act chiefly by virtue of the water, partly 



142 AQUA. 

in accordance with the effects of their various constituents. As baths, their 
action is doubtless entirely due to their temperature. 

Pathogenic Microbes of several diseases, notably those of cholera and typhoid fever, 
are conveyed to the human system in drinking water contaminated therewith. But these 
organisms are destroyed by a temperature of 212° F., that of boiling water, which if main- 
tained for fifteen minutes, destroys the pathogenic organisms. This fact is of the high- 
est practical importance, as it shows that no germs of disease need ever gain entrance to 
our bodies through our drinking water, if only we will boil it. Many years ago an English 
physician's report was quoted in Braithwaite's Retrospect, in reference to the immunity of 
the Chinese from typhoid fever, though he said that in Pekin there was no system of sewerage, 
but that all excreta were thrown on the ground to find their way into the watercourses by 
which the city was supplied, to soak into wells, etc. Yet, the author said, that contrary to 
all experience elsewhere, typhoid fever was unknown in Pekin. The reason is to be found 
in the fact that the Chinese boil all the water they drink. Those who know them best say 
that they never drink cold water, but always tea, *. e., boiled water. There must be some 
reason for their remarkable health under adverse hygienic surroundings. 

Therapeutics of Water. 

Cold water (or ice) has many external applications of value in the treat- 
ment of disease. Cold baths are the most effective antipyretic in the high 
temperature of fevers, and the cold wet pack is used for the same purpose. 
Ice or cold water is applied to the head in acute cerebral congestion, and to 
the spine in chorea; also locally in hemorrhoids, bubo, orchitis, and to the 
uterus in post-partum hemorrhage. Cold affusion to the body is employed as 
a preventive of spasmodic croup, as well as to lessen susceptibility to taking 
cold. 

Hot water externally, as fomentations, hot wet packs, baths, etc., is most 
effective in reducing local congestion and setting up resolution of local inflam- 
mation. Hot fomentations to the renal region are useful in functional inactivity 
of the kidneys. The hot spinal douche is used in affections of the spinal cord 
and meninges, and in the backache of women. The hot wet pack is highly 
esteemed in inflammation of the thoracic organs. The vaginal hot water douche 
is valued by gynecologists for many morbid conditions of the uterus and its 
appendages, especially catarrh of the vaginal and cervical mucous membrane, 
subinvolution of the uterus, also congestive, swollen and neuralgic conditions 
of the ovaries, tubes and adjacent tissues. The continuous hot water bath 
was commended in skin diseases by Hebra, who administered it in cases of ex- 
tensive burns, psoriasis, pemphigus and variola. In certain types of insanity 
characterized by marked mental and physical unrest the continuous immer- 
sion in a warm bath often succeeds in quieting the patient promptly when 
other sedatives fail. The continuous immersion in very hot water of an 
indolent wound, ulcer or sore, is a method of great efficiency for the promotion 
of the healing process in cases which have resisted the ordinary stimulant 
applications. Hot water dressings for wounds are strongly favored by many 
high surgical authorities. Vapor and Turkish baths are used as diaphoretics 
in advanced kidney disease, in acute and chronic rheumatism, mineral poi- 
soning, and syphilis. Warm baths, with cold applications to the head, are 
esteemed of value in infantile convulsions and chorea. 



AQUA. I43 

Internally, water is chiefly of value as a diuretic, and if hot as a diaphoretic. 
A glass of cold water before breakfast daily is often an effective means of over- 
coming constipation, while the drinking of hot water an hour before each meal 
has been of great value to many dyspeptics. The value of the popular teas in 
chronic diseases is almost entirely due to the diluent, diuretic and diaphoretic 
actions of the hot water used. Large draughts of water at regular intervals 
between meals are extremely useful in renal insufficiency, acute B right's dis- 
ease, acute cystitis, gravel, and gout, increasing the urinary flow and the ex- 
cretion of urea, washing out the kidneys, lessening renal irritation and pro- 
moting the excretion of uric acid. 

The various methods of introducing water into the body, by enteroclysis, 
hypodermoclysis, and infusion, are of great therapeutic value, and have almost 
entirely replaced the older measure of the transfusion of blood into the cir- 
culation. The normal saline solution (5j of sodium chloride to the pint of 
water) is preferred to plain water, as it does not injure the blood corpuscles, and 
prevents the abstraction of vital salts when used in the intestinal canal. Entero- 
clysis is the irrigation of the colon by large clysters of water, plain or medicated, 
hot (10 1° to 103 F.) or cold (65 F.), for the purposes of cleansing the canal, 
relieving intestinal obstruction, promoting diuresis and the elimination of toxins, 
preserving the body heat, and reducing fever; also as a stimulant in shock 
and collapse, and to supply lost fluid after copious hemorrhages, hyper-pur- 
gation, and other drains of the system. From 2 to 4 quarts may be used if 
injected slowly, and with proper position of the subject and suitable appliances, 
the injection may be carried to the caput coli. The medicinal agents usually 
employed are Sodium Chloride 1 to 140, making the normal saline solution, 
Tannic Acid 0.5 to 2 per cent., Boric Acid 1 to 500, Quinine Sulphate 1 to 1000, 
and Silver Nitrate 1 to 1500; the two latter agents being used in amebic and 
chronic dysentery. Hypodermoclysis is the deep injection into the cellular 
tissue of a sterilized normal solution. When slowly administered, and at dif- 
ferent sites, from J pint to a pint, at a temperature of about ioo° F., may be 
introduced without much pain or local irritation. The sites usually chosen 
are the thigh, buttocks, back, breast, and in women the sub-mammary region. 
Infusion is the injection of a sterilized normal saline solution, at a temper- 
ature of 120 F., directly into the vascular system, usually through a vein. 
These methods have proved extremely valuable in shock, hemorrhage, sepsis, 
uremia, diarrhea, acute, chronic and amebic dysentery, cholera, typhoid fever, 
poisoning by alkaloids, and other toxemic conditions. 

Therapeutics of the Mineral Waters. 

An undue value is placed by the laity and interested proprietors on the 
medicinal value of mineral waters, causing the various localities of the best 
advertised springs to become resorts for invalids and idlers from every civil- 
ized country. The benefit derived is in most instances due to the change of 



144 ARGENTUM. 

climate and scene, freedom from home cares and business worry, regularity 
of life and diet, drinking of water in quantity, and in many cases the substitu- 
tion of water for alcoholic beverages. In order to get the worth of their money, 
people will gladly submit to rigid hygienic and dietetic restrictions at a water- 
ing-place which they would totally ignore under treatment at home. The same 
may be said of the treatment at the so-called " hydropathic " or " water-cure' ' 
establishments. As a rule, those springs will prove of most value which are 
furthest removed from the patient's residence, — for " distance lends enchant- 
ment" in these matters as well as in many others. Invalids whose homes are 
in the vicinity of some wonder-working spring will not usually derive much 
benefit from its water, but will by that of another spring, similar in constituents, 
but located several hundred miles away. 

The principal affections in which mineral waters are esteemed most highly 
are the following: dyspepsia, cirrhosis of the liver, gout, rheumatism, lithiasis, 
diabetes of hepatic origin, constipation, obesity, plethora of the pelvic organs, 
hypochondriasis, skin diseases, especially those dependent on gastric derange- 
ment, phthisis, constitutional syphilis, and metallic poisoning, in all of which 
the influences above mentioned are especially efficacious, and are no doubt the 
chief factors in producing any benefit which may be attainable. Aperient 
and purgative waters are useful in many cases where a prejudice exists 
against purgative medicine, but none against the same agents in a natural 
water. The strong saline-aperient waters, as Carlsbad, Hunyadi, and Fried- 
richshall, have considerable repute in the treatment of the uric-acid diathesis 
and calculous affections, and the waters of St. Catherine's wells are credited 
with decided influence upon local and chronic rheumatism. 

The special therapeutics of mineral waters are found in this volume under the heads 
of their principal constituents, as Acidum Carbonicum, Sodium Chloride, Sodium Sulphate, 
Magnesium Sulphate, etc.; also in the therapeutical part of the book. 

ARGENTUM, Silver, Ag, — is a white, lustrous metal, which occurs in the 
free state, also as a sulphide, a chloride, and other compounds. It resists the 
action of oxygen and caustic alkalies, but is attacked by sulphur, sulphides, 
and nitric acid. In medicine it is represented by three official salts, and a 
large number of unofficial compounds. 

Official Salts of Silver. 

Argenti Nitras, Silver Nitrate, AgNo 3 , — occurs in colorless rhombic crystals, of bitter 
caustic taste and neutral reaction, soluble in 0.4 of water and in 30 of alcohol. Is best given 
in pill with Kaolin, or in distilled water; never with tannin or a vegetable extract, lest an 
explosive compound result. Dose, gr. £-£, [av. gr. £.} — if watched, up to gr. j may be given. 
When melted with 4 per cent, of Hydrochloric Acid, it makes — 

Argenti Nitras Fusus, Moulded Silver Nitrate, (Lunar Caustic), — for local use as a 
mild caustic and astringent. Argenti Nitras Mitigatus, Mitigated Silver Nitrate, — is the 
same salt melted with twice its weight of Potassium Nitrate. It is used locally by ophthal- 
mologists. The mitigated silver nitrate is not official. 

Argenti Oxidum, Silver Oxide, Ag 2 0, — a brownish black powder, nearly insoluble in 
water and insoluble in alcohol. It is liable to decompose with violence when mixed or trit- 



ARGENTUM. I45 

urated with readily oxidizable or combustible substances, as creosote, phenol, potassium 
permanganate and many others. It should not be brought into contact with ammonia. 
Dose, gr. |-ij [av. gr. j] in pill with Kaolin. It is not a dangerous internal remedy. 

All the silver salts should be protected from light in dark blue or amber-colored vials. 

Incompatibles. 

Incompatible with the Nitrate are: Acetates, Alkalies, Alcohol, Antimony salts, Arsenites, 
Bromides, Carbonates, Chlorides, Chromates, Creosote, Cyanides, Copper salts, Ferrous 
Sulphate, Glucose, Hypophosphites, Iodides, Morphine salts, Oils, Manganous salts, Organic 
substances, Phosphates, Sulphides, Sulphates, Tartrates, Vegetable astringent infusions and 
decoctions. Incompatible with the Oxide are: Antimony and Arsenic Sulphides; Salts of 
Bismuth, Copper, Iron and Mercury; Creosote, Iodine, Organic substances, Phosphorus, 
Tannic Acid. 

Unofficial Silver Compounds. 

Albargin, — is a compound of silver nitrate with gelatose containing about 15 per cent, 
of silver. It is a coarse, yellow powder, very soluble in water and used as a substitute for 
silver nitrate. 

Argentamin, — is a patented preparation consisting of Silver Nitrate 10 per cent., 
dissolved in a 10 per cent, solution of Ethylene-diamine. It is an efficient antiseptic and 
astringent, but the alkaline diamine renders it somewhat irritant. Aqueous solutions of 
various strengths, from 1 in 5000 to 1 in 1000, are recommended as urethral injections in 
gonorrhea. 

Argonin, — is a patented combination of Silver (4 per cent.), Casein and an alkali, occur- 
ring as a white powder which is soluble in hot water, non-irritant, not precipitated by chlorides 
or albumin, and does not stain the hands or clothing. It is a weaker antiseptic than argenta- 
min or silver nitrate, and has no effect on intestinal microbes. In the conjunctival sac its 
solutions are non-irritant, but it is said to give good results in catarrhal and purulent con- 
junctivitis. In gonorrhea a 2 per cent, aqueous solution is first used, the strength being 
gradually increased up to 10 per cent. Its solutions should be protected from the action of 
light. 

Argyrol, Silver Vitellin, — contains 20 to 25 percent, of silver, and is very soluble in water. 
It is absolutely painless and non-irritant, even in concentrated solutions on the conjunctiva. 
Solutions of 2 to 10 or 20, per cent, strength are used as local astringents, of 1 in 1000 for 
irrigating the vagina, bladder, and urethra. It is strongly bactericidal and has great pene- 
trative power. 

Collargol, Soluble Metallic Silver, Colloidal Silver, — is an allotropic form of silver, con- 
taining 78 per cent, of the metal. It is soluble in 25 of water. Solutions of 1 in 10,000 
to 1 in 5000 are used for irrigating the bladder, and as dressings. Dose, by the mouth, gr. 
j, intravenously gr. iij-vij, in \ to 1 per cent, solutions in distilled water. 

Ichthargan, Ichthyol Silver, — a compound of silver and ichthyol-sulphonic acid, con- 
tains 30 per cent, of metallic silver in organic combination. Solutions of 1 in 2000 to 1 in 
500 are used in gonorrhea. It is freely soluble in water, diluted alcohol, or glycerin, and 
is claimed to be more strongly bactericidal than Silver Nitrate and far less toxic. 

Novargan, — is an albumin-silver compound, containing 10 per cent, of silver. It occurs 
as a fine yellow powder, soluble in water, and is a powerful astringent and germicide, non- 
irritant and not precipitated by chlorides or albumin. It is used in gonorrhea, in the early 
stage of the affection. Dose, ngviij, of a 15 per cent, solution by instillation in anterior 
urethra. 

Protargol, — is a protein-silver compound, containing 8 per cent, of silver in organic 
combination, and occurring as a light brown powder, readily soluble in water. It is claimed 
to be absolutely non-irritant, either in the conjunctival sac or the urethra, but its effective 
solutions are somewhat painful. It is highly praised as an antiseptic and astringent appli- 
cation in \ to 2 per cent, solutions for affections of the conjunctiva, also for wounds and 
gonorrhea. 

Silver Citrate, — is the normal silver salt of citric acid. It is an odorless, heavy powder 
almost insoluble in water. It may be used in solutions of 1 to 4000 to 1 to 10,000 in 
strength. Even in very weak solutions it is an energetic antiseptic, disinfectant and germi- 
cide, has a powerfully destructive action on gonococci, is readily borne by the urethral 
mucous membrane, has deep-reaching power but no injurious effect on the tissues, and there- 



I46 ARGENTUM. 

fore meets all the requirements of an efficient injection for gonorrhea (Werler). In that 
affection the solutions should be very weak at first, 1 in 8000, gradually increased as the 
inflammation subsides until the full strength of 1 in 4000 is reached. 

Silver Lactate, — is the normal silver salt of lactic acid. It is soluble in 15 of water 
A solution of 1 to 300 to 1 to 500 is said to be equal in disinfecting power to a 1 to 1000 
solution of bichloride of mercury. It is used in 1 to 100 to 1 to 2000 solutions when a power- 
ful antiseptic is desired. 

Silver and Sodium Hyposulphite, — is very soluble in water, does not coagulate albu- 
min, and may be given by the stomach or hypodermically. It has been used internally for 
locomotor ataxia and is preferred to silver nitrate for local application to the throat, being 
more agreeable to the taste. It does not stain the skin or the clothing. Dose, by the mouth, 
gr. ss-iij; hypodermically, gr. £-f daily. 

Unguentum Crede, — is an ointment containing 15 per cent, of Collargol, used for the 
endermic administration of silver. Dose, by inunction, gr. xxx-xlv, thrice daily. 

Physiological Action. 

Metallic Silver is antiseptic, probably by forming a lactate with the lactic 
acid produced by microbes. In contact with colonies of germs it kills them 
without exercising any inimical action on the animal tissues (Crede). Locally 
the silver salts are antiseptic, astringent, irritant and caustic, according to the 
strength of the applications. They are less irritant than the salts of mercury 
and more so than the salts of lead. The soluble salts of silver, taken inter- 
nally in medicinal doses, are tonics to the nervous system, increase tissue change 
and promote the secretion of bile; in larger doses they depress the heart, re- 
duce the temperature and impair the respiration; in overdoses they act upon 
the central nervous system, producing tetanic convulsions or paralysis. In 
mammals they affect the medullary centres particularly, at first stimulating 
and then depressing them, causing a primary rise of blood-pressure which 
afterwards falls, also slowing and embarrassing the respiration, which finally 
fails from paralysis of the respiratory centre. The heart is but slightly affected 
and often continues to beat for some time after the breathing has stopped. 
The mucous membrane of the stomach and intestines shows congestion, ecchy- 
moses and ulceration, the kidneys are irritated and edema of the lungs often 
occurs. None of these effects have been observed in man, but in him the pro- 
longed use of the silver salts will produce chronic silver poisoning, known as 
Argyria. The first sign of this condition is a slate-colored line along the mar- 
gin of the gums, with some inflammatory swelling. Subsequently grayish 
patches appear on various parts of the skin and mucous membranes, and ex- 
tend over the whole integument, which becomes slate-colored. No organ of 
the body, except the parenchymatous cells and the epidermis, is exempt from 
this pigmentation, which is due to the deposit of silver, either in the metallic 
state or as an oxide or some organic compound, in the connective tissues. In 
the skin it is found in the derma, not in the epidermis. As a rule argyria does 
not produce any serious effect upon the health of the subject, though some 
authorities have ascribed to it gastro-intestinal catarrh, faulty assimilation, 
changes in the blood, and fatty degeneration of the heart, liver, and kidneys. 



ARGENTUM. 147 

It is probable that in most cases some degree of deranged nutrition is produced. 
A local argyria may be caused by the frequent topical application of a soluble 
silver salt for a long time. In a few cases general argyria has resulted from 
the local use of a silver salt, usually in the mouth or throat; and it appears 
in workers in the manufacture of artificial pearls, who use silver as a pigment. 
Argyria is incurable, though many attempts have been made to remove the 
discoloration by the administration of iodides. The only solvent is potassium 
cyanide, which is inadmissible by reason of its violent toxicity. 

Silver salts unite with albumin to form albuminates, which are soluble in 
the digestive fluids, but it is not certain that silver is thus absorbed. Accord- 
ing to some authorities the salts are reduced in the stomach and also in the 
intestinal canal, the tendency of such action being towards the separation of 
the metal, most of which passes through the alimentary canal unabsorbed, a 
very small portion finding its way through the lymphatics to the tissues and 
remaining imbedded therein indefinitely. 

The Nitrate is the most soluble of the silver salts. It is antiseptic, astrin- 
gent, hemostatic, irritant, and a limited escharotic, also antiphlogistic, antispas- 
modic and tonic. It has a strong affinity for albumin, with which it unites to 
form an albuminate. Locally applied in dilute solution it causes a marked 
contraction of the bloodvessels, but in stronger solutions it is irritant, dilating 
the vessels and acting as a superficial caustic by coagulating the albumin of 
the tissues to which it is applied and destroying their vitality. A dense layer 
is thus formed which prevents the further penetration of the salt and limits its 
escharotic action. This albuminous coating is at first white but soon turns 
black under the influence of light. The stains made by handling or applying 
it to the skin may be removed by washing with a strong solution of potassium 
cyanide, and may in great part be prevented by immediately neutralizing the 
silver salt with a solution of common salt. Internally, in small doses, the Nitrate 
stimulates the heart, promotes nutrition and acts as a nerve tonic. In large 
doses it produces violent gastro-enteritis, corrosion and ulceration of the gastro- 
intestinal mucous membrane, due to thrombosis of its veins. Burning pain is 
felt in the throat and stomach, followed by nausea, vomiting and often by purg- 
ing. Central impairment of the nervous system may occur, with loss of co- 
ordination power and paralysis. Collapse follows, with weak pulse, pinched 
face, coldness of the surface and shallow respiration; and this condition may 
be followed by coma, convulsions, and finally death from paralysis of the respira- 
tory centre. The lethal dose has not been determined. 

Therapeutics. 

The local uses of Silver Nitrate, which are the most important, depend on 
its antiseptic, hemostatic, astringent, caustic and stimulant properties. As an 
antiseptic it has proved an efficient prophylactic against ophthalmia neonatorum, 



I48 ARGENTUM. 

a drop of a 1 per cent, solution being instilled into each eye of the new-born 
infant. In this disease, when the discharge is purulent, a similar solution 
should be applied to the conjunctiva daily, and when the discharge is very 
profuse a 2 per cent, solution is not too strong. A solution of the latter strength 
is commonly employed in the purulent conjunctivitis of adults, applied once 
daily to the everted lids by a brush, after cleansing and drying the surface; the 
excess being removed by washing with warm water or by neutralization with 
a solution of common salt. When the cornea is intact a solution of J to ^ of one 
per cent, strength may be occasionally dropped into the conjunctival sac, but 
care must be taken that it does not come in contact with an inflamed or ulcer- 
ated cornea, as it is not well borne in such cases and may cause a permanent 
corneal opacity by the deposit of silver. 

In chronic purulent inflammation of the middle ear Silver Nitrate is one 
of the most valuable applications, in solutions varying from \ of one per cent, 
to saturation, applied by a special syringe through the perforated tympanic 
membrane or by dropping into the external meatus. Aural polypi have been 
successfully treated with solutions of from 6 to 20 per cent, strength. Weak 
solutions are useful in eczema of the ear and in external otitis, also for chronic 
inflammation of the lining membrane of the Eustachian tube, to abort aural 
furuncles, and to relieve pruritus of the external auditory meatus. 

In the local treatment of the nose and throat Silver Nitrate is useful but 
should be employed with care. The stick of caustic is brittle and liable to 
break off while in use, hence it might be swallowed and produce acute poison- 
ing. The danger of general argyria occurring from the prolonged use of the 
salt in this situation should be remembered. For ulcers on the nasal septum, 
vascular granulations arising after operations on the nose, fissures of the tongue 
and lips, and mucous patches and ulcers of the mouth, the fused stick or a moder- 
ately strong solution is a good application. In subacute and chronic laryn- 
gitis a weak solution is sometimes very effective, as it is also in ulcer of the 
larynx when not due to laryngeal tuberculosis. 

In genito-urinary surgery Silver Nitrate has many uses. In solutions of 
various strengths, 1 in 2000 to 1 in 500, it is an old remedy for gonorrhea, ap- 
plied to the urethra during the course of the disease. Stronger solutions, up 
to 5 per cent., have been employed in the early stage with the view of aborting 
the inflammation, but this procedure causes great pain and has many oppo- 
nents as well as many advocates. If it fails to cut the disease short it will prob- 
ably aggravate the inflammation considerably. The milder solutions are use- 
ful applications in chronic gleet, prostatorrhea, urethritis, vaginitis and chronic 
cystitis. In the form of gelatin bougies impregnated with the salt it may be 
applied to the urethral mucous membrane with more facility and with better 
results than by injection with a syringe. A 2 per cent, solution injected into 
the substance of buboes in their early stage has given satisfaction. Indolent 
sinuses from buboes or abscesses may be stimulated to healing by the appli- 



AEGENTUM. I 49 

cation of lunar caustic lightly or a strong solution of the salt. It has been much 
used in the treatment of cervical endometritis and erosion of the os uteri. 

In diseases of the skin the Nitrate is employed to destroy parasitic fungi, 
to cause exfoliation of the epidermis and for stimulant effect upon indolent 
ulcers and sores. Lunar caustic is used to destroy warts and othei small growths, 
to arrest capillary hemorrhage, and for other similar purposes. Solutions of 
various strengths are useful in some forms of eczema, relieve the itching in 
prurigo and lichen, and are said to prevent pitting in variola. It is a very 
efficient application in pemphigus, if used in a 4 per cent, solution to the sur- 
face of the derma, after removing the epidermis over the blebs and cleansing 
their bases of all secretion. Chilblains may be painted with a strong solution 
to relieve the irritation, and in lupus, psoriasis, erythema and ringworm, solu- 
tions of this salt have been applied with satisfactory results. In erysipelas 
a concentrated solution, 20 grains to the drachm, was formerly applied on the 
inflamed surface and over the healthy skin beyond, to the extent of two or three 
inches, after washing and drying the part, with the object of checking the spread- 
ing inflammation or at least rendering it less severe; but this procedure has 
been superseded by other methods of treatment. For application to the skin 
a solution in Spirit of Nitrous Ether is recommended. This solution deposits 
a light-colored precipitate but itself does not turn black like the simple alcoholic 
solution. It blackens the skin however in a shorter time than any other 
solution. 

In general surgery the moulded stick (lunar caustic) is much employed to 
cut down exuberant granulations in suppurating wounds, and to stimulate the 
healing of indolent ulcers, sores and sinuses. Bedsores may often be pre- 
vented by painting the red but unbroken skin with a 2 to 4 per cent, solution. 

The internal use of Silver Nitrate is almost wholly confined to the treat- 
ment of affections of the gastro-intestinal tract. Its astringent and tonic actions 
are sometimes very efficient in cases of weak and irritable stomach accompanied 
by great depression of spirits, morbid apprehensions and want of courage. It 
is employed in persistent vomiting, in chronic gastric catarrh, in hematemesis, 
and in gastric ulcer. When given for stomach affections it should be admin- 
istered when the viscus is empty. Chronic gastritis has been treated with 
benefit by irrigating the stomach with solutions of various strengths, from 2 
to 4 grains gradually increased to 20 grains in 6 drachms of water, immediately 
followed by a 3 to 5 per cent, solution of common salt. The Nitrate has often 
proved of value in chronic inflammation of the large and small intestine, espe- 
cially where there was ulceration of the intestinal mucous membrane. It has 
done good service as an internal remedy in acute dysentery, and in chronic 
dysentery a solution of 20 to 30 grains to the pint of distilled water as an injec- 
tion into the colon has given satisfactory results in many cases, and is considered 
one of the most valuable methods for the treatment of that affection. As an 
internal remedy it has rendered good service in cholera infantum after the acute 



150 ARGENTUM. 

symptoms abated. Its employment in spinal sclerosis, glosso-labio-laryngeal 
paralysis and similar affections has not proved very successful, but it is said to 
be one of the few remedies which are of any service in locomotor ataxia. It 
was formerly used as a nerve tonic in epilepsy, but has been superseded by 
other agents which are less objectionable and more efficient. It has bene- 
fited epilepsy where the bromides have failed, and it is an established fact 
that patients who have been subjected to a course of silver medication which 
has produced a deposit of the metal in the tissues possess a remarkable degree 
of immunity from various minor nervous ailments. It may be inferred that 
a remedy which is deposited in the tissues may interfere by its presence with 
the chemical activity of adjacent atoms, preventing their explosive union 
(Murray). 

Several silver compounds have been introduced as substitutes for the Nitrate, 
with the view of obtaining greater penetrative local action, as the latter salt is 
decomposed by the proteins and chlorides of the tissues and possesses only limited 
powers as an antiseptic. These compounds are marketed under various 
trade-names (see pages 145 and 146), and are used with satisfaction as local 
applications in gonorrhea, conjunctivitis, otitis media, laryngitis, pharyngitis, 
dysentery, erysipelas, empyema of the antrum, cystitis, and other inflam- 
matory and suppurative affections. Protargol has probably been the most 
popular, though Neissen states that the results of 870 cases of gonorrhea 
treated therewith show that the average duration of the disease is not lessened 
by this agent more than by other recognized methods of treatment. Collar- 
gol has been used internally, by inunction, and by intravenous injection. It 
is said to cause marked and rapid leucocytosis, to be completely excreted 
within a month, to be incapable of producing argyria, and to have inhibitory 
action in the blood on bacteria. It has been used with benefit in skin and 
venereal diseases, local suppurations, and septic disorders; also in diphtheria, 
scarlet fever, pneumonia, pericarditis, and typhoid fever. 

The Oxide is the least irritant of the silver salts and does not discolor the 
skin so quickly as the nitrate, but eventually the same result follows its con- 
tinued administration. It has been employed with more or less success in gas- 
tric neuralgia, irritable dyspepsia, pyrosis, gastric hemorrhages, dysmenor- 
rhea, menorrhagia and other uterine affections, also to check profuse sweating, 
to relieve vomiting even in severe gastritis, and to control diarrhea depending 
on reflex nervous irritation. As an ointment, 5 to 10 grains to the drachm of 
lard, it is employed for application to venereal sores and to the urethra in 
gonorrhea. 

A course of silver medication should be regulated by suspending the remedy after 5 or 
6 weeks' use, then promoting elimination by purgatives, diuretics and baths. To prevent 
the general discoloration Potassium Iodide may be given conjointly with the silver, and baths 
of Sodium Hyposulphite used frequently. The dark line at the margin of the gums is remov- 
able by a course of the Acid Tartrate of Potassium. Argyria has been produced in three 
months and after the use of §ss-j of the nitrate. 



ARNICA. 151 

ARNICA, Arnica, — is the dried flower-heads of Arnica montana, Leopard's 
Bane, a perennial of the nat. ord. Composite, indigenous to the mountains of 
Northern Europe and Siberia, and said to have been found in the mountains 
about the headwaters of the Missouri and Columbia rivers. It has large orange- 
yellow flowers and a small, curved rhizome with several rootlets. It contains 
two alkaloids, Arnicine and Cytisine, the latter being probably identical with 
the active principle of Cytisus laburnum, the Laburnum ; also Trimethylamine 
(CH 3 ) 3 N, an ammoniacal alkaloidal principle, which has been looked upon as 
the active ingredient. Arnica also contains Inulin, Capronic and Caprylic 
Acids, tannin, mucilage, resins, and two essential oils, one in the flowers, the 
other in the root. It is rarely given internally and when so administered the 
tincture is the preparation used. 

Preparations. 

Tinctura Arnicae, Tincture of Arnica, — strength 20 per cent. Dose, tt£v-xxx, [av. ttjjxv.] 

Infusum Arnicae, Infusion of Arnica (Unofficial), — Arnica flowers 20, to 100 parts 
of water, is thought by many observers to be the best form for local use, as it does not excite 
dermatitis, probably from containing none of the Volatile Oil. 

Trime thy lamina, Trimethylamine, C 3 H 9 N (Unofficial), — is a thin, colorless, strongly 
alkaline liquid, boiling at 49° F., and at ordinary temperatures a colorless, inflammable gas 
The Hydrochloride is the most stable salt, crystallizing in white or colorless prisms, nearly 
odorless, of pungent taste, very deliquescent, freely soluble in water and in alcohol. Dose, 
gr. ij-iij in syrup every 2 hours. 

Trimethylamine has been obtained from Arnica flowers and those of several other plants, 
from Ergot, Hops, Codeine, Cod-liver Oil, and decomposing albuminous substances, such 
as human urine, herring-pickle, and the residue left in making sugar from beets. It is some- 
times incorrectly named Propylamine, a term also applied to an impure trimethylamine, but 
in reality an allied and isomeric compound. 

Incompatibles. 

Incompatible with Arnica preparations are: Acids (mineral), Ferrous Sulphate, Lead 
Acetate, Zinc Sulphate. 

Physiological Action and Therapeutics. 

Arnica is irritant, stimulant, depressant, diuretic and vulnerary. It 
irritates the gastro-intestinal tract, and in some persons the local use of alco- 
holic preparations of the flowers will excite erysipelatous inflammation of 
the skin, though those of the root have not been observed to do so. In small 
doses internally it increases the action of the heart, raises the arterial tension 
and stimulates the action of the skin and the kidneys. Large doses produce 
a transient excitement, followed by depression of the circulation, respiration, 
and nerve-centres; headache, unconsciousness, and even convulsions being 
induced, the body-temperature lowered, the pupils dilated, and muscular par- 
esis produced. A toxic dose paralyzes the nervous systems of animal and or- 
ganic life, causing collapse and death. Cytisine is a powerful central emetic, 
and in large doses paralyzes the motor nerves. Its direct action on the circu- 
lation is slight; toxic doses cause a gradual lowering of arterial pressure, and 
death by respiratory paralysis. 



152 ARSENUM. 

Arnica is a popular remedy with those who patronize the so-called homeo- 
pathic school of practice, but like many other agents which the homeopathists 
claim to have given to medicine, it is a remedy much older than homeopathy, 
and was investigated originally by regular physicians, notably by Van der Kolk 
in the sphere of mental affections. Externally, the tincture in water has a popu- 
lar reputation in sprains and bruises, though an infusion is better for local use. 
Ecchymoses are rapidly dispersed by its administration externally. The 
aqueous preparation applied locally promotes the rapid union of cut surfaces. 

Internally, arnica is seldom used nowadays, having been replaced by drugs 
of more certain and less toxic action. 

Trimethylamine is an active escharotic and a gastrointestinal irritant. It lowers the 
rate and force of the heart, decreases the body-temperature, and diminishes (though some- 
times increases) the excretion of urea. The Hydrochloride is a powerful antipyretic in doses 
of gr. ij every 3 hours. It has been found useful in acute rheumatism and gout, relieving 
pain, reducing temperature, and diminishing the frequency of the pulse. In chronic rheu- 
matism, as a liniment (1 part to 3 of Glycerin), it is said to give relief equal to that produced 
by any anodyne. It has been used with benefit in chorea, moderating the spasmodic move- 
ments when not suspending them entirely. 

ARSENUM, Arsenic, As. — The metal Arsenum exists in many minerals, 
and occurs in the free state as a sulphide, and in combination, especially with 
iron, nickel, and cobalt. It is represented in medicine by its Trioxide and 
Iodide, Sodium Arsenate, and Potassium Arsenite, which are official; also by 
several unofficial compounds. The Trioxide (arsenous acid) is obtained by 
roasting native arsenides and condensing the fumes in a horizortal chimney. 

Official Compounds and their Preparations. 

Arseni Trioxidum, Arsenic Trioxide (Arsenous Acid), As 2 3 , — is a heavy, white solid, 
occurring as an opaque powder, or in semi-transparent masses having usually a striated 
appearance, soluble in water, the solubility varying with its physical condition, also sol- 
uble in 15 of boiling water, in alkalies and their carbonates, in hydrochloric acid and in 
glycerin. It is volatilized at 424.4 F. without melting, and when thrown on ignited char- 
coal it emits an alliaceous odor. It floats when sprinkled on water, though its weight is 
about 3I times that of the corresponding bulk of the fluid on which it rests. Dose, gr. 
A~i£ [av. gr. 3V] 

Liquor Acidi Arsenosi, Solution of Arsenous Acid, — is a 1 per cent, solution in HC1 
and Distilled Water. Dose, n^ij — vj, thrice daily in water after meals, [av. ir^iij.] 

Liquor Potassii Arsenitis, Solution of Potasssium Arsenite (Fowler's Solution), — is a 
1 per cent, solution, prepared by boiling together Arsenous Acid 1, Potassium Bicarbonate 
2, Comp. Tincture of Lavender 3, and Distilled Water to 100. Dose, Trj^ij-vj, [av. tijiij] in 
water thrice daily after meals. 

Soiii Arsenas, Sodium Arsenate, Na 2 HAs0 4 +7H0O, — is a salt of the second oxide, 
Arsenic Acid, As 2 5 . Occurs in colorless prismatic crystals, of feebly alkaline taste and 
reaction, soluble in 1.5 of water at j 
alcohol. Dose, gr. tV - !, t av - g r - rV 

Sodii Arsenas Exsiccatus, Exsiccated Sodium Arsenate, — an amorphous, odorless, white 
powder, very poisonous. Dose. gr. ^5~~rV> [ av - S r - ?V 

Liquor Sodii Arsenatis, Solution of Sodium Arsenate (Pearson's Solution), — is a 1 per 
cent, solution of the dried Arsenate in Distilled Water. Dose, nj?ij-vj, [av. n^iij] in water 
after meals. 



AESENUM. 153 

Arseni Iodidum, Arsenous Iodide, ASI3, — occurs in glossy, orange-red crystalline masses 
or scales, gradually* losing iodine by exposure to the air, soluble in 12 of water and in 30 of 
alcohol at 25°C; is gradually decomposed by boiling water and by boiling alcohol, and is 
completely volatilized by heat. Dose, gr. ^V~i> t av - g r - 12-] 

Liquor Arseni et Hydrargyri Iodidi, Solution of Arsenic and Mercuric Iodide, (Dono- 
van's Solution), — has Arsenic Iodide and Mercuric Iodide, of each 1 part in 100 of Distilled 
Water. Dose, njn-v [av. njnss], in water after meals. 

Sodii Cacodylas, Sodium Cacodylate, — is an odorless, white, granular powder very soluble 
in water and soluble in alcohol. Dose, gr. ss-ij [av. gr. j.] 

Unofficial Arsenum Compounds. 

Cupri Arsenis, Cupric Arsenite, — occurs in the various cupro-arsenical pigments used 
for wall-paper coloring and as insect-poison, viz. — Scheele's green, Mineral green, Paris green, 
etc. Is highly poisonous. Dose, gr. t J-q daily, in divided doses. 

Liquor Arseni Bromidi, Solution of Arsenic Bromide, Clemens' Solution, — is properly 
a Liquor Potassii Arsenatis et Bromidi, and contains 1 per cent, of the arsenic salt. It is 
prepared by boiling together Potassium Carbonate and Arsenous Acid, 5j.of each in 5* of 
distilled water, until a clear solution is formed; when cold 3ij of Bromine and 3xij of water 
are added, and the mixture is allowed to stand until all color disappears, when it is ready for 
use. Dose, njrj-v, thrice daily in water after meals. 

Solutions of the Bromides of Arsenic and Gold (Arsenauro), of Arsenic, Gold and 
Mercury (Mercauro), of Arsenic, Gold and Calcium (Calcauro), and of Arsenic, Gold and 
Manganese (Manganauro), are described under the title Aurum. 

Atoxyl, — is the trade-name for sodium arsanilate, containing 22 per cent, of arsenic, 
and occurs as a white, odorless, and almost tasteless powder, soluble in ith its weight of warm 
water. Dose, hypodermically, gr. -^-\ at first, gradually increased up to gr. iij. 

Salvarsan, Arseno phenol- amine Hydrochloride, Diamenodihydroxy-arseno Benzol Di- 
hydrochloride (C6H 3 AsOH.NH 2 Hcl 2 ) is a light yellow, crystalline powder, unstable in the 
air, soluble in water yielding a solution which is acid in reaction. It is marketed in her- 
metically sealed tubes containing 0.6 Gm. (gr. ix). For intravenous injection a clear alka- 
line solution is prepared by dissolving the contents in about 30 or 40 c.c. of sterile distilled 
water and adding 15 per cent, sodium hydroxide solution which at first causes a precipitate 
which dissolves upon further addition of the hydroxide solution (about 23 drops of a 15 per 
cent, sodium hydroxide solution is required). The solution is diluted to a bulk of about 
200 c.c. by adding normal salt solution. For intramuscular injection the solution is pre- 
pared in the same way, but its bulk is greatly reduced. Dose, 0.2 to 0.6 Gm. [gr. iij— ix.] 

Neosalvarsan is a yellow powder, unstable in the air, more soluble in water than 
salvarsan and yielding a solution which is neutral in reaction and ready for use. For in- 
travenous or intramuscular injection cold water, freshly distilled and sterilized, should be 
used, approximately 25 mils for each 0.15 Gm. 

Solution of salvarsan and neosalvarsan should be used immediately, as they rapidly 
deteriorate upon standing. Dose, 0.15 to 0.9 Gm. [gr. ij-xiv.] The drug is marketed in 
sealed tubes in six graded doses. The arsenic content of neosalvarsan is approximately 
two-thirds that of salvarsan and therefore must be given in larger doses to obtain equiva- 
lent effects. 

Soamin, — a form of sodium arsanilate containing approximately 22 per cent, of Arsenic. 
It is a white crystalline powder. Dose, gr. j-v. 

Incompatibles. 

Incompatible with Arsenic Trioxide and the Ar seniles are: Hypophosphorous Acid and 
the Hypophosphites in acid solution, Dialyzed Iron, Iron salts and salts of the other heavy 
metals, Lime-water, Magnesia, Potassium Iodide, Silver Nitrate, Sulphides, Tannic Acid and 
Vegetable astringent decoctions and infusions. With the Iodide as for other iodides (see under 
Iodum). 

Tests for Arsenic. 

The principal tests are simple and should be known by every physician. (1) Reinsch's 
Test, — Hydrochloric Acid and a clean strip of Copper are boiled with the suspected fluid; 
a dull steel-colored deposit of copper arsenide will appear on the copper if arsenic is present. 
(2) Marsh's Test,— Zinc and diluted Sulphuric Acid are placed in a flask with the suspected 



154 ARSENUM. 

liquid to produce nascent hydrogen, and the gas issuing fron the tube is ignited, and a clean 
porcelaine plate is brought into contact with the flame. If arsenic is present the gas will 
contain hydrogen arsenide (arsin) and on the plate will be formed a steel-blue mirror of arsenum, 
which is distinguished from that formed by antimony by being soluble in a solution of potassium 
hypochlorite (bleaching-powder). 



Physiological Action. 

Arsenic Trioxide, applied to the skin denuded of its epidermis, acts as a pain- 
ful escharotic, producing violent inflammation and resulting in a slough which 
forms a barrier to its absorption. If applied in dilute solution over a large 
surface, it will be absorbed, and may produce the systemic effects described 
below. 

In small doses it is a stomachic and general tonic, promoting the appetite 
and digestion, increasing cardiac action, the respiratory power, and the in- 
testinal secretions; stimulating peristalsis, exalting mental activity and the 
sexual appetite, and producing a fair skin and a rotund form. Experiment- 
ally, when small doses are given to young animals, growth is more rapid than 
in the controls. This has been variously explained as due to improved diges- 
tion, improved circulation and stimulation in the production of red blood 
cells and hemoglobin. When tolerance of the drug is established, large doses 
are used with impunity, as by the arsenic eaters of Styria, who can swallow at 
once as much as 5 grains with safety. They are careful, however, not to take 
any water into the stomach at the same time, so that the dose is slowly ab- 
sorbed, and probably eliminated rapidly. Not all those who begin its use 
can acquire tolerance of it, but those who do so seem to continue it without 
injury, and live to an old age, undergoing great exertion without exhaus- 
tion, and being enabled to ascend steep mountains without difficulty of 
respiration. 

In full medicinal doses, continued for some time, it causes itching and edema 
of the eyelids, ptyalism, nausea and vomiting, diarrhea or dysentery, epigastric 
pain and soreness, feeble and irritable heart, dyspnea, disordered sensibility, 
herpes zoster, urticaria, eczema and other skin eruptions, jaundice and albu- 
minuria. In large doses it is a powerful irritant to the gastro-intestinal and 
bronchial mucous membranes. Toxic doses may produce either symptoms of 
gastro-enteritis, or those of profoundly narcotic character. In the first and 
most usual form of acute arsenical poisoning, there is burning pain in the throat 
and stomach extending over the abdomen, vomiting, thirst, bloody stools, strang- 
ury, suppressed, albuminous or bloody urine, rapid and feeble heart, great 
anxiety, cold breath, finally exhaustion and collapse, — a group of symptoms 
much resembling cholera. The autopsy shows erosions, ecchymoses, and soft- 
ening of the gastro-intestinal mucous membrane, congestion of the lungs and 
bronchi, and fatty degeneration of the liver, kidneys and cardiac muscle. The 



ARSENUM. 155 

poison is found in the urine, saliva, tears, sweat, etc., and may be detected 
even in the parenchymatous tissues. After a fatal dose Arsenic is usually 
found most abundantly in the liver (Bastedo). In the nervous form of poi- 
soning by arsenic, profound coma and insensibility come on suddenly without 
any gastro-intestinal symptoms. 

Arsenical preparations are generally classed as alteratives, but they are 
valuable tonics and antiseptics, and possess antiperiodic powers second only 
to those of quinine. 

Chronic Arsenical Poisoning may occur from the inhalation of arsenical 
vapors or dust arising from wall-papers or other substances containing the 
poison. The quantity necessary to produce symptoms of poisoning when in- 
haled seems to be very small. The most prominent symptoms are, at first in- 
creased appetite, next colicky pains, mucous or dysenteric stools, irritation of 
the eyes, coryza, a short, dry cough, and a white and silvery tongue, all accom- 
panied by great bodily prostration. 

Arsenic exercises a stimulating and later an irritative influence on nerve 
structure, and may induce profound structural changes in the nerves when used 
in too large doses or over protracted periods. Sensory, motor and trophic dis- 
turbances of a serious character have resulted from its injudicious use. Inflam- 
matory dermatoses are aggravated by it, and a great variety of cutaneous 
manifestations may be produced by toxic doses. In chronic arsenical poisoning 
erythematous, papular and vesicular eruptions may appear, and hyperkeratosis 
of the skin, especially on the palms and soles is not uncommon. Cancer of the 
skin has been reported in a number of cases following its long-continued 
employment. 

The long-continued use of arsenic may induce peripheral neuritis, the chief 
symptoms of which when so caused are — severe darting pains in the limbs, 
paralysis of the muscles of the extremities, especially the extensors of the hands 
and feet, ataxic gait, herpes zoster, and rapid muscular atrophy. In several 
cases it has caused general brown pigmentation of the skin, and may give rise 
to the same pigmentation of psoriasis patches. After death from chronic poi- 
soning, in addition to the gastro-intestinal and nervous lesions, there is found 
widespread fatty degeneration, affecting most of the organs, but particularly the 
liver, kidneys, stomach and muscles, including the heart. 

Toxic symptoms after the use of Atoxyl have been recorded in numerous 
cases, the most serious being those affecting the eyes, as retinal hemorrhage, 
amaurosis and optic atrophy. Koch observed 22 cases of blindness after 
the use of this agent in 1633 cases of sleeping sickness. 

To avoid arsenical poisoning during a course of the drug full doses (tt#vj of Fowler's 
solution) should be used as the commencement, and always taken on a full stomach. The 
dose should then be steadily reduced. Susceptible persons often tolerate it better if a few 
drops of laudanum are administered with each dose. It is quickly absorbed, and slowly 
eliminated, chiefly by the kidneys and the skin, its excretion continuing for about 60 hours, 
hence it should be administered at infrequent intervals of time. 



156 ARSENUM. 

Therapeutics. 

Externally, Arsenic has been employed in the form of paste as a depila- 
tory, and as an escharotic in cancers, but is excessively painful . Most of the secret 
" cancer cures" have arsenous acid for their basis. It is a constituent of 
many of the preparations which dentists use to destroy the nerves in painful 
teeth. Internally, it is used as a tonic and astringent to the intestinal canal, 
as a tonic and antispasmodic in nervous diseases, and for its action on tissue 
change. It is of especial value in irritative dyspepsia, gastralgia, pyrosis, 
gastric ulcer, regurgitation of food without nausea, diarrhea coming on imme- 
diately after taking food, vomiting of drunkards and chronic alcoholism. It 
has proven of signal service in the commencement of phthisis. It is often very 
serviceable in chronic bronchitis with copious expectoration, in acute catarrh, 
hay fever, whooping-cough, asthma, chorea, epilepsy, angina pectoris and 
other spasmodic nervous disorders. In many forms of neuralgia it frequently 
gives prompt and permanent relief, especially in cases due to malarial poison- 
ing. As an antiperiodic, it has high rank, being, however, of particular value 
in chronic malarial poisoning, and as an adjunct to quinine in the intervals 
between the paroxysms of intermittents. Anemia of both the secondary and 
primary types, leukemia, chlorosis and Hodgkin's disease are remarkably 
benefited by it, and in rheumatic arthritis and chronic rheumatism it is some- 
times of great service. In chronic scaly and papular skin diseases its value is 
very great, but it is not serviceable in acute forms, and the more chronic the 
cutaneous affection the more likely it is to be amenable to Arsenic. Epithe- 
lioma may be retarded by small doses long continued, and it has certainly 
been useful in delaying the progress of other cancers, particularly scirrhus of 
the stomach and uterine carcinoma. Hypodermically its solutions have 
been extremely efficient in histrionic spasm, local chorea of the head and neck, 
obstinate cases of general chorea, and in lymphadenoma. 

The so-called Bromide of Arsenic, in the form of Clemens' solution, was 
formerly highly recommended as a remedy for diabetes mellitus. The 
Cacodylates have been used with benefit in anemia, chlorosis, chorea, chronic 
bronchitis, pulmonary tuberculosis, inoperable carcinoma, and other af- 
fections for which arsenic is indicated. Sodium Cacodylate is considered 
by Murrell more toxic than the ordinary arsenical preparations, and only 
to be used with the greatest caution. It is said to increase the menstrual 
flow, and to promote the growth of the hair. Sodium Cacodylate may be 
procured in sterile solution in ampules which form a convenient method for 
administering arsenic by subcutaneous injection. 

Atoxyl is claimed to be 40 times less toxic than Fowler's solution, and to 
afford the means of giving a large dose of arsenic without ill-effects. It has 
been used with satisfaction in dermatological practice, preferably by hypo- 
dermic administration, and in small doses at first, gradually increased up to 



ARSENUM. 157 

3 grains. Professor Koch found its injection to be specific against trypanoso- 
miasis, so far as causing the disappearance of the trypanosomes from the 
blood; but also that full doses induced blindness in many cases, and that 
when the disease reached the sleeping stage, (meningo-encephalitis), nothing 
could avert a fatal issue. 

Arsenic, like a great many other substances, has long been known to exert 
a destructive action on certain microorganisms. This knowledge was of little 
practical value in the treatment of disease, as doses sufficiently large to 
destroy the parasites, inevitably acted in a similar manner upon the body 
cells. Ehrlich, in a most extensive research directed toward a study of the 
affinities between certain chemical agents and certain cells or microorganisms, 
succeeded in preparing an arsenical compound which had lost its affinity and 
toxicity for the cells of the host while still retaining an affinity and destructive 
power for certain invading protozoa. Starting with trypan-red and its 
striking affinity for the trypanosome (and also for the host with fatal results) 
he worked with atoxyl, arsenophenylglycin and a large number of arsenical 
compounds until he finally found that the group known as " arsenophenol- 
amines" (salvarsans) possessed a maximum toxicity for the spirochetal and 
at the same time were practically innocuous to the host. The final prepara- 
tion, arsenophenolamine hydrochloride, was the six hundred and sixth, 
"606," and although the exact nature of its action is still but imperfectly 
understood, it has demonstrated a powerful destructive action upon the 
parasites found in trypanosomiasis, syphilis and spirillosis; and upon the 
causative agent in Yaws. In order to still further lessen the toxicity to the 
host and render available a more soluble compound, Ehrlich produced an 
improved arsenophenolamine preparation known as neosalvarsan. One of 
the first lessons to be learned in the use of the new drug was that one dose 
would not entirely rid the body of the infecting parasite and that two, three, 
four or six doses might be required. At the same time the intravenous 
method of administration was demonstrated to be superior to the subcu- 
taneous or intramuscular methods. At the present time intravenous injec- 
tion is used practically to the exclusion of other methods. 

Salvarsan has not supplanted mercury in the treatment of syphilis, 
although for a prompt control of the infection it is superior. Most syphilog- 
raphers at the present time commence antisyphilitic treatment with the use 
of salvarsan intensively, i.e., from three to six injections at 7- to 10-day inter- 
vals and follow by one or more courses of mercurial injections, inunctions, 
etc., for several years, the subsequent course being largely influenced by 
the clinical findings and the Wassermann blood and spinal fluid examinations. 
It may be said that we are still in an uncertain period with regard to how use- 
ful this treatment may be in preventing those long-delayed manifestations of 
syphilitic infection, paresis and tabes dorsalis. As a general proposition the 
success of antisyphilitic treatment by arsenic and mercury both upon the 



158 ARSENUM. 

immediate and remote evidences of infection depends upon early and vigorous 
application of the drugs, as it has been definitely shown that small doses of 
the drug increase the resistance of the spirochete to subsequent doses and as 
the infection becomes older they tend to colonize in inaccessible localities 
which may not be penetrable by salvarsan. The latter fact explains why 
paresis and tabes, which we now know to be due to the presence of spirochete 
in the tissues of the brain and cord, respond so unsatisfactorily to salvarsan 
and mercury. The direct injection of salvarsan into the spinal fluid by lumbar 
puncture is not without danger and should not be practised. Swift and Fllis 
have described the following method for these cases : — Salvarsan is admin- 
istered intravenously in the usual way and about 40 mils of blood withdrawn 
from the arm at the end of an hour. The serum is allowed to separate and 
upon the following day 12 mils of the serum diluted with 16 mils of normal 
salt solution and heated to 56 C. for thirty minutes is injected into the spinal 
fluid by lumbar puncture. (See article on Locomotor Ataxia, page 726. 
Also paragraph on Intraspinal Therapy, page 51.) Prior to injection an 
equal quantity of cerebrospinal fluid should be allowed to leak out of the 
needle so as to prevent undue increase in pressure of spinal fluid after in- 
jection. In fact some neurologists have seemed to have acquired as good 
results solely by drainage of the spinal fluid after intravenous salvarsan 
probably as a result increased activity of the secretory cells of the choroid 
plexus which lowered spinal pressure induced. Gilpin reports the beneficial 
influence of continuous drainage in locomotor ataxia. 

Salvarsan is- rapidly eliminated when administered intravenously and 
slowly absorbed and eliminated when given intramuscularly. Untoward 
effects following its use have been greatly reduced since the use of sterilized 
distilled water when preparing it for administration has been insisted upon. 
Death has followed its use and a number of cases have been reported, but 
these in many instances have been found due to some grave organic lesion in 
the presence of which most any procedure would have been dangerous. Oc- 
casionally after the injection the patient develops nausea and vomiting, 
headache, backache, malaise and fever varying in degree but usually very 
transient, disappearing in 24 to 36 hours at the most. Sometimes there 
is noted an increase or darkening of the rash or aggravation of the symptoms 
of infection (Herxheimer reaction) during the day or two following the injec- 
tion. This has been explained as the result of sudden destruction of a number 
of parasites with liberation of toxic products which are irritating. If severe 
symptoms suggesting meningeal irritation or renal insufficiency develop after 
the use of the drug, the possibility of idiosyncrasy to arsenic or arsenic poison- 
ing should be thought of and Ehrlich's advice heeded to give adrenalin in 
large doses hypodermatically. Salvarsan is contraindicated in the presence 
of severe organic disease of the optic and auditory nerves, heart and vascular 
system, lungs, kidneys and central nervous system. It should be given cau- 
tiously in children and in the aged. 



ASAFCETIDA. 1 59 

ASAFOETIDA, Asafetida, — is a gum-resin obtained by incision from the 
living root of Ferula fostida, a perennial herb of the nat. ord. Umbelliferae, native 
of Persia and Afghanistan. It occurs in whitish tears embedded in a grayish 
sticky mass, of alliaceous odor and taste, soluble in alcohol to at least 60 per 
cent., and when triturated with water it yields a milk-white emulsion. Its 
principal constituent is a Sulphuretted Volatile Oil, consisting chiefly of Allyl 
Sulphide, C 6 H 10 S; it also contains a gum and a resin, with ferulaic, malic, 
acetic, formic and valerianic acids. Dose, gr. ij-viij, [av. gr. iv.] 

Preparations. 
Tinctura Asafoetidae, Tincture of Asafetida, — strength 20 per cent. Dose, nj?x-xxx 

[av. TTJ7XV.] 

Emulsum Asafoetidae, Emulsion of Asafetida, (Milk of Asafetida), — strength 4 per cent 
in water. Dose, 3ij~5j, [av. 5iv]. 

Pilulae Asafoetidae, Pills of Asafetida, — each pill has gr. iij of Asafetida with gr. j of Soap. 
Dose, j-iv pills, [av. ij.] 

Mistura Magnesiae et Asafoetidae, Mixture of Magnesia and Asafetida, Dewees' Car- 
minative (Unofficial), has of Magnesium Carbonate 5, Tinct. Asafoetidae 7, Tinct. Opii 1, 
Sugar 10, Aqua Dest. q. s. ad 100 parts. Dose, 3ss-5ss. 

Physiological Action and Therapeutics. 

Asafetida is a powerful antispasmodic, a stimulant to the brain and nervous 
system, a stimulating expectorant, also tonic, laxative, diuretic, diaphoretic, 
emmenagogue, aphrodisiac and anthelmintic in action. Its odor and taste are 
extremely nauseous and persistent. In small doses continued it causes im- 
paired digestion, alliaceous eructations, acrid sensation in the fauces, gastral- 
gia, flatulent distention, fetid flatulence, burning urination, diarrhea and ten- 
esmus. Full doses produce various nervous or hyterical phenomena, with 
nausea, vomiting and purging. The Volatile Oil diffuses into the blood and 
tissues, and is excreted in the urine, sweat, and breath. By its action the cir- 
culation is stimulated, the arterial tension raised, the power of the cardiac motor 
ganglia is increased and the cardiac inhibition relaxed. Asafetida also stimu- 
lates the brain even to pleasant intoxication, and produces a subjective sen- 
sation of warmth without any rise of body-temperature. It stimulates the 
nervous system, the secretions and excretions, the menstrual flow and the sexual 
appetite. In Asia it is used as a condiment with food, and though at first it is 
nauseous to most people, a taste for it may be readily acquired. 

The disgust which is generally felt for Asafetida makes its use very restricted, 
though a valuable medicine. The Emulsion is extremely serviceable in the 
flatulent colic of infants, and as an enema in infantile convulsions. There is 
no better remedy in hysteria and hypochondriasis with indigestion and flatu- 
lence ; in constipation with amenorrhea of anemic subjects, due to ovarian and 
intestinal torpor; in bronchial affections, cough of habit, chronic catarrhs, and 
flatulent indigestion. It has been highly praised in the treatment of habitual 
abortion. 



160 ASCLEPIAS ASPIDOSPERMA. 

ASCLEPIAS, Pleurisy Root (Unofficial), — is the root of Asclepias tuberosa, a plant of 
the nat. ord. Asclepiadaceae and a native of the Eastern and Southern States. Two other 
species of Asclepias are used in medicine and were formerly official. 

An Infusion or Decoction may be made in the proportion of oj of the powdered root 
to a quart of water, and given in teacupful doses every 2 or 3 hours. 

Asclepias contains two resins a peculiar principle, tannic and gallic acids, albumin, 
pectin, gum, various salts and a volatile, odorous, fatty matter. It is emetic and cathartic 
in full doses, also diaphoretic and expectorant, as well as depressant to the action of the 
heart, and probably slightly sedative and astringent. It is a popular remedy in the Southern 
States for pleurisy (hence its common name), and has been used in medicine for catarrh, 
pneumonia, phthisis, diarrhea, dysentery, rheumatism, gastralgia, and to promote the eruption 
in exanthema tous fevers. It is undoubtedly a powerful diaphoretic. 

ASPIDIUM, — is the rhizome of Dryopteris Filix-mas, Male Fern, and of 
Dryopterls mar ginalis , Marginal Shield Fern, plants of the nat. ord. Filices, 
the former found in most parts of the world, the latter indigenous to N. America. 
The active principles are Filmaron, Albaspidin, and Filicic Acid, named in the 
order of their value as anthelmintics. It also contains several other principles, 
a green, fatty oil, a volatile oil, resin, tannin, etc. Dose, 5 ss- 3jss [av 3j] i n - 
a single dose fasting, or in divided doses at short intervals, followed by a 
purgative. 

Oleoresina Aspidii, Oleoresin of Aspidium, — is an ethereal extract and deposits Filicic 
Acid on standing. It should be well shaken before being used. Dose, gr. xx-§ j, [av. gr. xxx] 
in capsules, repeated every 3 hours for 2 or 3 doses. 

Aspidium is an efficient vermicide against tapeworm, particularly the un- 
armed variety (bothriocephalus latus). It is also of value in Uncinariasis. 
The Oleoresin is the best form, the patient having fasted for the previous day, 
or used only a milk diet, 5 j may then be given in 4 doses J hour apart. This 
may be repeated the next morning and followed by three drops of croton oil 
in emulsion. This is one of many methods. Cusso may be combined with it 
advantageously. 

A very useful formula which Dr. Hare recommends consists of 45 minims 
each of the oleoresin of aspidium and tincture of vanilla in one ounce of water 
containing half dram of powdered acacia; taking the entire amount after 
fasting and following in two hours by a full dose of Epsom salts. Castor oil 
should not be used as a purgative after the use of Aspidium as it predisposes to 
poisoning by increasing the tendency to absorption. 

ASPIDOSPERMA, Aspidosperma (Quebracho), — is the dried bark of the 
Aspidosperma Quebracho bianco, and occurs as brownish-gray or reddish- 
brown irregular chips. Wallace found two alkaloids in Quebracho bark, 
as pido spermine and quebrachine. Dose gr. xx to §j fav. §i]. The official 
preparation is: — 

FluidextractumAspidospermas,F/w^.r/rac/o/i45/>^o5^rwa. — Dose, ulx-g j [av. g j]. 



AURANTIUM. l6l 

Physiological Action and Therapeutics. 

Aspidosperma stimulates the respiratory centre and has been called the 
" digitalis of the respiratory apparatus." It has been recommended for 
bronchial asthma and in various types of dyspnea dependent upon depres- 
sion of the respiratory center. It is given as an expectorant, in bronchitis 
although its value is doubtful. 

AURANTIUM, Orange, — occurs in two official varieties of fruit and prepa- 
rations of their flowers, Citrus Aurantium amara, the Bitter Orange, and 
Citrus Aurantium sinensis, the Sweet or Portugal Orange, both trees of the 
nat. ord. Rutaceae, cultivated in almost all warm countries. Other varieties 
are described under Limon. The official titles are — 

Aurantii Amari Cortex, Bitter Orange Peel, — the dried rind of the fruit of 
Citrus Aurantium amara, characteristics well known. It contains a Volatile 
Oil isomeric with oil of turpentine, CioHie, and a bitter crystalline principle, 
named Hesperidin or Aurantiin. 

Aurantii Dulcis Cortex, Sweet Orange Peel, — is the fresh outer rind of 
the ripe fruit of Citrus A urantium sinensis. It contains a Volatile Oil differing 
from that of the bitter orange, and less of the bitter principle. 

Official Preparations. 

Fluidextractum Aurantii Amari, Fluidextract of Bitter Orange Peel. — Used as flavoring. 
Dose, TTj7x-3j, lav. njjxv.] 

Tinctura Aurantii Amari, Tincture of Bitter Orange Peel, — strength 20 per cent. Dose, 
3j-ij, [av. 3j.] A flavoring preparation. 

Tinctura Aurantii Dulcis, Tincture of Sweet Orange Peel, — strength 50 per cent. Dose, 
5j-ij, [av."3j.] A flavoring preparation. 

Syrupus Aurantii, Syrup of Orange, — Tincture of Sweet Orange Peel 5, Purified Talc 1.5, 
Citric Acid 0.5, Sugar 82, Water to 100. Dose, 3 j-ij. Used for flavoring. 

Syrupus Aurantii Florum, Syrup of Orange Flowers, — Sugar 85, Orange-flower Water 
to 100. Dose, 3j~ij. A delicate flavoring agent, but having to some persons an extremely 
sickish taste. 

Spiritus Aurantii Compositus, Compound Spirit of Orange, — Oil of Orange Peel 20, 
Oil of Lemon 5, Oil of Coriander 2, Oil of Anise £, Alcohol to 100. Dose, as for alcohol. 

Aqua Aurantii Florum Fortior, Stronger Orange-flower Water, — is water saturated 
with the volatile oil of fresh orange flowers. Dose, indefinite [av. 3ijl for flavoring. Used 
to prepare — 

Aqua Aurantii Florum, Orange-flower Water, — consists of equal volumes of the preceding 
and Distilled Water, mixed immediately before use. Dose, indefinite, [av. 3iv.] 

Oleum Aurantii, Oil of Orange, — a volatile oil, obtained by expression from the_ fresh 
peel of sweet orange. Is soluble in about 4 times its volume of alcohol, and is an ingre- 
dient of the official Spirit of Orange and also of Spiritus Myrciae (Bay Rum). Dose, 
gtt. j-v, [av. njmj.] 

Elixir Aromaticum, Aromatic Elixir {Simple Elixir), — has of the Comp. Spt. of Orange 
1.2, Purified Talc 3, Syrup 37J, Alcohol and Distilled Water to 100. A flavoring vehicle. 
Dose, 3j~Sj, or more. 
11 



162 AURUM. 

Orange is aromatic and tonic, also more or less bitter, but has little action 
except a mild stimulant influence on the nervous system due to its volatile oil 
Persons much exposed to its fumes are liable to cutaneous eruptions and various 
nervous disorders. The oil may produce violent colic and convulsions in chil- 
dren, one case being reported in which death resulted from eating the rind. 
Its use in medicine is confined to flavoring purposes, though the preparations 
of the bitter orange may be used as gentle tonics and stimulants to the digestion, 
but they are usually combined with more energetic agents. 

AURUM, Gold, Au, — is represented by only one official salt, the Gold 
and Sodium Chloride, but triturations of the metal itself may be prepared, 
according to the general pharmacopoeial formula for such preparations. The 
unofficial solution of Gold and Arsenic Bromide is a very efficient preparation. 

Auri et Sodii Chloridum, Gold and Sodium Chloride, — is a mixture composed of equal 
parts of dry Gold Chloride, AuCl 3 , and Sodium Chloride, NaCl; and occurs as an orange- 
yellow powder, of saline and metallic taste, slightly deliquescent in damp air, very soluble 
in water, partly soluble in alcohol, and contains not less than 30 per cent, of pure gold. Dose, 
gr. ^5—5 t av - g 1 - T2I once or twice a day. The Ph. Ger. gives the maximum single dose 
as gr. f , and the maximum daily dose as gr. iij, but these doses are too high. 

Incompatible with this salt are: Alkalies, Alkaloids, Arsenites, Hypophosphorous Acid, 
Ferrous and Mercurous salts, Organic substances, Oxalic Acid, Potassium Iodide, Sulphurous 
Acid, Thymol, Vegetable infusions. 

Unofficial Preparations. 

fAuri Pulvis, Powdered Gold, — may be obtained by triturating gold leaf with ten times 
its weight of sugar of milk or potassium sulphate until brilliant particles are no longer visible 
in it, and then washing the diluent away with boiling water. A Trituration of Gold may 
be prepared in the same manner, retaining the sugar of milk, as directed by the pharmacopoeia 
under the title Triturationes. Dose of powdered gold is gr. £-gr. j, or a little of it may 
be applied by friction to the sides of the tongue. 

'*% Auri Chloridum, Gold Chloride, — also called the perchloride or terchloride of gold, 
AuCl 3 , the "potable gold" of the alchemists, — occurs in needle-shaped prisms of a deep 
orange color, very deliquescent and freely soluble in water, in alcohol and in ether. Dose, 
gr. -gV^Vj m P^ or solution, preferably the latter. The commercial salt so named, and 
much used hy photographers, is not the pure chloride but a crystallized double salt of gold 
and sodium, containing 50 per cent, of metallic gold. 

Auri Bromidum, Gold Bromide, AuBr 3 , — occurs as a yellowish-gray, friable mass, 
which is insoluble in water but soluble in ether, and contains 55 per cent, of Bromine. Dose, 
gr. 2V-&, but against migraine the minimum quantity should be used twice daily an hour 
before meals. 

Auri et Sodii Bromidum, Gold and Sodium Bromide, AuBr 3 NaBr.2H 2 0, — may be 
used hypodermically in solution, 2 parts to 100 of distilled water, the dose of which is TT£viij 
increased to Trjjxxxij, respectively representing \ and f of a grain. 

Liquor Auri et Arseni Bromidi, Solution of Gold and Arsenic Bromide (Barclay), — 
is marketed under the trade-name "Arsenauro," and contains gr. 3^ of each salt in ttjjx. 
Dose, Tr£v-xv in water, thrice daily after meals, or hypodermically. 

This solution may be prepared as follows: (1) Take of Nitric Acid 5j and of Hydro- 
chloric Acid 5 hj, mix them and dissolve in the mixture 21 grains of pure Gold, then evaporate 
to dryness in a water-bath. Dissolve the resulting Chloride of Gold in distilled water oj. 
and add slowly a solution of 35 grains of Ammonium Bromide in 5iv of water. Shake with 
Squibb's ether until all the gold is taken out, separate in a separating funnel, and treat the 
ether solution with fused calcium chloride to remove all water. Distil off the ether, and dissolve 
the remaining Gold Bromide in §iv of water to make Solution No. 1. (2) Dissolve 48! 
grains of Arsenous Acid in §iv of distilled water by the aid of heat, and when cold add 5j 
of Bromine and let the mixture stand for 24 hours. Then drive off the excess of bromine 



AURUM. 163 

by boiling in a sand-bath until the solution is colorless, which gives Solution No. 2. (3) Mix 
the two solutions and add sufficient water to make 1 quart. 

Liquor Auri, Arseni et Hydrargyri Bromidi, Solution of Gold, Arsenic and Mercury 
Bromide (Barclay), — is marked under the trade-name " Mercauro," and contains gr. 3^ 
of each bromide in Ti£x. Dose, njv-xv in water, thrice daily after meals, or hypodermically. 

Similar solutions of the bromides of gold, arsenic and calcium ("Calcauro") and of the 
bromides of gold, arsenic and manganese ("Manganauro"), are on the market and may be 
used in like doses. 

Physiological Action. 

The action of the salts of gold upon the human organism is analogous in 
many respects to that of mercury, causing local irritation and escharotic effects 
when applied in substance or in strong solution. In continued medicinal doses 
given internally they produce a condition of general erethism which closely 
resembles the mercurial fever, and is accompanied by salivation but without 
tenderness or ulceration of the gums. The Chloride is one of the most active 
salts, being, according to Chrestien, even more toxic than corrosive sublimate. 
Locally, it produces irritant and caustic effects, and imparts a yellow stain 
to the skin, which later on turns violet and even black, from reduction of the 
metal therein. In overdoses it causes gastric pain and inflammation, also 
ulceration of the gastro-intestinal mucous membrane, and otherwise acts as a 
corrosive poison; toxic doses produce a violent gastro-enteritis with such nervous 
phenomena as convulsive tremor, cramps, priapism, insomnia and insensibility 
(Magendie). 

The salts of gold, administered in small medicinal doses, increase the appe- 
tite and the digestive power and stimulate the generative apparatus, exciting 
the menstrual flow in women and the sexual appetite in men. In large or con- 
tinued doses they cause dryness of the tongue, redness of the pharynx, gastric 
and intestinal colic, nausea and vomiting, and even erosion of the gastric 
mucous membrane. 

Therapeutics. 

The literature of gold shows that it is one of the most ancient medicines. 
Pliny, in the first century, recorded its use. It was employed as a panacea by 
the Arabian physicians and by the alchemists. During the 17th and 18th 
centuries it was highly esteemed as an antisyphilitic, also for leprosy, dropsies, 
epilepsy, the pest, fevers, amenorrhea, sterility and uterine diseases. During 
the first quarter of the present century it was in high repute among the Euro- 
pean physicians as a remedy for syphilis and for scrofula. 

Mitchill (1818) administered gold salts for syphilis in the New York Hospital, with 
excellent results. In his opinion " the muriate of gold will effect all that is achieved by the 
muriate of quicksilver, with incomparably less inconvenience to the patient, who gets well 
under the former without the hazard of a sore mouth or a salivation, and with very little 
wear and tear of constitution." Trousseau (185 1) said that the happy results of gold in 
the treatment of venereal diseases are incontestable; and von Schroff of Vienna (1868) gave 
it great praise for the restoration of a case of syphilis in which the strongest mercurials had 
failed to avert destruction of the nasal bones or the deep, spreading ulcers of the skin. Phillips 



1 64 BALSAMUM PERUVIANUM. 

(1S94) said that its efficacy is best seen in the later developments of syphilis, such as ulceration 
of the nose and larynx, cutaneous syphilides, hard nodes, etc., also that it may especially 
be employed in long-standing cases with chronic periostitis and when mercury has already 
been given to saturation. Still it has never obtained general professional favor in the United 
States or in England until recently. Professor Barton, of Jefferson Medical College, Phila- 
delphia (1827), pronounced the following judgment upon it in his lectures on materia medica. 
" On the whole view of what has been said in favor of gold, I am not inclined to attach great 
importance to it as a remedy. It is well enough in its proper place and for its proper purposes, 
for which it is more useful than as a medicine. Plenty of it would doubtless cure many diseases 
of mind and body." Such has been the general opinion since the above words were printed. 

There are very few physicians who use Gold at the present time. It is 
interesting to note that at one time it was widely recommended for a large 
number of conditions; thus Dr. Piffard of New York found that Gold was 
unquestionably useful in the later stages of syphilis, and said that its best 
effects were obtained with very small doses, gr. -^ or less, continued for not 
more than one or two weeks at a time. Several other observers have given it 
great praise as a remedy in constitutions which are broken down by the com- 
bined influence of syphilis and mercury, for syphilis in strumous subjects, and 
for the various manifestations of scrofula. Under its use the auric fever may 
develop, and the local affections for which it is administered may assume an 
aggravated intensity, and even new ones appear; but these phenomena do not 
call for suspension of the remedy, for the disease retrogrades rapidly in a few 
days after they appear (Trosseau) ; and on lessening the dose pyrexia subsides 
and good effects are more conspicuous (Phillips). 

A so-called Bichloride-of-Gold Cure for inebriety has become highly notori- 
ous through extensive advertising and other commercial methods, but from the 
most reliable information obtainable it is reasonably certain that the only prepa- 
ration of gold which plays a prominent part therein is the gold coin which passes 
from the patient's pocket to that of the manager of the "institute." The phys- 
iological symptoms produced by the remedy employed are those of strychnine 
and atropine, the administration of which hypodermically several times daily 
for three or more weeks is decidedly dangerous. In many cases cardiac failure 
has occurred soon after the completion of the treatment, and in a large num- 
ber of instances insanity or other serious psychoses have developed immediately 
after the subjects had been through one of these so-called " cures." 

BALSAMUM PERUVIANUM, Balsam of Peru,— is a balsam obtained 
from Toluifera Pereircs, a Central American tree, of the nat. ord. Leguminosae. 
It occurs as a thick, brown-black liquid, its odor reminding of benzoin and 
vanilla, soluble in 5 of alcohol, almost insoluble in water, which extracts from 
it only some cinnamic acid and cinnamein. It is not a true balsam, as it con- 
tains no volatile oil. Its composition is: Cinnamein (benzyl cinnamate, C 16 - 
H14O2) 50 per cent., Cinnamic Acid 10 per cent., Resins 30 per cent.; also ben- 
zoic acid and other bodies. Dose gr. x-xxv [av. gr. xv.] in emulsion. There 
are no official preparations. 

Incompatible with Balsam of Peru are: Ferric salts, Iodoform, and Hydrogen Peroxide. 



BALSAMUM TOLUTANUM BAPTISIA. 1 65 

The action of Balsam of Peru is that of its several constituents, namely, 
antiseptic, stimulant to the circulation, and sedative to the nervous system; 
acting chiefly on the mucous membrane, it is tonic and expectorant, diuretic and 
diaphoretic. In large doses, it causes gastralgia, nausea and vomiting, colic and 
diarrhea. It closely resembles in physiological action its congeners, Styrax 
and Benzoin. It encloses bacteria and is bactericidal, also chemotactic, and 
prevents putrefaction in dead tissues. It is a valuable dressing for contused and 
lacerated wounds. 

Balsam of Peru is used locally in chronic skin diseases of inflammatory 
type and sore nipples, to relieve itching, cleanse bed-sores, promote the healing 
of wounds and ulcers, and to kill the acarus scabiei, being considered by some 
authorities the best of all applications in itch. It should be remembered that 
a severe temporary albuminuria may follow its free application externally, as 
in scabies. In the absence of albuminuria, the urine may contain a resin 
which is precipitated by the addition of acid giving rise to a mistaken diagno- 
sis of albuminuria. The precipitated resin may be dissolved in an excess of 
alcohol (Hatcher and Wilbert). Internally, it is used as a stimulant and dis- 
infectant expectorant in chronic bronchitis and asthma, as well as in gonor- 
rhea, gleet, leucorrhea, an<J other discharges from mucous membranes. 

BALSAMUM TOLUTANUM, Balsam of Tolu ,— is a balsam obtained from Tduifera 
Balsamum, a tree of the nat. ord. Leguminosse. a native of Venezuela and New Granada. 
Its composition and properties are similar to those of Balsamum Peruvianum, except that 
it is of lighter color, more agreeable odor, and contains a volatile oil, Tolene, in the proportion 
of about 1 per cent. Dose, gr. x-xx [a v. gr. xv.] 

Tinctura Tolutana, Tincture of Tolu, — contains 20 per cent, of the Balsam dissolved 
in alcohol. Dose, Ttj?xx-xl [av. Trgxxx.] 

Syrupus Tolutanus, Syrup of Tolu, — has of the Tincture 5 per cent., with Sugar 82, 
and Water to 100. It is much used in cough mixtures, and covers the taste of Chloral Hydrate 
well. Dose, 3j-vj [av. 5iv.] 

Balsam of Tolu has similar action to that of Balsam of Peru, but being more agreeable 
in flavor it is more used internally than the latter. It is chiefly employed as a pleasant ex- 
cipient in cough mixtures, and is a constituent of the Compound Tincture of Benzoin. 

BAPTISIA, Wild Indigo (Unofficial), — is the root bark of Baptisia tinctoria, a plant of 
the nat. ord. Leguminosae, native in North America. It contains an alkaloid and a resin, 
neither of which have been examined critically. The so-called Baptisin is an impure 
resinoid, obtained by precipitation from the alcoholic extract with water. 

Unofficial Preparations. 

Extractum Baptisiae, Extract of Baptisia, — Dose, gr. j-x. 
Fluidextractum Baptisiae, Fluidextract of Baptisia, — Dose, ttjuj-xx. 
Tinctura Baptisiae, Tincture of Baptisia, — Dose, njjv-xxx. 
Baptisin, — the resinoid. Dose, gr. j-v. 

Baptisia has a bitter and acrid taste; in small doses it is laxative, in large ones violently 
emeto-cathartic, and may excite severe gastro-intestinal inflammation. It is a decided 
stimulant of the liver, and increases the secretions of the glandular appendages of the 
gastro-intestinal mucous membrane. It has considerable power as an antiseptic. It 
has fallen into disuse within recent years, its place having been taken by more reliable 
remedies. 



1 66 BARIUM — BELLADONNA. 

BARIUM, Ba., — is one of the alkaline metals, and is characterized by its 
strong affinity for oxygen. Several of its salts are official only as test-solutions, 
but the Chloride has important physiological actions which may obtain for it 
a permanent place in practical medicine. 

Barii Chloridum, Barium Chloride, BaCl 2 + 2H 2 0, (Unofficial),— occurs in colorless 
translucent tables or lamellae, soluble in 3 of water, insoluble in absolute alcohol. Dose, 
gr. ss-ij, in water, thrice daily after meals. 

Incompatibles. 

Incompatible with Barium salts are: Carbonates, Chlorates, Oxalic Acid, Oxalates 
Phosphoric Acid, Phosphates, Sulphuric Acid, Sulphates, Tannic Acid, Tartaric Acid, 
Tartrates. 

Physiological Action and Therapeutics. 

Barium salts in overdoses act as irritant poisons, causing salivation, thirst, 
vomiting, purging, dyspnea, and a slow pulse. Toxic doses paralyze the cen- 
tral nervous system and the heart, which is arrested in systole. In medicinal 
doses the Chloride stimulates the cardiac muscle like Digitalis, causing the 
contractions of the ventricles to become slower and more forcible. It con- 
stricts the arterioles by action on their muscular coat, raising the blood-pressure, 
stimulates the intestinal muscular fibres, and increases peristalsis, in these 
respects acting like Ergot. Applied locally to voluntary muscles it prolongs 
their contraction, like Veratrine. It was formerly used as a remedy in glandular 
affections and nervous diseases, and has been found efficient in mitral insuffi- 
ciency, irregular heart, hemorrhages, and atony of the bladder and of the in- 
testine. The Sulphide is occasionally used as a depilatory. 

BELLADONNA, Deadly Nightshade. — The Atropa Belladonna is an her- 
baceous, perennial plant, of the nat. ord. Solanaceae, having dark-purple, bell- 
shaped flowers, and glossy, purplish-black berries about the size of cherries. 
It is indigenous in the mountainous districts of central and southern Europe 
and Asia, and is cultivated in Europe and the United States. It contains the 
official alkaloid Atropine, C 17 H 23 N0 3 , which may be decomposed into Tropine 
and Tropic Acid. The official titles are as follows: — 

Belladonnae Folia, Belladonna Leaves, — ovate and tapering, brownish- 
green above, grayish-green below, of slight odor and bitter, disagreeable taste. 
Stramonium leaves are more wrinkled, Hyoscyamus leaves are more hairy. 
Dose, gr. ss-jss [av. gr. j], gradually increased. 

Belladonnae Radix, Belladonna Root, — occurs in cylindrical, tapering, 
wrinkled pieces, ^ to 1 inch thick, nearly odorless, taste bitter and acrid. Dose, 
gr. ss-j [av. gr. f ], cautiously increased. 

The "belladonna group," a term which is used frequently in pharmacology, includes 
belladonna, hyoscyamus and stramonium, all of which belong to the^ Solanacea and have 
similar constituents and related physiological actions. The active principles of this group 



BELLADONNA. 1 67 

are alkaloids, — atropine, hyoscyamine and scopolamine (also known as hyoscine). Atro- 
pine consists of equal parts of dextro- and levo-hyoscyamine; hyoscyamine is levo-hyoscya- 
mine. In the growing Belladonna the hyoscyamine is said to form in the young leaves, 
to be later changed to atropine (Bastedo). Scopolamine is levorotary and obtained from 
various plants of the solanacea. A brief comparison of the alkaloidal values of the solanacea 
reveals (1) Belladonna leaves 0.3 per cent, and root 0.45 per cent, of alkaloids mostly 
atropine; (2) Hyoscyamus leaves 0.065 P er cent, of alkaloids, mostly hyoscyamine, but also 
scopolamine and a trace of atropine; (3) Stramonium leaves 0.25 per cent, of alkaloids, 
mostly hyoscyamine with small amounts of scopolamine and atropine. 

Preparations of the Leaves. 

Extractum Belladonnae Foliorum, Extract of Belladonna Leaves. — Dose gr. T V to £, 
[av. gr. \.\ 

Tinctura Belladonnae Foliorum, Tincture of Belladonna Leaves, — 10 per cent. Dose, 
njrj-xx [av. TTjjxij.] 

Emplastrum Belladonnas, Belladonna Plaster, — has of the above extract 30 per cent., 
mixed with Adhesive Plaster. It may produce the physiological action of the drug. 

Unguentum Belladonnae, Belladonna Ointment, — has of the above extract 10, Diluted 
Alcohol 5, Benzoinated Lard 55, Hydrous Wool-fat, 30. 

The Extract is a constituent of Pil. Laxativae Comp., and Pil. Podophylli, Belladonnae 
et Capsici. 

Preparations of the Root. 

Fluidextractum Belladonnae Radicis, Fluidextract of Belladonna Root. — Dose, irjjss-ij 
av. ttkj.] 

Linimentum Belladonnae, Belladonna Liniment, — has of Camphor 5, dissolved in 
Fluidextract of Belladonna Root to 100. 

Atropine and its Derivatives. 

Atrophia, Atropine, C17H23NO3, — white, rhombic prisms, odorless, of bitter taste and 
alkaline reaction; very soluble in alcohol and in chloroform, also in 455 of water at 25 C. 
Is decomposed by prolonged contact with caustic alkalies and is resolvable into Tropine 
and Tropic Acid. [Av. dose, gr. T io«] 

Atropinae Sulphas, Atropine Sulphate (C 17 H 23 N0 3 ) 2 H 2 S0 4 , — a white powder of bitter 
taste and neutral reaction, soluble in 0.4 of water andin 6.2 of alcohol at 25 C. Dose, gr. 
20 o-T^o t av - gr- IM-] 

Homatropinae Hydrobromidum, Homatropine Hydrobromide, C 16 H 21 N0 3 HBr, — is 
the hydrobromide of an alkaloid obtained by the condensation of tropine and mandelic acid. 
It is soluble in 6 of water, 7,7, of alcohol, insoluble in ether. Dose, gr. xlo'ioo t av - S^ T2o-3 
It is used by ophthalmologists as a mydriatic, its effects passing off much sooner than those 
of Atropine. Homatropine slows the heart, Atropine quickening it. 

Allied Plants. 

These are Duboisia (see below), Hyoscyamus and Stramonium, which are described under 
the title Hyoscyamus. 

Duboisia, (Unofficial), — is the leaf of Duboisia myoporoides, an Australian tree of the 
order Solanaceae. It contains a poisonous alkaloid, Duboisine, which is believed to be identical 
with Hyoscyamine; also Hyoscine, Pseudohyoscy amine, and other alkaloids. Another species, 
Duboisia Hopwoodii, contains Piturine, an alkaloid which is practically identical with Nicotine. 

Extractum Duboisiae, Extract of Duboisia, (Unofficial), — Dose, gr. \-\. 

Tinctura Duboisiae, Tincture of Duboisia, (Unofficial), — Dose, t^v-xx. 

Duboisinae Sulphas, Duboisine Sulphate (Langenberg's), — Dose, gr. rho~jo- 

Incompatibles. 

Incompatible with Belladonna, Atropine or Duboisine are: Alkaloidal precipitants, Alkali 
Hydrates or Acids with heat, Tannic Acid, Vegetable decoctions or infusions. Physiologically 
incompatible are: Aconitine, Bromal Hydrate, Chloral Hydrate, Hydrocyanic Acid, Jaborandi, 
Morphine, Muscarine, Physostigmine, Phytolacca, Pilocarpine, Quinine. 

Physiological Action. 
The effects of Belladonna are those of its alkaloid Atropine, the dominant 
actions of which are stimulant to the vaso-motor and respiratory centres-and 



1 68 BELLADONNA. 

the cerebral cortex, and paralyzant to the terminal nerve-organs. In thera- 
peutic doses its influence upon the medulla, especially the respiratory and 
vaso-motor centres, is greater than upon the higher centres although in toxic 
doses the effects upon the cerebrum are more pronounced. It depresses or 
paralyzes the terminal nerve-organs of the parasympathetic system supply- 
ing the involuntary muscles, the intestines, the secretory glands, and the 
inhibitory apparatus of the heart. By stimulating the vaso-motor centre 
it greatly raises the arterial pressure; by depressing the vagus cardiac ter- 
minations it increases the rate but not the force of the heart [Digitalis slows 
the rate and increases the force], and at the same time it raises the body tem- 
perature. If the dose be sufficient the blood-pressure becomes progressively 
lowered by depression of the cardiac muscle and the muscles in the capillary 
walls, the temperature falls, but the rapid pulse continues to the last. The 
respiration is stimulated by small doses but is depressed by large ones, which 
paralyze the respiratory centre and the motor nerves of the respiratory muscles. 
Death occurs by asphyxia combined with cardiac failure. Excepting the vaso- 
motor and respiratory spinal centres the spinal cord is affected but slightly, 
though very large doses may produce convulsions and paralysis. The motor 
nerves are directly depressed without any apparent stimulation, the sensory 
nerves are but slightly affected, though they are depressed by its local appli- 
cation. The voluntary muscles are unaffected, the involuntary are paralyzed 
by the action of the drug on their nerve terminations. All the secretions of the 
body are checked by the paralysis of the nerve-endings in the secretory glands, 
except the urine, which is sometimes increased. 

A small dose of Belladonna or Atropine causes dryness of the mouth and 
throat and some slight disorder of vision. Under large doses the dryness is 
more intense, the fauces reddened, the pupils are dilated, the vision disordered, 
the pulse becomes very rapid, and a bright red flush, resembling that of scar- 
let fever, appears on the face and neck and may spread over the whole body. 
The intellect is not affected, but some giddiness and confusion of thought may 
be experienced, and sometimes spectral illusions occur. Large doses produce 
a talkative, wakeful delirium, which is often wild, the patient being violent 
and uncontrollable; a very large dose may cause a fatal stupor with complete 
muscular relaxation, or severe convulsions, ending in coma and paralysis. Con- 
gestion of the lungs, the membranes and substance of the brain and cord, and 
the retina, are usually found after death. There is suppression of urine after 
a toxic dose, though medicinal doses sometimes increase its flow. 

The pupils are dilated by either the local or systemic use of the drug, which 
stimulates the end organs of the sympathetic and paralyzes those of the motor 
oculi, thus increasing the power of the radiating iris fibers and lessening the 
action of its circular ones. Atropine applied locally also paralyzes accom- 
modation and increases the intraocular pressure. The least quantity of atropine 
which will affect the pupil is variously stated at from the one-two thousandth 



BELLADONNA. • 1 69 

to the one-seven hundred thousandth of a grain, the latter amount being that 
given by Donders. 

Atropine is rapidly absorbed and quickly eliminated, the latter process 
being complete within two hours. Its excretion is performed by the kidneys, 
and the urine of an atropinized animal will dilate the pupil of another animal. 
Birds and herbivorous animals are affected very slightly, and pigeons seem to 
be entirely unaffected by it. Children bear proportionately larger doses than 
adults. 

The actions of Duboisia are in all respects similar to those of its congener, 
Belladonna, except that Duboisine is more soluble in water than Atropine, is 
less irritant to mucous membranes, and more prompt in mydriatic action, but 
its effects are of shorter duration. It is also less of a cerebral excitant and 
more of a calmative and hypnotic. On man its action is said by some author- 
ities to be more powerful than that of Atropine, but less powerful on frogs. 
If administered before meals it disorders the ensuing digestion, but does not so 
act if given while digestion is in progress. Homatropine also acts locally upon 
the pupil like atropine but the effect is not so lasting. 

Therapeutics. 

Belladonna is one of the most valuable agents in the materia medica, rank- 
ing high in its efficacy and its wide range of usefulness. It is employed in direct 
conformity with its physiological action, to relieve pain, relax spasm, stimulate 
the circulation, decrease secretion, and check local inflammation. Atropine 
is used for the same purposes, also to antagonize the effects of certain poisons, 
to dilate the pupils, and to paralyze the accommodation of the eye. These 
agents are efficiently administered in rheumatic torticollis, lead colic, spasmodic 
colic, spasmodic dysmenorrhea, laryngismus stridulus, whooping cough, asthma, 
constipation, irritability of the bladder, and many other spasmodic affections. 
They are of little value in relieving pain unconnected with spasm, though they 
have been used with benefit in the pain of inflammation, particularly that of 
rheumatism, gout, neuralgia due to peripheral disturbance, sciatica, cancer, 
and pelvic affections. The sedative action of Atropine on the vagus has been 
successfully utilized in cholera infantum and other forms of cholera, on the 
theory that the gastro-enteric branches of the nerve are powerfully excited 
by the toxin of the disease. It is of great value in sudden collapse occurring 
in acute disease, and characterized by failure of arterial tension, subnormal 
temperature and excessive sweating; also in shock when the loss of temperature 
is chiefly due to vaso-motor paralysis. As a vaso-motor contractor it has been 
highly commended in pneumonia, congestion of the lungs, cerebral and spinal 
hyperemia, congestive headaches, encephalitis, meningitis, and myelitis. Bella- 
donna is often a valuable remedy in recent cystitis from chill, incontinence of 
urine in children, acute coryza, sore throat with fever, acute tonsillitis, epileptic 



I70 ' BELLADONNA. 

and puerperal convulsions, spermatorrhea, and involuntary seminal emissions. 
In scarlet fever it is indicated when the rash is imperfectly developed, the pulse 
feeble, and the general condition adynamic, also in typhus fever when the pupils 
are contracted, and in erysipelas of superficial and non-vesicular character. 
The prophylactic power of Belladonna against scarlet fever was at one time 
believed in by many practitioners, strenuously denied by others, and is now 
generally discredited. The Ointment is an efficient application in mastitis, 
rectal ulcer, anal fissure, boils, carbuncle, and other superficial inflammations. 

Beside the affections already mentioned, Atropine is used internally or 
hypodermically as a hemostatic remedy in metrorrhagia and phthisical hemop- 
tysis; also in ptyalism due to mercury and pregnancy, for the night-sweats 
of phthisis, in colliquative diarrhea, and as an antagonist to all the effects of 
Muscarine, and to some of the effects of Morphine, Physostigmine, Hydro- 
cyanic Acid, Ether, and Chloroform. It is synergistic to many of the effects 
of Morphine, and in poisoning thereby it should be used in very small doses, 
chiefly as a respiratory stimulant. Most of the unsuccessful cases treated by 
it were instances of overdosing with the antagonist, thereby superinducing 
atropine-narcosis upon the morphine-narcosis. In many cases of apparent 
death from ether or chloroform, the hypodermic injection of Atropine has saved 
life when other methods had failed. A solution of gr. iv to the § is used locally 
to dilate the pupils, paralyze accommodation, and contract the vessels of the 
eye, as in iritis, phlyctenular keratitis, and perforating ulcer of the cornea. 
It is contraindicated whenever there is increased intraocular tension, and should 
not be used in persons over 40 years of age, or in gouty or rheumatic subjects, 
in whom its instillation may light up a latent or incipient glaucoma. 

Duboisine is highly praised for its sedative action in the mental excitability 
of the insane, in the treatment of the morphine habit and in paralysis agitans. 
In doses of gr. T fa to tt °f tne sulphate, administered hypodermically twice 
daily, it induces quiet and refreshing sleep and is not dangerous. When given 
in larger doses it may produce vertigo, nausea or even syncope, but no fatal 
cases from its moderate use have been reported (Massant). Its sedative effect 
is at the same time the most persistent and also that of which the patient first 
acquires a tolerance. Of 22 cases in which the calmative effect was at first 
decided, a tolerance was acquired in eight. In such cases the sedative action 
of the drug may be restored by ceasing its continuous administration and length- 
ening the interval between the doses (De Montyel). It has been well employed 
in puerperal mania, and may be used instead of Atropine in many conditions, 
especially in the night-sweats of phthisis, respiratory neuroses and cardiac 
failure. It is employed as a mild mydriatic by eye surgeons, its advantages 
over Atropine being its more rapid action in paralyzing accommodation and 
effecting mydriasis, the shorter duration of its effects and the slight degree of 
-conjunctival irritation produced by it. 

Homatropine in a 1 per cent, solution is used as a mydriatic, a few drops 



BENZOINUM. 17I 

instilled every five or ten minutes. The mydriasis so produced lasts from 
thirty-six to forty-eight hours. 

BENZOINUM, Benzoin, — is a balsamic resin obtained from Styrax Ben- 
zoin, a tree of the nat. ord. Styracea?, native in Sumatra and Siam, by incision 
of its bark. It occurs in agglutinated tears or a brown, mottled mass, is soluble 
in alcohol and solution of potassa, and is composed of Resins 80 per cent., Ben- 
zoic Acid 10 to 20 per cent., and a trace of Volatile Oil. Some varieties yield 
also Cinnamic Acid. Dose, gr. v-xx, [av. gr. xv]. Benzoin is an ingre- 
dient of Adeps Benzoinatus, Benzoinated Lard. 

Preparations. 
Tinctura Benzoini, Tincture of Benzoin, — has of Benzoin 20 parts, Alcohol 100. Dose, 

TT£X-XX, [av. TTJ7XV.] 

Tinctura Benzoini Composita, Compound Tincture of Benzoin (Friar's Balsam), — 
has of Benzoin 10, Aloes 2, Storax 8, Balsam of Tolu 4, Alcohol to 100. Dose, ttj?x-x1, 

[av. TTJ7XXX.] 

Benzoic Acid and its Salts. 
Acidum Benzoicum, Benzoic Acid, HC 7 H 5 2 , — occurs in light, feathery plates and 
needles, and is obtained from Benzoin by sublimation, or prepared artificially, chiefly from 
Toluol. It is soluble in 275 of water, and in 2.3 of alcohol at 25 C, but its solubility in 
water is aided by Borax, one part of each being soluble in 100 parts. It is a constituent of 
Tinctura Opii Camphorata. Dose, gr. v-x [av. gr. viij] in wafers. 

Ammonii Benzoas, Ammonium Benzoate, — is soluble in 10 parts of water and in 35 of 
alcohol. Dose, gr. v-xxx, [av. gr. xv.] 

Sodii Benzoas, Sodium Benzoate, — is efflorescent on exposure to air, soluble in about 
2 parts of water and in 61 of alcohol. Dose, gr. v-xxx [av. gr. xv.] 

Unofficial Derivatives and Preparations-. 
Acidum Cinnamicum, Cinnamic Acid, C 9 H 8 2 , — occurs in the balsams, in styrax, 
and in some benzoin resins. It occurs in fine needles or thick prisms, which are soluble in 
hot water and in alcohol. Dose, gr. j-x, hypodermically. 

Lithii Benzoas, Lithium Benzoate, — soluble in 4 parts of water and in 12 of alcohol- 
Dose, gr. v-xxx, [av. gr. xv.] 

Sodii Cinnamas, Sodium Cinnamate, (Hetol), — occurs as a white, crystalline powder, 
soluble in water. Dose, gr. j-x, in 5 per cent, sterilized solution, internally or hypodermically. 

Incompatibles. 
Incompatible with Benzoin are Alkalies, Acids, Water; with the Benzoates are Acids 
Ferric salts. 

Physiological Action and Therapeutics. 

The action of Benzoin is that of Benzoic Acid, which is antiseptic, anti- 
pyretic, analgesic, diaphoretic, and diuretic. A solution of 1 in 1000 prevents 
the development of bacteria, and one of 4 in 1000 is fatal to most of them. 
Taken internally it causes slight epigastric heat, increases the pulse-rate, and 
stimulates the action of the skin and kidneys, the salivary glands, and the 
bronchial mucous membrane. It is principally excreted by the kidneys, 
partly as hippuric acid by combination with glycocoll, and in part unchanged. 
Benzoin is irritant to the fauces, and the powder excites sneezing and cough- 
ing when inhaled. 



172 BERBERIS. 

Benzoin is principally used as a stimulating expectorant, especially in the 
chronic bronchitis of the aged, and by atomization in laryngeal affections. 
The compound tincture, 5 j to § j in a pint of boiling water, is a useful sedative 
inhalation for the irritation and cough of subacute laryngitis and tracheitis. 
It has been used beneficially in chlorosis and some uterine disorders. The 
compound tincture is a good local application (1 part to 4 of glycerin and water) 
for sore nipples and chaps of the hands and lips. For use as a cosmetic, either 
tincture is mixed with 20 parts of water, and employed to remove freckles, and 
for other skin affections, especially urticaria. The tinctures are excellent appli- 
cations to foul-smelling wounds, and form the basis of all the proprietary prepa- 
rations sold for that purpose. 

Benzoic Acid and its salts are generally considered to be efficient agents for 
rendering an alkaline Urine acid. They are valuable remedies in chronic cystitis, 
not only neutralizing the alkalinity of the urine, but also stimulating the ves- 
ical mucous membrane. 

Sodium Benzoate has been largely used as a substitute for the salicylates 
in the septic diseases, being equally antiseptic and antipyretic. Though slower 
in action, its effects are more permanent, and it is capable of being used in larger 
doses (5ij-iij daily). In diphtheria and scarlet fever it has been highly effi- 
cient, and in acute rheumatism, typhoid and the malarial fevers it has rendered 
good service. It has proved very efficient in whooping-cough. 

Cinnamic Acid resembles benzoic acid in its action. It increases leuco- 
cytosis, and promotes the excretion of uric acid in a marked degree. Sodium 
Cinnamate has been used internally and by intravenous injection in pulmonary 
tuberculosis with varying results. 



BERBERIS, Berberis (Barberry) (Unofficial), — is the root of several species of the nat. 
ord. Berberidaceae, the one generally used being the Berberis aquifolium, or Oregon grape, 
which grows on the Pacific slope of the United States. Its value is probably due to its 
alkaloid, Berberine, C20H17NO4, a yellow, crystalline body, soluble in hot water and alcohol, 
but not in ether, which is found also in several other plants, as Hydrastis, Coptis, Podo- 
phyllum, Menispermum, Calumba, Xanthoxylum, etc. Dose, gr. x-xl [av. gr. xxx.J 

Fluidextractum Berberidis, Fluidextract of Berberis (Unofficial), — Dose, ttjjx-xI [av. 

TTRXXX.] 

Berberina, Berberine (Unofficial), — Dose, gr. j-x. It usually occurs in commerce as 
Hydrastin, which is a Berberine Hydrochlorate prepared from Hydrastis. 

Berberis is an astringent bitter, a tonic and stomachic in small doses, but in large doses 
it is cathartic, producing watery diarrhea with abdominal pain. It is believed to possess 
considerable alterative powers. It has been successfully used as a local application in con- 
junctivitis, and internally as a remedy for intermittent, remittent and typhoid fevers, diarrhea 
and dyspepsia. As an alterative and tonic it is useful in syphilitic and strumous affections, 
and in pain, soreness and burning sensations along the biliary or urinary tracts with a ten- 
dency to gravel or gall-stones it will be found a useful remedy. 

. Berberine has some antiseptic and antiperiodic value, but in large doses it is a gastro- 
intestinal irritant. The Hydrochlorate is a useful injection in gonorrhea, in which it acts 
by virtue of its antiseptic and astringent powers. Alkaloidal precipitants and soluble Tar- 
trates are incompatible with Berberine salts. 



BISMUTHUM. 173 

BISMUTHUM, Bismuth, Bi. — This metal is represented in medicine by 
six official salts and several unofficial ones, the most important of which are the 
following: — 

Official Salts of Bismuth. 

Bismuthi Betanaphtholas, Bismuth Betanaphthol, — is a compound of Bismuth and Beta- 
naphthol yielding not less than 15 per cent, of Betanaphthol and not less than 73 per cent, 
of Bismuth oxide. It is buff colored, amorphous, odorless, tasteless powder. Nearly 
insoluble in water and alcohol. Dose, gr. v-xv [av. gr. viij.] 

Bismuthi et Ammonii Citras, Bismuth and Ammonium Citrate, — is a combination 
of the citrate with aqua ammonias, and has no definite chemical composition. Small, pearly 
scales, very soluble in water, sparingly in alcohol. Dose, gr. j-v, [av. gr. ij.] 

Bismuthi Subcarbonas, Bismuth Subcarbonate,- — a white or yellowish-white powder, 
of somewhat varying chemical composition, tasteless and odorless, insoluble in water or 
alcohol. Dose, gr. v-xx [av. gr. viij], in powder or emulsion. 

Bismuthi Subnitras, Bismuth Subnitrate, — a heavy, white powder, of somewhat varying 
chemical composition, odorless and almost tasteless, of slightly acid reaction; insoluble in 
alcohol, almost insoluble in water. Dose, gr. v-xx [av. gr. viij], several times a day, in 
powder, pill, or milk; often combined with opium, morphine or belladonna. 

Bismuthi Subgallas, Bismuth Subgallate {Dermatol),- — fine, odorless, saffron-yellow 
powder, insoluble in all ordinary solvents. Dose, gr. v-xx [av. gr. viij.] 

Bismuthi Subsalicylas, Bismuth Subsalicylate, — should yield not less than 80 per cent, 
of pure bismuth oxide; almost insoluble in water, insoluble in alcohol. Dose, gr. v-xv [av. 
gr. viij.] 

Unofficial Bismuth Salts. 

Bismuthi Citras, Bismuth Citrate, BiC 6 H 5 7 , — a white, amorphous powder, odorless 
and tasteless, insoluble in water or alcohol, soluble in Water of Ammonia. Used only for 
pharmaceutical purposes. Dose, gr. j-iij [av. gr. ij.] 

Bismuthi Subiodidum (Oxyiodidum), Bismuth Subiodide, — a brick-red, heavy, amor- 
phous powder, insoluble in water, insoluble in any reagent without decomposition. Used 
locally as an antiseptic dusting powder, and internally in doses of gr. jss-iij. 

Bismuthi Oleas, Bismuth Oleate, — a pearly-gray, soft, bland substance. [See under 
Acidum Oleicum.] 

Airol, Bismuth Oxy-iodo-gallate, — is a patented combination of Bismuth Subgallate 
and Iodine, occurring as a bulky, gray powder, odorless and tasteless, insoluble in water 
or alcohol. It is used as a dusting powder for ulcers and wounds, or mixed with Vaselin 
or Lanolin as an ointment. Calomel is incompatible with it. 

Eudoxin, Bismuth Tetra-iodo-phenol-phthalein, — is a bismuth salt of Nosophen and 
contains about 53 per cent, of Iodine and 14 per cent, of Bismuth. It occurs as a reddish- 
brown, odorless and tasteless powder, insoluble in water. It is said to be an efficient internal 
antiseptic for gastric and intestinal affections. Dose, for children, gr. j-iij; for adults, 
gr. iij-viij. 

Bismuth Tribromphenate, — is a preparation which contains about 50 per cent, of Bi 2 3 
and occurs as a yellow, insoluble powder, having a faint odor of carbolic acid. It is almost 
non-toxic and unirritating to mucous surfaces. It is an excellent surgical and intestinal 
antiseptic, and has been used locally with benefit in chancroids, buboes, foul ulcers, in- 
fected wounds, burns, eczema and other skin diseases. It has been given internally with 
satisfactory results in cholera, intestinal catarrh and the summer diarrhea of children, also 
for chronic urticaria and certain forms of infantile eczema. Dose, gr. vij-x'v, three times 
a day. 

Xeroform, — is a proprietary preparation complying with the standards for bismuth 
tribromphenate. 

Incompatibles. 

Incompatible with Bismuth and Ammonium Citrate are Acids; with Bismuth Subnitrate 
are Alkali Carbonates and Hydrates, Calomel, Hypophosphites, Gallic Acid, Iodides, Sali- 
cylic Acid, Sulphur, Tannic Acid; with the Subcarbonate as with the carbonates (see under 
Carbon); with the Subgallate, Acids. 



174 BISMUTHUM. 



Physiological Action. 



The action of the insoluble Bismuth salts is chiefly a local one, they being 
sedative to the end-organs of the nerves, though a minute quantity passes into 
the blood and acts as a tonic, promoting constructive metamorphosis by increas- 
ing the appetite and digestion. They are actively antiseptic and feebly astrin- 
gent, and produce constipation after a time, coloring the stools and tongue a 
dark clay color, from their conversion in part into the sulphide. Toxic effects 
when occurring are ascribed to Arsenic, with which the commercial preparations 
were formerly contaminated; but it has been shown that the Bismuth salts possess 
toxic powers of their own, and that the symptoms of bismuth-poisoning may 
develop when these preparations are applied as a dressing to a large, denuded 
surface, or taken internally in large doses for a long period of time. A black 
line along the margins of the gums, headache, nausea, vomiting, pale face, 
elevated temperature, rapid pulse, edema of the lower extremities, diarrhea, 
and an odor of urine on the breath, are some of the symptoms observed in such 
cases. Black and gangrenous sloughs may occur in the intestines, and the urine 
may contain albumin. 

The insoluble Bismuth salts are used internally in many forms of disordered 
digestion, gastralgia, vomiting and diarrhea, especially in children, but large 
doses are necessary for efficiency. The best vehicle for them is milk. Locally 
they are used with advantage in acne rosacea, stomatitis, nursing sore mouth, 
eczema, intertrigo, conjunctivitis, coryza, gonorrhea, gleet and leucorrhea. 
The Subnitrate is regarded by many practitioners as almost a specific in cholera 
infantum, given in hourly doses of 3 to 6 grains: also in the diarrhea of phthisis, 
dysentery and intestinal ulceration, it is highly efficient, in doses of 15 grains 
every hour or two. In amoebic dysentery large doses, 3j to 3iij every 3 hours 
are effectively used. Externally, it is employed as a dusting powder, either 
pure or mixed with starch (1 to 5) ; as a drying application for the nasal, pharyn- 
geal and laryngeal mucous membranes; in suspension as an injection in gonor- 
rhea (4 to 10 per cent.); and with vaselin (10 to 15 per cent.) as an ointment 
in eczema, also for burns and wounds. 

The Bismuth and Ammonium Citrate being soluble, is more rapid in action, 
but also more astringent and irritant than the other salts, though it is prob- 
ably precipitated in the stomach by the hydrochloric acid of the gastric juice. 
It is serviceable in diarrhea without irritation of the intestinal mucous mem- 
brane, but rather with relaxation thereof. The Subsalicylate when pure is 
well borne by the stomach, and can be used for longer periods than the sub- 
nitrate. It has been especially serviceable in the diarrhea of phthisis, in that 
of typhoid fever, and in chronic gastric and intestinal disorders, also as an in- 
ternal antiseptic in dilatation of the stomach. 

The Subgallate, also known as Dermatol, is one of the many substitutes 
for Iodoform. It has great stability, as well as valuable drying and bactericidal 



BROMUM. 175 

qualities, and is an excellent vulnerary for wounds and burns. It has proven 
useful in the treatment of moist eczema, ulcers, and other affections of the eye,, 
diseases of the middle ear and dental caries. It occasionally produces der- 
matitis, and Dr. Cantrell holds that it is decidedly irritating, is a stimulant rather 
than an astringent, does not check but rather increases discharge, and does not 
fulfil the claims made for it. Efforts are made to show value for it as an internal 
remedy in fermentative dyspepsia and gastric catarrh. It is efficiently employed 
internally for diarrhea in doses of 10 or 20 grains every two or three hours. 
The Oleate is credited with mildly astringent and emollient properties, and 
has been used with benefit in pustular affections of the skin and in acne. The 
Subiodide is an exceedingly valuable agent in the treatment of burns, wounds, 
ulcers, and similar affections as a substitute for Iodoform. It is remarkably 
efficient as a stimulant of granulation in wounds, and is odorless, non-irritant, 
and highly antiseptic. 

BROMUM, Bromine, Br, — is a non-metallic element found in sea-water 
and in the mother-liquid of -certain salt-works, usually in combination with 
other substances. It occurs as a dark, brownish-red, volatile liquid, evolving 
an irritant vapor of peculiar and suffocating odor. It is soluble in 30 of water 
at 59 F., very soluble in alcohol, ether, chloroform and carbon disulphide. 
On exposure to air or heat it is completely volatilized. It destroys the color 
of solutions of litmus and indigo, and imparts a yellow color to solution of starch. 
It is used only rarely and then usually locally as an escharotic. It is official 
as:— 

Acidum Hydrobromicum Dilutum, Diluted Hydrobromic Acid, — is com- 
posed of 9.5-10.5 per cent. Hydrobromic Acid, HBr, in Water, and occurs as 
a clear, colorless and odorless liquid, of pungent and acid taste. It is pro- 
duced by decomposing Potassium Bromide with Sulphuric Acid and distilling. 
Dose, Tflx-5j [av. TTLxv], well diluted. 

Bromides and their Preparations. 

Potassii Bromidum, Potassium Bromide, KBr, — colorless, cubical crystals, soluble in 
1.5 of water and in 250 of alcohol. Dose, gr. ij~5j, [av. gr. xv], well diluted. 

Sodii Bromidum, Sodium Bromide, NaBr, — colorless, monoclinic crystals, soluble in 
1.1 of water and in 16 of alcohol. Dose, gr. ij-3j, [av. gr. xv], well diluted. 

Lithii Bromidum, Lithium Bromide, LiBr, — a white, granular, deliquescent salt, very 
soluble in water and in alcohol. Dose, gr. ij-xl, [av. gr. xv], well diluted. 

Ammonii Bromidum, Ammonium Bromide, NH 4 Br, — colorless, prismatic crystals* 
soluble in 1.3 of water and in 12 of alcohol. Dose, gr. ij-xl [av. gr. xv], well diluted. This 
Bromide is well borne by children in comparatively large doses if epileptic from reflex causes. 
A child one year old can tolerate gr. v every 4 hours (Barton). 

Calcii Bromidum, Calcium Bromide, CaBr 2 , — a white, granular, deliquescent salt, very 
soluble in water and in alcohol. Dose, gr. ij- 3 j, [av. gr. xv], well diluted. 

Strontii Bromidum, Strontium Bromide, SrBr 2 (H ? 0) 6 , — colorless, hexagonal crystals, 
very deliquescent, very soluble in water and in alcohol; insoluble in ether. Dose, gr. ij-xxx 
[av. gr. xv], well diluted. 



\ 



176 BROMUM. 

Syxupus Ferri Bromidi, Syrup of Iron Bromide (Unofficial), — is a syrupy liquid con- 
taining 10 per cent, of Ferrous Bromide, FeBr 2 , prepared by acting on Iron Wire 35 parts 
with Bromine 75, adding Sugar 600 and Water up to 1000 parts. A translucent, pale-green, 
odorless liquid of sweet, ferruginous taste and neutral reaction. Dose, 5ss-j. 

Arsenic Bromide is described on page 153, Aurum Bromide on page 162, Ethyl Bromide 
on pages 82 and 85, and Camphora Monobromata under Camphora. 

Official Derivative of Bromine. 
Bromoformum, Bromoform, (Tri-bromo-methane), CHBr 3 — is prepared by the action 
of sodium hypobromite on acetone, or by the action of bromine upon a solution of equal 
parts of caustic potash and methyl alcohol. A clear and colorless liquid, of pleasant odor 
and sweet, agreeable taste; slightly soluble in water, readily soluble in alcohol and in glycerin. 
Dose, ttjjj-v [av. njjiij]. If it has color it should be rejected as unsafe by reason of decomposi- 
tion 

Unofficial Derivatives of Bromine. 
Bromipin — is a combination of bromine with the fatty acids of Sesame oil, and occurs 
as a yellowish liquid containing 10 per cent, of Bromine. Dose, 5 j— iv thrice daily, in emulsion, 
warm milk or capsules. 

Adalin, Bromidethyl-acetylcarbamide, — is a colorless, odorless powder, readily soluble 
in alcohol, soluble with difficulty in water. Dose, gr. v-x as a sedative; gr. x-xx as a 
hypnotic. 

Brometone, Tribrom-Tertiary-Butylalcohol, — is a fine, white, crystalline powder, 
slightly soluble in water, soluble in alcohol. It is produced by the action of acetone on 
bromoform. Dose, gr. v. 

Bromural, Monobrom-isovaleryl bromide, — occurs as small, white, almost tasteless 
needles, easily soluble in hot water and alcohol, less so in cold water. Dose, gr. v-x. 

Sabromin, Dibrombehenate of Calcium, — occurs as colorless, odorless and tasteless 
powder, insoluble in water and alcohol, alleged to contain about 29 per cent, of Bromine 
and about 3.8 per cent, calcium. Dose, gr. v-xxx, [av. gr. xv.] 

Incompatibles. 
Incompatible with Bromine are: Alkali Hydrates, Arsenites, Ferrous salts, Hypophos- 
phites, Hydriodic Acid, Mercurous salts; with Bromoform are: Caustic Alkalies, Aqueous 
liquids; with the Bromides are: Acids, Alkaloids, Antimony salts, Bismuth salts, Chlorine- 
water, Chlorates and Chromates in acid solutions; Salts of Copper, Lead, and Silver; Mer- 
curous salts, Nitric Acid, Spirit of Nitrous Ether if acid. 

Physiological Action. 

Bromine is an active and painful escharotic. It is antiseptic, disinfectant 
and deodorant. A solution of 1 in 500 is germicidal in moist air and with an 
exposure of not less than three hours. Its vapor is irritant to the eyes and the 
respiratory tract, causing cough, hoarseness and dyspnea. Internally it acts 
as a corrosive poison, producing violent gastritis, depression, and collapse. 

The Bromides are powerful depressants to the nervous system and the cir- 
culation, the Potassium salt being the most active in this respect. They lower 
the activity of the cortical motor area, and that of the brain as a whole, and 
are powerful hypnotics. The excessive use of Potassium Bromide produces 
degeneration of the cortical cells, beginning at the periphery of the dendrons. 
They lower the reflex excitability of the spinal cord, and impair the functions 
oT the peripheral nerves and the sensory apparatus, causing anesthesia of the 
skin and mucous membranes. They depress the muscular system, by direct 
action on the muscles themselves, as well as by their action on the nerves sup- 
plying them. The Potassium salt is directly paralyzant to the heart, lessening 



BROMUM. 177 

the force and frequency of its contractions, and finally stopping it in diastole. 
They lower the arterial tension and the body temperature, depress the sexual 
appetite and power, cause pallor and emaciation, a coated tongue and disordered 
digestion, a fetid breath, acne on the face and upper extremities, somnolence, 
dysphagia, sluggish reflexes and defective coordination; and if long continued 
may even impair the mental faculties, producing hallucinations in some cases, 
in others melancholia with suicidal tendency; also incompetence of the sphincters 
and paralysis, beginning at the periphery and extending to the centres. They 
sometimes cause maniacal excitement, as in the case of a physician who com- 
mitted suicide in a frenzy caused by bromidizing himself for sea-sickness. The 
general result of their action is termed Bromism, and is heralded by the acne 
and lowered faucial sensibility. It is probably due to the sedative influence of 
these agents on the sympathetic system, causing general anemia of the brain, 
spinal cord, sexual organs, and skin. It is believed that a previous prolonged 
use of opium or morphine renders the organism extremely susceptible to the 
action of the bromides. 

Bromides are rapidly absorbed and slowly eliminated by the kidneys, skin, 
saliva, intestinal and bronchial mucous membranes, and the milk. After 
absorption the larger part is temporarily retained in the tissues, and if con- 
tinuously administered replaces some of the normal sodium chloride. As 
much as one-fourth of the chlorides of the blood may be so displaced when 
saturation has occurred, after which elimination keeps pace with absorption 
{Hatcher and Wilbert) . When the drug is stopped it may require some weeks 
before the bromide which is fixed in the tissue is entirely eliminated. When 
given to a mother in large doses it may effect the nursling. It irritates 
the mucous membranes at the points of elimination, and increases the quan- 
tity of the urine and the excretion of the chlorides and the nitrogenous con- 
stituents, but decreases the elimination of the phosphates. 

Hydrobromic Acid is more irritant to the stomach than the bromides, but 
after absorption it has the same action as these agents on the nervous system 
and the circulation. 

Dr. Hammond mentions several cases of fatal bromide-poisoning in one of the last chapters 
of his treatise on Nervous Diseases, and several cases of poisoning by Potassium Bromide 
have been published by Dr. Greenless. The first was that of an epileptic who took 75 grains 
a day for three weeks, when stupor, coma, and extreme prostration and death followed. The 
post mortem showed intense congestion of the meninges. In another case, an epileptic, the 
same amount of potassium bromide, 75 grains a day, was given, and in ten days coma and 
death followed. Both the brain and meninges were congested and the kidneys were in the 
advanced stage of cirrhosis. The other cases were less prominent and clearly resulted from 
bromism due to long use of the drug. In some cases of inebriety large doses of bromides 
produce stupor and prostration, from which recovery is slow, and is followed by continued 
prostration. 

Differences in Action between the Bromides. 
Potassium Bromide is the most toxic to the heart and the muscular system, and is the 
least hypnotic. It contains 67 per cent, of Bromine. 

Sodium Bromide is the least toxic, but the most hypnotic, and acts more energetically 
on the circulation. It contains 78 per cent, of Bromine. 
12 



I78 BROMUM. 

Ammonium Bromide resembles the Potassium salt in action, except that it exerts less 
influence on the heart and on the muscular system, and is somewhat more stimulating. 

Lithium Bromide contains the most Bromine, 92 per cent., and resembles the sodium 
salt in action. It has proved better than the others in some cases of epilepsy, and is by several 
authorities considered the best hypnotic of the series. 

Calcium Bromide is an efficient hypnotic, but otherwise much less active than the other 
bromides. 

Strontium Bromide is said to be less apt than the other bromides to produce the bromic 
acne and the other results of bromism. 

Zinc Bromide, in large doses, is violently irritant. It is supposed to combine the tonic 
effects of zinc with the sedative action of the bromides. 

Ferrous Bromide is not official. It is supposed to combine the actions of iron and the 
bromides, and to produce the effects of a sedative chalybeate tonic. It is not an eligible 
chalybeate. 

Therapeutics. 
The Bromides are used as sedatives to the nervous system, to lower reflex 
activity, to produce sleep, to subdue excitement of the genital apparatus, and 
to antagonize cerebral excitement when not inflammatory in character. In 
epilepsy their power of lowering the excitability of the cerebral cortex makes 
them the most valuable remedies for diminishing the number of the attacks, 
though they rarely cure the disease. They are greatly abused in many in- 
stances, and should usually be restricted to those cases in which motor irrita- 
bility is more marked than psychic irritability, and where the disease is not 
due to gross organic lesions. They should not be used in anemic or adynamic 
cases, and should never be continued for any length of time without the daily 
supervision of a competent physician. Their dosage in this disease is usually 
much heavier than is necessary, instead of 40 to 60 grains and more thrice 
daily, less than one-half these quantities give equally good results, particularly if 
sodium chloride is withdrawn from the food, as the bromides act more efficiently 
in the absence of the chlorides. In the use of the drug in epilepsy it is well 
to recall that the drug is slowly eliminated and that when the tissues become 
saturated, elimination keeps pace with absorption and the excess bromide can 
be of no benefit and may induce harmful depression and evidences of bromism. 
Large doses for a few days, followed by small doses with- restriction of the 
chlorides in the food is the desirable method. If opium be administered for 
4 to 6 weeks before a course of bromide treatment the latter will be more effec- 
tive in smaller dose than otherwise. In various forms of insanity they are 
largely used, often to the detriment of the patient, causing a degree of mental 
dulness which simulates dementia, lowering nutrition and checking recovery. 
As hypnotics they are valuable in the insomnia of overwork or worry, in 
nightmare and the night-screaming of children, and when there is no organic 
reason for the wakefulness, but they are useless in cases due to pain, and in 
delirium tremens. They are efficiently palliative in many spasmodic affec- 
tions, as laryngismus stridulus and whooping-cough, also for the nervous 
symptoms of the climacteric period, and those complicating uterine disease. 
Tetanus has been cured by large doses of the bromides combined with chloral 
and in strychnine poisoning they have proved efficient as antagonists, though 



BROMUM. 179 

too slow of action to be of much practical service. Bromides are often very 
efficient in migraine, neuralgia, and hysteria, nervous erethism, infantile colic, 
cholera infantum, vomiting of cerebral origin, sea-sickness, cardiac irrita- 
bility not due to anemia and other varieties of functional disease of the heart, 
seminal losses when plethora exists, and nymphomania. 

Strontium Bromide is favorably known for its beneficial action in gastric 
affections, particularly in dyspepsia, acetic and lactic fermentation, flatulence 
from decomposition and vomiting of various origin, including the morning 
nausea of early pregnancy. In severe cases of the latter affection it proved 
entirely successful, administered in doses of gr. xv with meals, twice daily for 
a month. It has been used in the treatment of nervous and sick headaches, 
sea-sickness, insomnia and other conditions for which the bromides are con- 
sidered suitable. It is said to be less productive of the bromic acne than any 
other bromide in general use. 

The Syrup of Iron Bromide has been reported by some observers as very 
efficient in chorea, and its usefulness therein is as strenuously denied by others. 
Hydrobromic Acid has been useful in hysteria, congestive headaches, neuralgia, 
and tinnitus auriurm It is considered less depressant than the bromides of 
potassium and of sodium, and is recommended as a substitute for those salts. 
Fothergill used it with benefit in reflex and spasmodic coughs, and in the cere- 
bral disturbance of simple continued fever. Used as a solvent for quinine it 
retards cinchonism, and prevents the headache due to the full action of quinine 
and iron. 

The Bromides should be administered in plenty of water, two or three times a day after 
meals, and when given for any length of time Arsenic should be conjoined with them to pre- 
vent the bromic acne, and an occasional purgative to prevent accumulation. The mixture 
of Potassium Bromide and Chloral, so much used in alcoholism, is dangerous in cases of 
weak or fatty heart, both drugs being active cardiac depressants. 

Within recent years a number of synthetic compounds have been prepared 
with the purpose of eliminating some of the objectionable effects of the alka- 
line bromides. These compounds are split up in the system and the bromine 
liberated gradually, lessening the likelihood to bromism. Among these are 
Bromipin, Sabromin, Bromurol, etc. Bromipin may be administered for 
a long time, it is said, without irritating the stomach, impairing the appe- 
tite, or producing bromism. It is highly praised by those who have used it, 
as supplying all the therapeutic efficacy of the bromides, with few or none of 
their drawbacks. 

Bromine is not much used in medicine. It is the most efficient escharotic 
for chancre and hospital gangrene, and its vapor inhaled from hot water is 
useful in acute coryza and hay-fever. A solution of 8 minims to the ounce, 
used internally in doses of TTlj-iij every half -hour, together with inhalation of the 
vapor, has been successfully employed in severe cases of laryngeal diphtheria. 

Bromoform is an analogue of Chloroform, inhalation producing anesthesia 
of brief duration. Overdoses internally have caused deep narcosis in children 



l8o BRYONIA BUCHU. 

tempted by its agreeable taste to the surreptitious ingestion of a greater than the 
prescribed quantity. It is an efficient palliative in whooping-cough, administered 
in daily doses of 5 to 20 minims in glycerin and alcohol solution. It aborts 
the paroxysms of coughing and reduces their number, but has little influence 
otherwise on the regular course of the affection. Increasing doses must not be 
pushed very far for fear of toxic symptoms, and the drug must be absolutely 
colorless if pure. Inhalations of Bromoform have been used with some success 
in the treatment of diphtheria, and it has been employed locally with benefit, 
as a deodorizer, disinfectant and analgesic, in ozena and in tuberculous and 
other ulcers of the larynx. 

BRYONIA, Bryonia, Bryony (Unofficial), — is the root of Bryonia alba and 
of Bryonia dioica, European perennial plants of the nat. ord. Cucurbitacese. 
Its taste is acrid and bitter, but it is inodorous. The active principle is the 
glucoside Bryonin, C 48 H 80 O 19 , which is intensely bitter, and soluble in water 
and in alcohol, but insoluble in ether. Dose, of the powdered root, gr. x-xxx. 

Tinctura Bryoniae, Tincture of Bryonia (Unofficial), — a 10 per cent, solution of the 
root in alcohol. Dose, tt£v-3ss. 

Bryonin (Unofficial), — is a violent poison in doses of from 3 to 4 grains. Dose, as a 
drastic purgative, gr. \-\. 

Physiological Action and Therapeutics. 

Bryonia is a pure irritant, setting up local inflammation wherever applied, 
with febrile phenomena* It has a vesicant action on the skin, and is violently 
irritant to the serous and mucous membranes. Taken internally, it has caused 
fatal gastritis; introduced into the pleura, fatal pleuritis has resulted with fibrin- 
ous effusion. It has a specific determination to serous and synovial mem- 
branes, especially the pleurae, and is irritant to muscular fibre and to the bron- 
chial mucous membrane, causing dry, continuous, shaking cough, with sore- 
ness behind the sternum. It produces cerebral congestion, with frontal head- 
ache, vertigo and epistaxis; also hepatic and renal congestion, burning pain 
and tenderness in the hepatic region with bilious disturbance amounting some- 
times to severe jaundice, vesical tenesmus, and depression of the action of the 
heart. It is a drastic purgative and a powerful diuretic. 

It is rarely used by regular physicians although employed in a number of 
affections by homeopaths. In the atonic states of stomach and intestines 
inducing dyspepsia and constipation small doses exert a beneficial influ- 
ence. It is no longer used as a drastic purge having been replaced by the 
safer and more efficacious saline purgatives. 

BUCHU, Buchu, — is the dried leaves of Barosma betulina, a S. African 
shrub of the nat. order Rutaceas. They contain a Volatile Oil, which is probably 
the active principle, and yields on exposure to cold Barosma Camphor or Dios- 
phenol. It also contains Barosmin {Rutin), a bitter extractive, and resin, gum, 
lignin, etc. Dose, of the leaves, gr. xv-xl [av. gr. xxx.] 



CACTUS GRANDIFLORUS. l8l 

Preparations. 
Fluidextractum Buchu, Fluidextract of Buchu, — Dose, ttexv-x! [a v. ttjjxxx.] 
Infusum Buchu, Infusion of Buchu (Unofficial), — 5 j to the pint. Dose, 5ss-ij. Incom- 
patible with Buchu are: Ferrous Sulphate, Infusion of Galls. 

Physiological Action and Therapeutics. 

Buchu in small doses causes a sense of heat in the stomach, which is grad- 
ually diffused over the body. It increases the pulse-rate, stimulates the appe- 
tite, and produces slight moisture of the skin. It increases the flow of urine 
slightly. In large doses it causes vomiting, purging and strangury, with a 
burning sensation at the stomach. 

Buchu is of especial value in chronic affections of the genito-urinary mucous 
membrane, on which the volatile oil acts topically, being eliminated by the 
kidneys. It is a useful remedy in pyelitis, cystitis, urethritis, and in affec- 
tions of the prostate gland. Hare states that if the urine is continually 
highly acid, muddy, laden with salts and productive of incontinence by reason 
of the vesical irritation which it produces, buchu in the form of the fluid- 
extract combined with an equal amount of sweet spirit of niter (5j) and 20 
grains of potassium acetate, given three times a day, will be of great service. 
It is recommended in atonic dyspepsia, chronic rheumatism and affections 
of the skin, also for dropsy, but it is not so actively diuretic as to be very 
efficient in the latter condition. It is contraindicated in acute inflammations 
of the alimentary or urinary tracts. 

The Infusion makes an excellent vehicle for saline diuretics. 

CACTUS GRANDIFLORUS, Night-blooming Cereus (Unofficial),— is a native of tropical 
America, and has long had a local reputation as a remedy for dropsy, but was brought into 
notice as a cardiac remedy by Dr. Rudini. Its active principle, Cactine, a supposed alkaloid, 
has been physiologically studied by Dr. Myers, who finds it possessed of very decided stimulant 
action upon the heart, the arterial tension and the spinal motor centres. Therapeutically, 
this drug has been employed as a cardiac stimulant in the functional disorders of the heart 
connected with anemia, neurasthenia, dyspepsia, tobacco-poisoning, exophthalmos, sexual 
exhaustion and low fevers, also in pseudo angina pectoris. It does not prolong the diastole, 
as Digitalis does, and on this account it has been especially recommended in complicated aortic 
regurgitation. A tincture is prepared, §iv of the fresh stems to a pint of strong alcohol, the 
dose of which is n#v-x, up to xxx-, every 4 hours. Dose of Cactine, gr. t£o~3V> three or four 
times a day. Recent studies by. Hatcher and others would seem to indicate that this 
drug is not possessed of much power. 

Pellotine, C t3 H 19 NO., (Unofficial), — is an alkaloid obtained from Anhalonium Williamsii, 
a member of the cactus family growing in Mexico. This alkaloid is a powerful hypnotic and 
also somewhat analgesic, though not possessing the pain-relieving power of morphine. It 
has the advantage of being capable of hypodermic administration, and has given relief to the 
pains of locomotor ataxia and peripheral neuritis. The dose is about gr. 3 for an adult. 
Mezcaline, another alkaloid, seems to be the cause of the exaltation produced by drinking 
the fermented liquor Mezcal prepared from this plant. 

CADMIUM, Cd., — in its physiological action resembles both Antimony and Zinc, its 
salts being escharotic, astringent, depressant, and emetic; in overdoses acting as irritant poisons, 
with cerebro-spinal symptoms such as convulsions and coma. They are never used internally, 
but for external employment the important ones are — 

Cadmii Sulphas, Cadmium Sulphate (Unofficial), — transparent oblique prisms, efflo- 
rescent, and very soluble in water. Used externally in a solution of gr. ss-iv ad §j aq. destil., 
or as an ointment (1 to 40 of fresh lard). 



1 82 CAFFEINA. 

Cadmii Iodidum, Cadmium Iodide (Unofficial), — large, white, pearly crystals, soluble 
in water and alcohol. Used as an ointment, i to 8 of lard. 

The Sulphate has been used almost exclusively as a stimulating astringent in gonorrhea 
and conjunctivitis. Corneal opacities are lessened by the use of a solution of gr. ij to the 
o, and in gonorrhea a mild injection (gr. | ad § j) is very beneficial. An ointment of the 
Iodide has been usefully employed for enlarged glands, chronic joint affections, cutaneous 
diseases, nodes and chilblains. Alkalies, Carbonates, Chromates, Phosphates, and Sulphides, 
are incompatible with the soluble Cadmium salts. 

CAFFEINA, Caffeine, (Theine, Trimethyl-xanthine) C 8 H 10 N 4 O 2 +H 2 O — 
is a feebly basic proximate principle, obtained from the dried seeds of Cqffea 
arabica, or the dry leaves of Thea sinensis, and found also in other plants; or 
prepared synthetically. It occurs in white, silky crystals, which are soluble in 
46 of water and in 66 of alcohol. The commercial Caffeine is usually ob- 
tained from old tea leaves. It contains more nitrogen than almost any other 
vegetable principle. Dose, gr. ss-iv [av. gr. ijss.] 

The coffee-plant is a small tree of the nat. ord. Rubiaceae, 15 to 30 feet high, 
native of Arabia and Abyssinia, but cultivated in various parts of the world. 
Its seeds contain the alkaloid Caffeine (partly free, partly as a tannate), also 
tannic and cafTeic acids, sugar, legumin, etc. By roasting them, part of the 
caffeic acid is converted into methylamin, the sugar is changed into caramel, 
and several volatile substances are formed, which give to coffee its peculiar 
aroma and some of its stimulant qualities, and are collectively known as 
Caffeone, one of them being called Cqffeol. 

Allied Plants are — Thea sinensis, the tea-plant, which contains Caffeine and Theophyl, 
line; Theobroma cacao, containing Theobromine, a principle allied closely to caffeine; Ster cut ia 
acuminata, the Kola-plant, the nut of which contains Caffeine and small quantities of Theo- 
bromine; Paullinia sorbilis, the seeds of which (Guarana) contain Caffeine and Theobromine; 
Ilex Paraguayensis (Mate) contains a very small quantity of Caffeine; Erythroxylon Coca- 
contains the alkaloid Cocaine, which is allied to caffeine in action, but is more powerful. 

Theobromine, Dimethyl-xanthine, C7H 8 N 4 2 , — is closely allied to caffeine, both chemi- 
cally and physiologically. It is official as Theobromine Sodio-Salicylas (see below). 

Theophylline, Dimethyl-xanthine, C7H8N4O2, — is isomeric with theobromine, differing 
only in the arrangement of its formula and in some of its reactions. It is official itself and 
unofficial as a number of compounds (see below). 

These bodies are derivatives of Xanthine, C^H^N^, which occurs as a waste product 
of metabolism in muscles and other organs, and appears also in urine and feces. 

Preparations. 

Caffeina Citrata, Citrated Caffeine, — is a very uncertain mixture, and is not considered 
to be a definite compound. It contains not less than 48 per cent, anhydrous caffeine. It 
is prepared by dissolving equal weights of Caffeine and Citric Acid in double the quantity 
of hot distilled water, evaporating the solution to dryness and powdering the product, 
which is white, odorless, of acid taste and acid reaction, soluble in about 3 parts of water, 
precipitated as Caffeine on further dilution with water, and redissolved with about 25 
parts of water. Dose, gr. j-v [av. gr. v.] 

Caffeina Citrata Effervescens, Effervescent Citrated Caffeine, — composed of citrated 
Caffeine 4, Citric Acid iof, Sodium "Bicarbonate 57, Tartaric Acid 30, triturated, dried 
and powdered. Dose, gr. xxx-5 jss [av. 5 j], in a glassful of water, as an effervescing drink. 

Caff einae Sodio-Benzoas, Caffeine Sodio-Benzoate, — is a mixture of caffeine and sodium 
benzoate containing when dried from 46 to 50 per cent, of anhydrous caffeine. It is a white, 
odorless powder with a slightly bitter taste. It is very soluble in water (1.1 parts) and in 
30 parts alcohol. It may be administered hypodermically or by mouth. Dose, gr. iij-v. 






CAFFEINA. 183 

Official Analogues of Caffeine. 

Guarana, — is a dried paste consisting chiefly of the crushed seeds of Paullinia Cupana, 
a climbing plant of the nat. ord. Sapindacese, growing in Brazil. It occurs in brown cakes or 
sticks, having an odor of chocolate, and a bitter, astringent taste, partly soluble in water and 
in alcohol. It contains Caffeine (not less than 4 per cent.) and Theobromine, also tannic 
acid, gum, albumin, starch, and a fixed oil. Dose, gr. xv-xlv [av. gr. xxx.] 

Fluidextractum Guaranae, Fluidextract of Guarana, — contains from 3.6 to 4.4 per cent, 
caffeine. iQose, njLxv-xlv [av. iTpxxx.] 

Theobrominae Sodio-Salicylas, Theobromine Sodio-Salicylate, — contains sodium theo- 
bromine and sodium salicylate and occurs as a white, odorless powder, of sweetish, saline 
and alkaline taste, soluble in 1 part of water, and should contain 46! per cent, of Theo- 
bromine. Being a very unstable compound, it should not be prescribed in combination 
with other drugs, and when dispensed it should be well sealed from contact with the air, 
from which it rapidly absorbs carbonic acid, thereby undergoing decomposition. It is 
identical with the proprietary preparation known as Diuretin. Dose, gr. x-xv, in powder 
or aqueous solution, several times a day, as a diuretic. 

Theophyllina, Theophylline, — is an organic base isomeric with theobromine found in 
the leaves of Thea sinensis; and also prepared synthetically. It is a white, odorless, crys- 
talline powder with a bitter taste and soluble in 100 parts water and 80 parts alcohol. 
Dose, gr. iij-v [av. gr. iv.] 

Incompatibles. 

Incompatible with Caffeine are: the same substances as for the alkaloids generally (see 
page 6). Physiologically incompatible are Chloral Hydrate, Morphine, Physostigmine. 

Incompatible with Theobromine Sodium Salicylate are: Acids, Bicarbonates, Borates, 
Chloral Hydrate, Ferric Chloride, Phosphates, Phenol, Phosphoric Acid, also the incom- 
patibles for salicylates (see under Salicinum). 

Physiological Action. 
Caffeine is in general terms at first a stimulant and subsequently a pa- 
ralyzant to the nerve-centres in the cerebrum, medulla and cord. In small 
doses it quickens the action of the heart and raises arterial tension; stimulates 
the cerebral functions, by increasing the supply of blood to the brain; and in- 
creases the respiration rate and the secretion of urine. Larger doses (gr. v-viij) 
often over-stimulate the cerebral circulation, causing great heaviness of the 
head, flashes of light before the eyes, tinnitus aurium, insomnia, restlessness, 
and even delirium, the pulse becoming rapid, feeble, irregular and intermit- 
tent, and the general body-temperature elevated, though that of the periphery 
may be lowered. Large doses depress the heart and respiration, and lower 
the blood-pressure; in the smaller animals it exalts the reflex excitability of 
the cord, producing tetanic convulsions, and in lethal doses paralyzes the 
cardiac muscle as well as its motor ganglia, but causing death by paralysis of 
respiration. It powerfully affects muscular fibre, both voluntary and involun- 
tary kinds, throwing it into a state of tetanic contraction resembling rigor mortis. 
Caffeine is a reliable diuretic, acting by stimulation of the secreting apparatus 
in the kidney, as well as by generally raising the arterial tension (Brunton). 
The action of caffeine on the kidneys is two-fold; first, it acts on the circulation 
causing a transient constriction of the renal vessels at the time of splanchnic 
vaso -constriction during which the urine maybe temporarily diminished; this 
is soon followed by renal vaso-dilation while the systemic pressure continues 
high during which the urinary output is increased; second, it acts directly on 
the renal cells. In its action on the renal cells caffeine is non-irritating and 



184 CAFFEINA. 

produces the increased urinary flow either by stimulating them to increased 
secretion or by inhibiting the reabsorption of water in the tubules or in both 
ways. 

If caffeine were administered in sufficient quantity it would doubtless 
prove fatal to man, but its lethal dose for him would be large. Zenetz has 
recently published the details of three cases of sudden death during the use 
of full doses of caffeine, in all of which the heart was found at the autopsy to be 
so firmly contracted that it was cut with difficulty. He infers therefrom that 
caffeine may cause sudden arrest of the heart in systole. 

Caffeine is excreted as such very slightly and slowly by the kidneys. In 
its passage through the body it largely loses its methyl groups, most of it being 
transformed into xanthine, which probably breaks up into urea. 

Theobromine and Theophylline act similarly to Caffeine on the kidneys, 
heart, and muscular tissue, but have little effect on the central nervous system. 
In large doses Theobromine is fatal to small animals. 

Coffee is a cerebro-spinal stimulant, stomachic tonic, laxative and diuretic. 
The green bean produces very different effects from those of the roasted one, 
exhibiting the action of Caffeine alone, unmodified by that of the empyreu- 
matic products. A tincture of green coffee is an efficient diuretic. Coffee 
when freshly roasted and ground is deodorant, antiseptic, and germicidal, an 
infusion of J per cent, inhibiting the growth of many pathogenic organisms, 
and those of 10 per cent, killing anthrax bacilli in 3 hours, cholera spirilla in 
4 hours, and other bacteria in 2 to 6 days. Infusions of green coffee do not 
possess this antiseptic action, which is probably due to the empyreumatic prod- 
ucts developed by the process of roasting. 

As a beverage, if used with moderation Coffee assists digestion, promotes 
intestinal peristalsis, allays the senses of fatigue and hunger, increases tissue- 
waste and consequently promotes the formation and excretion of urea. Used 
to excess it disorders digestion, and causes functional disturbances of the ner- 
vous system, shown by headache, vertigo, mental confusion, and palpita- 
tion of the heart. It increases secretion, blunts sensation, exalts reflex excit- 
ability, increases mental activity, and may produce insomnia and great nervous 
restlessness. It first briefly stimulates the heart and raises arterial tension, 
but soon depresses both. The wakefulness is usually preceded by a short 
period of drowsiness. 

The brief stimulation of the intellect, consequent on drinking a cup of good 
coffee, cannot be obtained from an infusion of raw coffee, and is probably due 
to the volatile constituents developed in roasting. Cqffeone opposes Caffeine 
in its action on the circulation, as it quickens the pulse and lowers arterial ten- 
sion. Its action, however, is of brief duration, and soon gives way to the in- 
fluence of the principal constituent. Tannin is the ingredient which enables it 
to produce dyspepsia, and is most abundant in those infusions which are kept 
a long time on the stove before being served. 



CAFFEINA. 185 

The ground coffee of the groceries is generally adulterated with Chicory, the root of Cico- 
rium Intybus, the blue dandelion, also with beans and artificial coffee, a paste of flour stamped 
by machinery with the characteristic shape and marks of the coffee-bean. A common nostrum, 
extensively advertised as a substitute for coffee, is composed of similar materials with molasses, 
the identical "coffee" of the southern soldiers during the American Civil War. 

Tea (Thea sinensis, nat. ord. Ternstromiaceae), is one of the most refresh- 
ing and stimulating members of the group. Used to excess, it powerfully 
affects the stability of the motor and the vaso-motor nerves, the action of the 
heart, and the digestive function, producing flatulent dyspepsia, tremulousness 
of the limbs, pallor of the surface, irregular cardiac action and feeble impulse, 
hallucinations, nightmare, anorexia, headache, nausea and vomiting, obstinate 
neuralgiae, especially of the supra-orbital and occipital nerves; also constipa- 
tion and a pain in the left side are not -infrequent. The condition of chronic 
tea-poisoning is termed Theism, and is very often seen among women of the 
lower class in cities, who do not indulge in alcoholic beverages, but freely accept 
the dominion of the "cup that cheers" and worse than inebriates. Tea con- 
tains much more tannin than coffee, and that used as a beverage by the poorer 
classes is little more than a decoction of tannin, and a fruitful source of dyspepsia 
and other forms of gastric disorder. 

Cocoa (Theobroma Cacao, the Chocolate-tree, nat. order Sterculiaceae), 
pronounced Ko-ko, — is more nutritious than any other of the group, containing 
a large quantity of fat, Oleum Theobromatis (cacao-butter), which makes it 
difficult of digestion to many persons. The various preparations of this agent 
are made from the seeds, after the oil has been expressed from them. They 
are ground in a mill, mixed with rice, barley, sugar, flour, etc., and put up in 
powdered form, called Cocoa, — but when flavored with vanilla and pressed into 
a cake the product is named Chocolate. The thin husks which envelop the seeds 
are known as Shells, and are used to make a beverage similar to but milder 
than cocoa or chocolate. [Compare the article entitled Theobromatis Oleum.] 

Coca, or Cuca (Erythroxylon Coca, nat. ord. Lineae), is probably more sus- 
taining than either tea or coffee and less of a direct stimulant, at least as used 
by the Peruvian natives. Its habitual and excessive use produces a very serious 
train of nervous symptoms. [Compare the article entitled Coca.] Its alkaloid, 
Cocaine, is allied in action to Caffeine, but is more powerful, and its proportion 
in the leaves of the plant varies greatly in the different samples which occur in 
commerce. 

Kola (Cola acuminata, nat. ord. Sterculiaceae), is the nut or seed of the 
Kola plant, a handsome tree growing 30 to 60 feet high in the tropical forests 
of Africa and in the West Indies. It contains both Caffeine and Theobromine, 
the former in larger proportion than any member of the group except Guarana; 
also Kolatannic Acid and a glucoside substance named Kolanin, which, in the 
presence of a ferment, splits up into free caffeine and glucose, its yield of caffeine 
being 3 per cent. The Kola nut is highly valued by the negroes as a stimulant 
beverage and food and as an aphrodisiac, the latter quality being ascribed to the 



1 86 CAFFEINA. 

essential oil, which is not present in the dried nuts. It improves the appetite 
and the digestion, and promotes cheerfulness of the spirits and inclination to 
exertion. It is becoming a fashionable stimulant under the commercial methods 
which are employed in pushing the sale of the various preparations on the 
market. 

Guarana (Paullinia Cupana of Brazil, nat. ord. Sapindaceae), contains 
an alkaloid — Guaranine, in the proportion of 5 per cent., which is identical 
with Caffeine. It is especially noted for relieving a nervous headache, for 
which purpose the official fluidextract may be used in doses of Tfl, xx, three or 
four times daily, when the basis of that preparation happens to be of good 
quality. 

Mate {Ilex Paraguayensis, nat. ord.-Aquifoliaceae), is supposed to be inter- 
mediate as to its effects between tea and coffee. It contains a very small quan- 
tity of Caffeine, about 1 per cent., also a little tannin. 

The qualities possessed in common by these substances, and for which 
they are so universally esteemed by mankind, are three-fold. They all promote 
the retrograde metamorphosis of the body-tissues (tissue-waste), and enable - 
the work of the individual to be done upon a smaller supply of reparative mate- 
rial (food), and with less fatigue. Furthermore, when used in moderation, 
they are more or less stimulating to the mental processes, and sedative to the 
nervous system. 

This similarity of action they owe to the possession of principles, which are so closely 
related to each other that until very recently they have been considered identical both by 
chemists and pharmacologists. The divergence from each other, in the finer shades of their 
action, depends most probably on the existence in each of differing aromatic and volatile 
principles, which modify the action of the alkaloid in some degree. Other principles are 
developed in them by the various processes of preparation (roasting, drying, etc.), which have 
some part in determining the general action of the beverages containing them. 

Therapeutics. 

Although without a very extensive range of usefulness, Caffeine is a valuable 
stimulant in many forms of nervous and cardiac depression, and has proved 
especially efficacious in headaches of neuralgic or nervous type, the pain being 
general over the head; gr. j of Caffeine every half hour, or the fluid extract 
of Guarana, in 20-minim doses every 2 or 3 hours. In choleraic diarrhea, and 
that of phthisis, it checks outward osmosis by stimulating the depressed nerv- 
ous apparatus. In cervico -brachial neuralgia, Caffeine may be used hypo- 
dermically in doses of gr. ss, increased to gr. ij. In lithemia and gout, a tinc- 
ture 'of the green bean has marked diuretic and antispasmodic powers, and is 
very useful in these conditions. In the insomnia of chronic alcoholism gr. \ 
of Caffeine hypodermically is often efficient. For adynamic fevers, it may 
well be used in place of alcoholic stimulants. In intermittents Coffee has a 
curative reputation among the inhabitants of the Philippines, which is corrob- 
orated by the Dutch physicians. In asthma, Coffee is valuable for the par- 
oxysm if not used habitually. In opium narcosis, Caffeine hypodermically, 



CAJUPUTI OLEUM. 1 87 

or better still, strong black coffee by the mouth or by rectum, will antagonize 
the increasing torpor of the nervous centres. 

Although Caffeine is an efficient diuretic in cardiac and renal dropsies, 
there are many objections to its use for this purpose. It sometimes acts as 
a purgative as well as a diuretic, and although at first it produces copious diu- 
resis, tolerance is soon established and it loses its diuretic power. Moreover, 
it is a powerful cardiac stimulant, and in many persons it exerts a very marked 
excitant action upon the central nervous system. Lastly, and as a minor dis- 
qualification, it sometimes sets up considerable smarting in the penis and pro- 
duces a mild form of urethritis (Murrell) . Its tendency to produce tetanic con- 
traction of muscular tissue and its possible influence to arrest the heart in systole 
should be kept in mind when it is being administered for any prolonged period. 

Caffeine is contained in many proprietary preparations of which Acetanilid is the active 
ingredient (see page 55). Its office therein is that of a corrigent, to antagonize the depressant 
action of the latter drug upon the heart. 

Kola is a useful agent in gastric catarrh and in the dyspepsia of alcoholic 
subjects, as an adjunct to other treatment. After an alcoholic debauch it will 
do much toward restoring the nervous system to its normal condition. It will 
counteract the depressing effects of tobacco, and has been employed with bene- 
fit in asthma of both the nervous and cardiac forms. As it contains a good 
deal of tannin, it is especially efficient in atonic diarrhea, and in gastrointes- 
tinal irritation with looseness of the bowels, a restricted diet and Kola-wine 
are frequently all that is needed. As an aphrodisiac it deserves high rank, 
though it acts in this respect not so much by stimulating the sexual appetite as 
by enabling the organism to escape the sense of exhaustion and extreme 
debility which neurotic patients are apt to complain of. 

Guarana is chiefly employed in the treatment of nervous sick-headache (migraine) 
administered in half-drachm doses of the fluidextract when the attack is developing. It 
has been used in the diarrhea of phthisis, in convalescence from acute diseases, and generally 
in conditions requiring tonic treatment. 

Theobromine Sodio Salicylate or so-called "Diuretin" has been employed with marked 
benefit in both cardiac and renal dropsy, in hepatic cirrhosis, and in various diseases of 
the heart and kidneys accompanied by edema. The author has seen a large pleuritic effu- 
sion disappear rapidly under its use, the fluid having re-accumulated after having been once 
removed by tapping the pleural cavity. It should be administered in aqueous solution, 
avoiding acids or acid vegetable juices, which are chemically incompatible, as they pre- 
cipitate the alkaloid in the form of a thick white sediment. 

Theophylline has not so great a stimulant action on the heart as Caffeine, but is a much 
more powerful diuretic than either Caffeine or Theobromine. It may give rise to some 
gastric irritation, and is said to not irritate the kidneys to any harmful extent. 

CAJUPUTI OLEUM, Oil of Cajuput,— is a volatile oil distilled from the leaves of 
Melaleuca Leucadendron, a tree of the nat. ord. Myrtaceae, native of the Molucca Islands. 
It is a bluish-green or colorless liquid, of camphoraceous odor and neutral reaction, freely 
soluble in alcohol. It should yield not less than 55 per cent, by volume of Cineol. Dose, 
ttjv-x [av. TTgviij.] 

Cajuput Oil resembles Oil of Turpentine, and has similar action to that of the other 
volatile oils, being a stimulant carminative, somewhat diuretic and diaphoretic, antiseptic, 
parasiticide and anthelmintic. Externally used it is irritant to the skin. Swallowed, it 
produce? a sense of warmth in the stomach and accelerates the pulse. 



1 88 CALCIUM. 

It is not much used internally, though it has been given with benefit in flatulent colic, 
dropsy, hysteria, chronic rheumatism, scrofula, and syphilis, also in elephantiasis and other 
cutaneous disorders. Externally, as a strong, stimulating rubefacient, it is efficient in chil- 
blains, muscular rheumatism and nervous headaches. 

CALAMUS, Sweet Flag (Unofficial), — is the rhizome of Acorns Calamus, a plant of 
the nat. ord. Araceae, native in Europe and North America, having an aromatic odor and 
pungent taste. Only the unpeeled root should be used, peeled or bleached calamus being 
almost inert. It contains a volatile oil and Acorin, which is a nitrogenous, bitter principle, 
also benzoic acid, starch, etc. Dose, gr. x-xx [av. gr. xv.] 

Fluidextractum Calami, Fluidextract of Calamus (Unofficial), — is made with Alcohol 
and Water as a menstruum. Dose, Trgx-xx [a v. ftjjxv.] 

Calamus is an aromatic bitter, and a stomachic tonic, increasing the appetite and stimu- 
lating digestion. It is one of the constituents of the preparations termed "bitters," and 
is chewed as an appetizer. 

CALCIUM, Ca, — is the metal characteristic of Lime, Chalk, and all cal- 
careous substances, and although itself unofficial it is represented by several 
official salts and preparations. Lime (Calx) and Chalk (Creta) are respec- 
tively the Oxide (CaO) and the Carbonate (CaC0 3 ) of Calcium, the carbonate 
occurring in the native forms called chalk, marble, lime-stone, oyster-shells, 
etc., which are converted into lime by heating to full redness (calcination), 
thereby driving off carbonic acid and leaving the oxide behind. The latter, 
in this form, is known as "burnt lime" or " quicklime"; and, by the addition 
of J to | its weight of water, combines with one molecule of H 2 to form Cal- 
cium Hydroxide, Ca(HO) 2 , or "slaked lime," the process being termed "slak- 
ing" and being accompanied by the evolution of a high degree of heat. 

Lime is one of the four alkaline earths, the other three being Baryta, Magnesia, and 
Strontia. As such, however, it never occurs naturally, though in combination with various 
acids it is found in all the three kingdoms of nature; its base, the metal Calcium, being a 
widely distributed element, forming the basis of all calcareous and cretaceous substances. 
Besides the forms mentioned above, Calcium occurs as a sulphate (gypsum), also as a phos- 
phate in bones, shells and various organic tissues, and as a silicate and a fluoride in certain 
minerals and vegetables. 

Official Salts of Calcium. 
Calx, Calcium Oxide, Lime, CaO, — is Lime prepared by burning white marble, oyster- 
shells, or the purest varieties of native Calcium Carbonate. Occurs in hard, white masses, 
gradually resolving to a white powder in the air, odorless, of sharp, caustic taste and alkaline 
reaction, soluble in 840 of water and 1740 of boiling water, insoluble in alcohol. Not used 
internally except in solution. 

Calcii Carbonas Praecipitatus, Precipitated Calcium Carbonate, CaC0 3 , — a fine impal- 
pable, white powder, odorless and tasteless, insoluble in water or alcohol, but soluble in 
mineral acids or acetic acid with effervescence. Creta (chalk) is native Calcium Carbonate. 
Dose, gr. v-xxx [av. gr. xv.] 

Calcii Chloridum, Calcium Chloride, CaCl 2 , — hard, colorless masses, deliquescent, of 
sharp, saline taste, soluble in 0.6 of water and in 8 of alcohol. Dose, gr. iij-x [av. gr. viij], 
in solution. This salt should not be confounded with Chlorinated Lime. 

Calcii Lactas, Calcium Lactate, — is a white, odorless powder, tasteless, soluble in 20 of 
water, nearly insoluble in alcohol. Dose gr. v-xv [av. gr. viii.j 

Calcii Sulphidum Crudum, Crude Calcium Sulphide, is described under Sulphur; Calcii 
Bromidum, Calcium Bromide, under Bromum; Calcii Hypophosphis, Calcium Hypo phos- 
phite, Calcii Glycerophosphas, Calcium Glycerophosphate, and Calcii Lactophosphas, under 
Phosphorus. 



CALCIUM. 189 

Preparations of the Oxide. (Lime.) 

Liquor Calcis, Solution of Calcium Hydroxide, Lime-water, — contains not less than 0.14 
per cent, of Calcium Hydroxide, Ca(HO),. A clear, colorless liquid, of saline taste and 
alkaline reaction. Dose, Sss-j [av. 5iv.] 

Linimentum Calcis, Lime Liniment (Carron Oil), — contains equal volumes of Lime 
water and Linseed Oil, mixed by agitation. For local use. 

Calx Chlorinata, Chlorinated Lime, is described under Chlorum; and Calcii Sulphidum 
Crudum, Sulphurated Lime, under Sulphur. 

Preparations of the Carbonate. (Chalk.) 
Creta Praeparata, Prepared Chalk, CaC0 3 , — is native Calcium Carbonate, freed from 
most of its impurities by elutriation; a white, amorphous powder, odorless and tasteless, 
insoluble in water or alcohol. Dose, gr. x-xxx [av. gr. xv.] It is a constituent of Hydrargyrum 
cum Creta, and also of the following: 

Pulvis Cretae Compositus, Compound Chalk Powder, — has of Prepared Chalk 30, Acacia 
20, Sugar 50 parts. Dose, gr. v-3 j [av. gr. xxx.] 

Mistura Cretae, Chalk Mixture, — has of the preceding 20 parts, Cinnamon Water 40, 
Water to 100, rubbed together and made fresh as required. Dose, 3j-§j [av. 3iv.] 

Testa Praeparata, Prepared Oyster-shell (Unofficial), — contains animal matter intimately 
mixed with the Carbonate of Calcium. Dose, gr. x-xx or more. 

Allied Substances. 

Substances allied to Chalk, and derived from the animal kingdom, are — Crabs'-eyes, 
which are concretions obtained from the stomach of the craw-fish, Coral, Cuttle-fish Bone, 
Egg-shell and Oyster-shells (Testa, see above) ; all of which are mainly composed of Calcium 
Carbonate, but also contain the phosphate and sulphate of calcium and other metallic salts 
in small quantity, as well as organic material. In the past special virtues have been ascribed 
to these substances, and even now some authorities maintain that the animal carbonates 
derange the stomach less than the mineral ones, and are to be preferred for infants and delicate 
persons. 

Incompatibles. 

Incompatible with the Carbonate are Acids, Alum, Ammonium Chloride, Sulphates, 
Tartar Emetic, and other metallic salts; with the soluble Calcium Salts are Alkalies, Carbonates, 
Citrates (with heat), Oxalates, Phosphates, Tartrates. 

Physiological Action. 

Lime, in its unslaked form (quick-lime) , has a great affinity for water and 
readily combines with sulphur, thereby decomposing and destroying organic 
matter. Upon the skin its action is irritant and superficially caustic, but more 
severe on the mucous membranes, and if inhaled or swallowed it may produce 
dangerous local inflammation, followed by ulceration. In weak solution it has 
an astringent and sedative effect both locally and internally, and acts as an ab- 
sorbent and an antacid. Chalk possesses the astringent and antacid qualities 
of lime without its irritant properties. 

Calcium Chloride and Lactate are the salts usually employed for internal 
administration. Full doses produce symptoms of muscular poisoning similar 
to those caused by potassium salts, with lowered temperature, a slow pulse, 
and a tendency to cardiac paralysis. They inhibit intestinal peristalsis and 
lessen intestinal secretions. In large doses they are irritant poisons. Cal- 
cium Chloride has a great affinity for water, and is used in pharmacy to 
abstract water from other substances, as in the preparation of absolute alco- 
hol and ether. In solution it is used as a test for tartrates, citrates and 
oxalates. 



I90 CALCIUM. 

Calcium plays an important part in metabolism. The heart or any other 
muscle, deprived of calcium, will no longer contract. These salts have a 
remarkable influence on the nutrition of plants and animals, being as essential 
to the nourishment of the organs of locomotion (cartilage, bone, tendon and 
muscle) as iron is to the blood or phosphorus to the nerve tissue. When the 
diet of young animals contains a deficiency of calcium, symptoms develop 
which resemble rickets and osteomalacia. A reduction in the normal amount 
of calcium in the body causes a marked increase in the irritability of nervous 
tissue. The tetany which follows parathyroidectomy is probably due to an 
impoverishment of the tissues in calcium and the nervous symptoms so pro- 
duced may be checked by the administration of calcium salts. The permea- 
bility of the smaller vessels is increased by the withdrawal of calcium (Chiari) 
and lessened by its administration. Although calcium takes part in the nor- 
mal coagulation of the blood it is questionable whether any influence upon 
coagulability can be obtained by oral administration; in fact, Wright has 
thought that its continuous administration may lead to lessened coagula- 
bility. The calcium salts taken by mouth are excreted almost entirely by the 
intestines, a very small portion being absorbed, and but little of that passes 
out by the kidneys. Their absence from water renders the latter flat and 
insipid to the taste, but if present in excess (above 20 grains of the carbonate 
to the gallon) the water containing them is believed to be one of the factors of 
goitre. The Sulphate, in even so small a proportion as 6 grains to the gallon, 
is unwholesome, as it is liable to irritate the bowels and produce constipa- 
tion and diarrhea alternately, according as its astringent or irritant effect 
predominates. 

Therapeutics. 

Lime may be used as a caustic and depilatory, but is better known as an 
agent for hastening decomposition, which it does by its affinity for water, the 
resulting hydrate absorbing many of the products. Chlorinated Lime is an 
excellent antiseptic and disinfectant, but as it owes its energy entirely to its 
power of evolving chlorine it will be described under the title Chlorum. Lime- 
water is a favorite remedy for vomiting, especially in children, and is added 
to milk to increase its digestibility. A mixture of milk and lime-water will be 
retained by the stomach when no other food can be borne. Lime-water is an 
efficient agent in acid dyspepsia, mucous enteritis and typhoid fever, as an 
astringent and antacid. Locally, it is well employed as an enema against thread- 
worms, though inferior to quassia, as a mouth wash for aphthae, and as a 
lotion for cracked nipples, eczematous eruptions, and many mucous and 
purulent discharges. For such purposes it may be mixed with oil or glycerin, 
and if a few drops of carbolic acid be added the efficacy of the mixture is much 
increased. The Liniment is best known by the name Carron Oil, from the 
foundries at Carron, where it is extensively used. It is one of the best appli- 



CALCIUM. 191 

cations for burns and scalds, and makes a good dressing for the face in small- 
pox, and for cases of eczema affecting a large area of the skin. Lime-water is a 
good injection into the bladder in vesical calculus, in which its benefit is 
probably due to its astringent and soothing effects on the inflamed vesical 
mucous membrane, blunting its sensibility, and preventing the further growth 
of the stone by neutralizing the free acid of the urine. It is the antidote in 
poisoning by oxalic acid, with which it forms the insoluble and non-corrosive 
calcium oxalate in the stomach, while lime in any form (wall-plaster, whiting, 
etc.) is the best antidote for any mineral acid. For the systemic manifesta- 
tions of oxalic acid poisoning an intravenous injection of a pint of 1 per cent, 
sodium bicarbonate with J per cent, calcium chloride will be found of value. 

Chalk is the basis of all dentifrices, and may be used as a dusting-powder 
on ulcers, burns and excoriations of the skin. Chalk-mixture is a common 
remedy for diarrhea, and is usually employed in combination with other as- 
tringents, also with opium and aromatics. It is particularly serviceable for 
the diarrheas of children with sour-smelling stools and other symptoms of gastro- 
intestinal acidity. 

One of the curiosities of medical history is the fact that in 1739 the British Parliament 
gave the sum of ^5,000 to Mrs. Johanna Stephens for divulging the nature of a certain 
Hthontriptic remedy. This, she stated, consisted of calcined egg-shells and soap, with various 
aromatic bitters, a combination which had previously been recommended by Barbette for 
the same purpose. The nauseousness of this compound suggested to Whytt the use of lime- 
water as a substitute, and the latter was found to be efficacious in many instances. Calcium 
salts were believed to prevent the formation of uric acid calculi by binding the phosphates 
of the food and blood, and thereby lessening the excretion of phosphoric acid, the di- 
sodium phosphate holding uric acid in solution, though the monosodium phosphate pre- 
cipitates it. The carbonate was the salt preferred for this purpose, given in doses of gr. 
xv-xx thrice daily in plenty of water. 

Calcium has been extensively used as an internal remedy in the treatment 
of hemorrhages due to constitutional states such as hemophilia, purpura, etc., 
and in hemorrhages due to local disease of the various organs, e.g., hemopty- 
sis in pulmonary tuberculosis, hematemesis in gastric ulcer, etc. In the first 
group with delayed coagulability of the blood it has been of benefit although 
recent experimental evidence would seem to question the ability to influence 
appreciably the coagulation time in the amounts ordinarily used. In the 
hemorrhages due to local disease the coagulation time of the blood is normal 
and the use of calcium can be of little value. As it inhibits intestinal per- 
istalsis it is a rational and useful remedy for the diarrhea of hysteria and other 
forms of nervous excitability, and is a very efficient remedy for chilblains. 
It is useful in tetany following parathyroidectomy and in association with 
rickets. In nervous conditions associated with hyperexcitability, e.g., epi- 
lepsy, chorea, it is of value. Because of the sedative influence on the nervous 
system and the lessened permeability of the smaller blood-vessels which it 
induces it has been highly recommended in bronchial asthma, hay fever, 
urticaria and various angioneuroses. It is of value in preventing serum 



192 CALENDULA CALUMBA. 

rashes and in so-called physiological albuminuria. It is recommended in 
rickets and osteomalacia, although the disturbance in calcium metabolism 
found in these conditions is dependent more upon an inability to utilize cal- 
cium rather than a deficiency in the intake. It is difficult to see how its 
administration by mouth can be of much value although experience has 
taught that in some cases it has been of benefit. 

CALENDULA, Marigold, — is the florets of Calendula officinalis, the common Garden 
Marigold, a plant of the nat. ord. Composite, frequently cultivated for ornament. The 
tincture (20 per cent.) is also official, and is exclusively used as a local application to promote 
the healing process in wounds, ulcers, burns, and other breaches of tissue. Extravagant 
views of its powers as a vulnerary are promulgated by the so-called "homeopathic surgeons," 
and serve as one of their excuses for professing an exclusive position in the art of surgery. 
Dose of Calendula, gr, x-xx [av. gr. xv.j 

CALUMBA, Columbo, — is the root of Jateorhiza palmata, a plant of the 
nat. ord. Menispermaceae, native in southeastern Africa, but cultivated in the 
East Indian Islands. It contains the alkaloid Berberine (see under Berberis, 
page 172), a bitter principle named Calumbin, also Calumbic Acid and Starch, 
but no tannin. Dose, gr. v— xlv [av. gr. xxx.] 

Tinctura Calumbae, Tincture ofCalumba, — 2 in 10. Dose, 3 ss— i j [a v. 5j-l 

Incompatible with Calumba preparations are: Mineral Acids, Ammonia, Cinchona 
infusion, Galls infusion, Ferric salts, Lead Acetate, Lime-water, Mercuric Chloride, Silver 
Nitrate, Tartar Emetic. 



Physiological Action and Therapeutics. 

Calumba is one of the simple bitters, a group of vegetable agents which con- 
tain no volatile oil, have no astringent property, and no effect upon the general 
system, but markedly affect the stomach as stimulants. This group includes 
also Chirata, Cornus, Gentian, and Quassia. They stimulate the nerves of 
taste, increase the flow of saliva, excite the gastric circulation and the flow of 
gastric juice, and thereby increase appetite, aid digestion, and promote the 
constructive metamorphosis. As they also increase the production of the gas- 
tric mucus, their long-continued use will set up gastric catarrh and impair diges- 
tion, though they are the least irritant of all the stomachic tonics. 

As Calumba contains no tannin, it may be administered with- the salts of 
iron, and is often prescribed with the sub-carbonate. It is useful in atonic 
dyspepsia with pain after eating and in the convalescent stage of disease to 
promote appetite and digestion. An Infusion of Calumba with Ginger and 
Senna is effective in flatulence, and the same preparation is a good vehicle 
for the administration of acids and alkalies, tonics, aromatics, and mild ca- 
thartics. Having little or no irritant quality, it is an excellent tonic in the hectic 
fever of phthisis. 



CAMBOGIA CAMPHORA. 1 93 

CAMBOGIA, Gamboge, — is a gum-resin, obtained from Garcinia Hanburii, a Siamese 
tree of the nat. order Guttiferae. It contains 73 per cent, of Gambogic Acid, a resinous sub- 
stance, also 25 per cent, of gum and 2 of water. It is partly soluble in alcohol and in ether. 
The only official preparation is the Pil. Catharticae Co. (described under Colocynthis), 
each pill containing gr. \ of Gamboge. Its dose, as a cathartic, is gr. ij-v, — as a diuretic, 
gr. j at short intervals, [av. gr. ij.] 

Gamboge is an irritant purgative, decidedly diuretic, and its powder is sternutatory. 
Its catharsis is accompanied by vomiting and colic, and the stools produced are watery, 
but not so much so as generally believed. It has no cholagogue action. Full doses are 
liable to produce violent gastro-enteritis, and incautiously used (as in Morrison's pills) it 
has caused death. On the other hand, large doses have been given continuously in some 
cases, without producing any dangerous symptoms. 

Gamboge was formerly much used as a hydragogue cathartic and diuretic in dropsies, 
but its irritant qualities have caused it to be superseded by other agents (elaterium, digitalis, 
etc.). However, for dysentery, especially when in young subjects, very small doses (gr. -^q) 
at short intervals, up to gr. f in 24 hours, have proven to be remarkably efficacious. 

CAMPHORA, Camphor, CioHi 6 0, — is officially described as a ketone 
obtained from Cinnamomum Camphor a, a tree of the nat. ord. Lauracese. It 
is dextrorotary and occurs in white, translucent, waxy masses, of penetrating 
odor and pungent taste, lighter than water, in which it is sparingly soluble (i 
to 1300), but dissolves readily in alcohol, ether, chloroform, benzin, and oils. 
The camphor-tree is indigenous to China, Japan, Formosa and other parts of 
Eastern Asia. Borneo-camphor has the formula CioHisO, bears the same 
relation to Japanese camphor as alcohol bears to aldehyde, and is heavier than 
water. Dose, gr. j-iij [av. gr. ij.] 

Derivatives of Camphor are — Camphor -cymol, which is obtained by its 
distillation with zinc chloride; Camphoric and Camphretic Acids, which result 
respectively from its lesser or greater oxidation; and Safrol, also contained in 
Sassafras oil, but obtained in much larger quantities from Camphor oil, a 
waste by-product in the manufacture of crude camphor. An artificial Camphor 
is made by synthesis from oil of turpentine. 

Official Preparations. 

Aqua Camphorae, Camphor-water, — Camphor 8, Alcohol 8, Talc 15, Distilled Water 
to 1000. Used externally or as a vehicle internally. Dose, 3J~iv, [av. 3ijss.] 

Spiritus Camphorae, Spirit of Camphor, — 10 per cent, in Alcohol. Dose, tij?v-xx [av. 
TJSlxv.] 

Linimentum Camphorae, Camphor Liniment, — Camphor 20, Cotton-seed Oil 80. 

Camphora Monobromata, Monobromated Camphor, C 10 H 16 BrO, — colorless, prismatic 
needles or scales, of mild camphoraceous odor and taste, and neutral reaction; almost insoluble 
in water, slightly in glycerin, freely in alcohol, ether, oils. etc. Dose, gr. j-v [av. gr. ij], in 
emulsion. 

Camphor is an ingredient of Linimentum Saponis, Linimentum Belladonnae, and Tinc- 
tura Opii Camphorata.. 

Acidum Camphoricum, Camphoric Acid, C 8 H 14 (COOH) 2 , — is a dibasic acid, obtained 
by the oxidizing action of nitric acid on camphor. Occurs in white, acicular, odorless crystals, 
of feebly acid taste; insoluble, or nearly so, in cold water, readily soluble in hot water, alcohol, 
ether and fatty oils. Dose, gr. x-xx [av. gr. xv], dry on the tongue. 

Unofficial Preparations. 

Rubini's Tincture of Camphor, — is a saturated solution in alcohol, oj in 0J4, of 
which the dose is from 4 to 10 drops, rr^vij have caused toxic symptoms in an adult. 

Raspail's "Eau Sedative," — contains Aq. Ammoniae §ij, Sodii Chloridum oij, Cam- 
phorated Spirit of Wine 5hj, Water Oij. Used externally. 

13 



194 CAMPHOKA. 

Camphora Carbolata is the name given to a mixture of 2\ parts of camphor with one 
each of carbolic acid and alcohol. This preparation, mixed with olive oil, is a good non- 
irritating and antiseptic dressing for wounds and breaches of surface. 

Camphor-Chloral is a fluid obtained by triturating together equal parts of camphor 
and chloral hydrate. It dissolves morphine sulphate readily (gr. xx in 5ij), also many 
other salts of alkaloids. It is often a serviceable application in superficial neuralgia, and 
is said to allay spasmodic cough if painted over the larynx. 

Camphora Salicylata is obtained by heating together n parts of salicylic acid and 
14 of camphor. An ointment prepared therefrom has been used with satisfactory results 
in the treatment of phagedena, spreading syphilitic sores, epithelioma and lupus. 

Oleum Camphorata, Camphorated Oil, — strength 10 per cent., is used for hypodermic 
injection, in doses of TT£xv-5j. 

Incompatibles. 

Incompatible with Camphor preparations are: Butyl-chloral Hydrate, Chloral Hydrate, 
Chromic Trioxide, Dichlor-acetic Acid, Euphorin, Hydrochloric Acid, Menthol, Monochlor- 
acetic Acid, Naphtol, Phenol, Potassium Permanganate, Pyrocatechin, Pyrogallol, Resorcin, 
Salol, Salicylic Acid, Thymol, Urethane, Water; with Camphora Monobromata are: Chloral 
Hydrate, Euphorin, Phenol, Pyrocatechin, Salol, Thymol. With Spirit of Camphor are 
Acacia, Aqueous fluids, Gelatin. 



Physiological Action. 

Camphor is antispasmodic, anodyne, antiseptic, diaphoretic, a stimulant, 
a cerebral excitant, a gastro-intestinal irritant, and a rubefacient. It has 
an acrid, hot taste, and irritates the skin and mucous membranes, in quan- 
tity exciting severe gastric inflammation with all the effects of an irritant poison. 
In medicinal doses it stimulates the vasomotor system and the cardiac motor 
ganglia, and lessens the influence of the pneumogastric, — thus increasing 
the circulation and raising arterial tension. It also stimulates respiration and 
mental activity, even producing intoxication; promotes diaphoresis, allays 
pain, and increases the sexual appetite, but its continued use depresses the 
generative function. " Camphora per nares castrat odore mares." 

Large doses cause gastro-intestinal inflammation, depress the heart and 
lower arterial tension, diminish the reflex function of the spinal cord, produce 
coldness of the surface, insensibility, coma, convulsions, intense cerebral conges- 
tion, and perhaps death. As many as 200 grains have been taken without fatal 
result, yet 6 or 7 grains have produced extreme drowsiness and weakness of the 
pulse, 20 grains laid up an Alpine guide for a day, and §ss of the spirit caused 
profound symptoms of poisoning, including epileptiform convulsions and severe 
headache. The autopsy in one fatal case showed congestion of the cerebral 
meninges. It is eliminated by the bronchial mucous membrane, skin and kid- 
neys, and has often caused dysuria. 

Monobromated Camphor resembles the bromides, but its action is not iden- 
tical with theirs. In mammals it produces muscular weakness passing into 
paralysis, lowered temperature and respiration, stupor and death. In some 
cases its use by man has been followed by epileptiform convulsions. It is a 
nervous sedative and hypnotic, and a gastric irritant. 



cannabis. 1 95 

Therapeutics. 

Camphor was much used by the older physicians as an antispasmodic, and 
is greatly valued still in China and Japan. It has a reputation for uncertainty 
of therapeutic action, but is usefully administered in cholera and choleraic 
diarrhea, summer diarrhea and that of infants, vomiting, gastralgia, cardiac 
depression, nervousness and nervous headache, dysmenorrhea, afterpains, 
chordee, strangury, and catarrhal colds. Locally it is effective in myalgia, 
lumbago, toothache, and other conditions where counter-irritation or a local 
anodyne is required. A solution in ether is a beneficial application in erysip- 
elas. It is frequently added to oily sprays in the treatment of subacute and 
chronic rhinitis, acting beneficially by its local antiseptic and stimulant effect. 

Subcutaneous injections of camphor in doses of gr. j dissolved in mxv of 
olive oil are employed with excellent results in pneumonia, typhoid fever, and 
other conditions when collapse is imminent. In fibrinous pneumonia these 
injections produce a depression of about one degree in the temperature, and 
greatly ameliorate the general condition. They are also employed with benefit 
in the treatment of phthisis during the period of softening, rendering the patient 
more comfortable and prolonging life. Camphor administered in this manner 
is not well borne by young children, even in minimum doses. 

Monobromated Camphor is used as a nerve sedative and hypnotic, but 
is not particularly efficient. It has been employed with advantage in whoop- 
ing-cough, neuralgia, chorea, hysteria, delirium tremens and epilepsy, but it 
is taken with difficulty and is liable to irritate the stomach. 

Camphoric Acid, in solutions of \ to 6 per cent, strength, has been used with benefit 
as a topical agent in cystitis, also in coryza, acute bronchitis and other affections of the respira- 
tory tract. Internally administered it is one of the most efficient agents against sweating 
from various causes, especially the profuse night-sweats of pulmonary tuberculosis. For 
this purpose it is best administered dry on the tongue, in dose of 10 to 30 grains, not more 
than two hours before the time for the expected sweating to occur, as it is quickly and 
abundantly eliminated by the urine. 

CANNABIS, Cannabis {Cannabis Indica), — is the dried flowering tops of 
the female plant of Cannabis sativa; a coarse, pubescent, somewhat viscid 
annual of the nat. ord. Moraceae. Its odor is peculiar and narcotic, its 
taste slightly acrid. Cannabis and its preparations must be standardized 
by physiological assay according to the U. S. Pharmacopoeia. The assay is 
based upon the amount of the drug which is required to produce symptoms 
of incoordination in the dog. 

Cannabis contains a resin named Cannabin, and a Volatile Oil, from the 
latter of which are obtained Cannabene, a light hydrocarbon, and Cannabene 
Hydride, a crystalline body. It also contains traces of an alkaloid, Canna- 

BININE. 

Preparations. 
Extractum Cannabis, Extract of Cannabis. — Dose, gr. f-f [av. gr. J.] When assayed 
biologically it produces incoordination in dogs in a dose of not more than 0.004 Gm. per 
kilo of body weight. 



196 CANNABIS. 

Fluidextractum Cannabis, Fhiidextract of Cannabis. — Dose, njj-v (av. ttej'ss.) When 
assayed biologically it produces incoordination in dogs in a dose of not more than 0.03 mil 
per kilo of body weight. 

Tinctura Cannabis, Tincture of Cannabis, — strength 10 per cent. Dose, ttjjv-xxx 
[av. TTjxij.] "When assayed biologically it produces incoordination in dogs in a dose of not 
more than 0.3 mil per kilo of body weight. 

Preparations used in the East. 
Churrus is an impure resin, prepared by rubbing the leaves of the plant together and 
scraping off the adhering resin. 

Gunjah is the dried leaf and tops as sold in the bazaars for smoking purposes. 

Hashish, Bhang or Siddhi is a confection consisting of the leaves and small stalks 
coarsely broken and mixed with Poppy seed, Ginger, Pepper, etc., boiled together. In the 
East Cannabis is invariably used in mixture with Opium and Hyoscyamus, and most of its 
deleterious effects are believed to be due to these constituents. 

Incompatibles. 

Caustic Alkalies are incompatible with preparations of Cannabis. Water precipitates 
the resin from alcoholic preparations. 

Physiological Action. 

Cannabis is antispasmodic, analgesic, anesthetic and narcotic, a cere- 
bro-spinal stimulant and a powerful aphrodisiac. It increases intellectual 
and motor activity, stimulates the vaso-motor nerves, raising arterial tension, 
depresses sensation, and strengthens the energy of the uterine muscular fibre, 
but has no power to initiate uterine contractions. In large doses it causes a 
peculiar but generally pleasant form of intoxication, during which the particular 
traits of the individual are exaggerated, and the ideas follow each other so 
rapidly as to produce a sense of great prolongation of time, minutes seeming 
as if hours or even days. With this occurs increased sexual desire and uterine 
activity, also sensations of double consciousness and enormous dimensions. 
The sight and hearing are exalted, pupils dilated, anesthesia sets in, the reflexes 
are lowered by stimulation of inhibition, and if the dose be a heavy one a cata- 
leptic state is induced. Sleep or coma follows according to the size of the dose, 
but death has never been produced by this drug. 

After-effects are dulness, heaviness, vertigo, headache, confused thought, 
anesthesia of the skin, and marked diuresis, — but no nausea, no vital depression, 
no constipation. Repeated use of the drug causes mental weakness and sexual 
impotence, the results of over-stimulation. It is much used by the natives of 
Egypt, and is responsible for most of the crime and insanity seen in that country. 
A ravenous appetite is usually one of its early effects. 

Therapeutics. 

Cannabis was formerly much employed as an anodyne and hypnotic, 
also as an anesthetic during surgical operations. It is now somewhat out of 
fashion. In migraine it is useful to prevent recurrence of the attack, and in 
neuralgia it is often very efficient. The pain and discomfort of uterine 
affections, such as chronic metritis, subinvolution, menorrhagia and dysmen- 



CANTHARIS. 1 97 

orrhea, are greatly relieved by its anodyne quality. It is one of the best 
hypnotics in delirium tremens, and in paralysis agitans large doses of this 
drug will lower the reflex activity. The tincture, in doses of 2 to 8 minims 
every 3 or 4 hours for children below ten years of age, is highly praised in 
chorea minor and whooping-cough. Dysuria and retention of urine are often 
relieved by it, while in spasm of the bladder and other painful affections of 
that organ it will be found a most efficient remedy. It is useful in functional 
impotence, especially if combined with Ergot and Nux-vomica. In gonor- 
rhea it lessens the burning pain and restlessness, and allays chordee. Full 
doses of the tincture are extremely efficient in many cases of headache at the 
menopause, but should be used cautiously until the activity of the sample and 
the susceptibility of the patient are tested. 

Dr. Lees has called attention to the fact that aqueous preparations of this 
drug, which contain but little of the resin, are much used by the natives of India 
for intoxicating and stimulating purposes, which indicates that the volatile oil 
and not the resin is the active principle. He uses a strong aqueous extract, 
prepared without heat, which gives all the beneficial effects of the alcoholic 
preparations without the extreme exhilaration bordering on intoxication so often 
produced by even medium doses of the latter. He finds that, in pulmonary 
affections generally, this Liquor Cannabis Indicce acts favorably as an anodyne 
and hypnotic, while in phthisis pulmonalis it relieves the cough and aids the 
patient by its stimulant and exhilarating qualities to a degree which no other 
drug can accomplish. Lees has also used it with benefit in indigestion with 
constipation, and in many affections of children in which nervous symptoms 
are prominent. The adult dose is 3 ss— j. 

CANTHARIS, Cantharides (Spanish Flies),— is the dried beetle, Can- 
tharis vesicatoria, an insect of the nat. ord. Coleoptera, about an inch long, 
of a shining green color, the powder being grayish-brown with green particles, 
odor very disagreeable, yielding not less than 0.6 per cent, of Cantharidin, C10- 
H12O4, the active principle; also a greenish volatile oil and peculiar fatty 
bodies. Dose, gr. J-j [av. gr. ss.] 

Preparations. 

Tinctura Cantharidis, Tincture of Cantharides, — 10 per cent. Dose, TTgj-x [av. njrjss.l 

Ceratum Cantharidis, Cantharides Cerate {Blistering Cerate), — Cantharides 35, Yellow 
Wax, Rosin, of each 17.5, Glacial acetic acid 2.5, oil of Turpentine 15, Benzoated Lard 20. 

Collodium Cantharidatum, Cantharidal Collodion {Blistering Collodion), — Cantharides 
60, Flexible Collodion 85, Glacial Acetic Acid 5, Acetone to 100. 

Emplastrum Picis Cantharidatum, Cantharidal Pitch Plaster, Warming Plaster (Un- 
official), — has of Cerate of Cantharides 8 parts, Burgundy Pitch to 100. 

Incompatibles. 

Incompatible with Cantharidin are: Copper Sulphate, Lead Acetate, Mercuric Chloride, 
Silver Nitrate. 



198 cantharis. 

Physiological Action. 

Cantharis applied to the skin is a rubefacient and vesicant, acting more 
slowly than mustard but much more severely. Internally it is irritant, caus- 
ing heat of stomach, gastralgia, nausea and vomiting, the circulation is stimu- 
lated, temperature elevated, the urine becomes scanty and irritating, is voided 
with difficulty and pain, and often contains blood and albumin. Afterwards 
the pulse falls, temperature and arterial tension are lowered, and depression 
ensues. A toxic dose produces severe gastro-enteritis, abdominal tenderness, 
tenesmus, mucous or bloody stools, pain in the stomach and lungs, dysphagia, 
ptyalism, strangury, priapism, hematuria, swollen genitals, abortion, muscular 
tremor, convulsions, coma and insensibility. The post-mortem shows evidences 
of violent metritis, gastro-enteritis and general peritonitis. Cantharis is aphro- 
disiac by causing vascular turgescence of the genital apparatus, but only in 
doses which produce dangerous symptoms. It is abortive only in toxic doses. 
In small doses it is diuretic and emmenagogue. 

Counter-irritation by rubefacients or blisters acts on disease probably through 
the nervous system. Its influence is explained by the theory that the periph- 
eral extremities of the nerves supplying the skin of the part to which the agent 
is applied undergo some molecular change, which extends to the nerve centre 
and is thence radiated to centrifugal or trophic nerves, effecting various changes 
in nutrition and secretion over the areas to which they are distributed. In addi- 
tion to this method of action, neighboring parts are affected by direct exten- 
sion of the inflammation produced, and distant parts are also implicated by 
absorption through the vesicated surface of agents having special affinities for 
certain organs. 

Therapeutics. 

As a counter-irritant and vesicant Cantharis is of great value in neuralgia 
if applied close to the emergence of the nerve from the spinal column, also in 
sciatica and neuritis, and in subacute and chronic arthritis around the 
affected joints. A blister at the nape of the neck controls many headaches, 
and one behind the ear will modify affections of the eye. In pleuritic effu- 
sions a succession of small blisters (flying-blisters) will promote absorption of 
the pleural contents, and a blister applied to the perineum will often cure a 
rebellious gleet. A favorite method of treating tuberculous patients with 
hoarseness and evidences of beginning involvement of the larynx is absolute 
vocal rest and the application daily or every other day of fly blisters to the 
anterior neck.. Though valuable as a therapeutic measure in very many con- 
ditions, blistering is going out of fashion except in hospitals and among 
people who believe in heroic treatment. . 

As an internal remedy Cantharis must be employed in very small doses 
(TTLj of the tincture) in order to be efficient. It has been recommended as an 
admirable agent in acute desquamative nephritis after the active inflam- 



CAPSICUM. 199 

mation and fever have subsided, to reduce the albumin in the urine. Its use, 
according to the editor, is not without danger in this and other inflammatory 
conditions of the urogenital tract and safer and more efficient remedies can be 
obtained. Drop-doses are particularly useful in irritable bladder with fre- 
quent desire to micturate, so often observed in women, also in the inconti- 
nence of the aged and of children; and in cystitis, gonorrhea and gleet. In 
spermatorrhea, prostatorrhea, scanty menstruation, and menorrhagia in 
subjects of lax fibre and general want of tone, it is often very serviceable. 
Cutaneous squamae and vesiculae are greatly improved by small doses fre- 
quently administered and gradually increased, and it is one of the best 
remedies for psoriasis. For alopecia areata it is of the utmost value as an ex- 
ternal application, and the tincture, largely diluted, is an ingredient of all the 
hair renewers in common use. 

CAPSICUM, Capsicum {Cayenne Pepper), — is the dried, ripe fruit of 
Capsicum frutescens, Chillies or African pepper, a plant of the nat. ord. Sola- 
naceae, native in tropical Africa and America. It contains Capsicin, which is 
a thick, red liquid, and is the active principle, and a volatile alkaloid. Dose 
of the powdered drug, gr. ss.-ij [av. gr. j.] 

Preparations. 

Tinctura Capsici, Tincture of Capsicum, — 10 per cent, strength. Dose, tt^v-xx [av. TTjjviij.] 

Oleoresina Capsici, Oleoresin of Capsicum, — extracted by ether. Dose, gr. £-j [av. 
gr. ss.] 

Emplastrum Capsici, Capsicum Plaster, — prepared by applying a thin coating of Oleo- 
resin of Capsicum to Adhesive Plaster so that each fifteen square centimeters may contain 
0.25 Gm. of the oleoresin. An excellent warming plaster. 

Capsicum is an ingredient of the Pilulae Podophylli, Belladonnas et Capsici (see under 
Podophyllum). 

Incompatibles. 
Incompatible with Capsicum are: Alum, Ammonia, Alkaline Carbonates, Copper Sul- 
phate, Ferrous Sulphate, Galls infusion, Lead Acetate, Mercuric Chloride, Silver Nitrate, 
Zinc Sulphate. 

Physiological Action and Therapeutics. 

Capsicum is irritant to the skin and mucous membranes. Externally used 
for sufficient length of time it will produce vesication, internally in quantity 
it will excite gastritis. In medicinal doses it increases the saliva, excites a sen- 
sation of warmth in the stomach, promotes appetite and digestion, and produces 
easier and more copious alvine evacuations. It is said to be a stimulant to 
the circulatory and nervous systems but its effect on these systems after the 
usual therapeutic doses is not noticeable. 

Capsicum is an excellent stomachic tonic in atonic dyspepsia and in that 
of chronic alcoholism with tremor and insomnia. In acute dipsomania and 
delirium tremens large doses are efficient in producing sleep and promoting 
appetite. It is the best substitute for alcohol and opium in attempts to cure 
those habits. " It is well used in aerophagia and in flatulent colic, especially 



200 CARBONEUM. 

when occurring in hysterical women and hypochondriacs. It gives good 
results in functional impotence, in spermatorrhea from loss of tone, in chronic 
parenchymatous nephritis to check the waste of albumin, and is beneficial in 
chronic cystitis and in prostatorrhea. Locally the tincture diluted (5j to 
§viij) forms an excellent gargle for relaxed throat and its accompanying 
cough, relaxed uvula, inflammatory sore throat, and the cynanche of scarlet 
fever, but it must be used with caution, as such applications are sometimes 
very irritating. 

The Capsicum plaster is a mild counter-irritant, of great value in lumbago 
and other muscular rheumatisms as a palliative application. 

CARBONEUM, Carbon, C. — This element is widely distributed through- 
out all the kidgdoms of nature. United with oxygen in the form of Carbon 
Dioxide, C0 2 , it occurs in the air and in many mineral waters, while as car- 
bonates, such as limestone, it constitutes a large portion of the surface of the 
earth. Another compound with oxygen, Carbon Monoxide, CO, a highly poison- 
ous gas, is formed in the incomplete combustion of carbonaceous matter. 

CarboLigni, JFofld Charcoal (Official), — prepared from softwood, and very 
finely powdered; is black, shining, brittle, inodorous, tasteless and insoluble. 
Dose, gr. x-xx [av. gr. xv.] 

Acidum Carbonicum, Carbonic Acid, Carbon Dioxide, C0 2 (Unofficial). 
The body which is commonly called Carbonic Acid, but should be called Car- 
bon Dioxide, is a colorless and odorless gas, of slightly sharp taste, soluble in 
its own volume of pure water at the ordinary temperature and pressure, much 
more soluble under increased pressure and lowered temperature of the water, 
also more soluble in water containing phosphates. By pressure it is converted 
into a colorless liquid, which boils rapidly on removal of the pressure, and is 
partly converted into white flakes of solid carbonic anhydride. In water it pro- 
motes the solution of phosphates and carbonates. Its aqueous solution gives an 
acid reaction, and is "sparkling" from rapid escape of the gas, especially when 
agitated. It is prepared by treating any carbonate (usually calcium carbonate 
in the form of marble-dust) with dilute hydrochloric acid; the resulting gas 
is passed into water under pressure, and the solution is thus obtained. 

Carbon Dioxide occurs in the atmosphere in the proportion of 0.4 volume in 1,000, also 
in all water in varying quantity. Certain sparkling waters contain it in the proportion of 
more than one-half their volume, Johannis having more than 90 per cent. It occurs also in 
all the liquids of the body, especially in the blood, originating in the oxidation processes which 
are constantly taking place in the tissues, and readily passing by osmosis through animal 
membranes. It is continuously produced by the action of the yeast-plant, and by all other 
fermentation processes, and accumulates in brewers' vats, old wells, some caves, grottoes and 
deep valleys, also in mines. It is constantly evolved during respiration and in the burning 
of fuel. When the air of a room contains 0.6 volume of this gas per 1000 it is considered 
vitiated. 

True Carbonic Acid, C0 3 H 2 , or Hydrogen Carbonate, is an organic acid which is not 
known in the separate state, but only in combination. It is supposed to exist in a solution 
of carbon dioxide in water. 



CARBONEUM. 20I 

Preparations. 

Aqua Carbonata, Carbonated Water, Soda-water (Unofficial), — is water highly charged 
with carbon dioxide, the excess of gas being dissolved in the water by pressure, and escaping 
in bubbles when the pressure is taken off. It was official in the U. S. P., 1870, under the 
title Aqua Acidi Carbonici, the formula requiring that the water be charged with five times 
its volume of gas, for which a pressure of five atmospheres is required. Among the carbonated 
mineral waters are — ■ 

Selters, Nassau, Germany, 30 cubic inches ] 

Apollinaris, Neuenahr, Prussia, 47 I of C0 2 

Old Sweet Spring, West Virginia, n " (to the pint. 

Sweet Chalybeate Spring, Virginia, 13 " J 

There are 10 official Carbonates and 2 official Bicarbonates, which are severally described 
under their basic titles. 

Incom-patibles. 

Incompatible with the Carbonates are: Acids, Acid salts, Alkaloidal salts, Bismuth Sub- 
nitrate; Salts of Aluminum, Antimony, Barium, Bismuth, Cadmium, Calcium, Chromium, 
Cobalt, Copper, Iron, Lead, Manganese, Mercury, Nickel, Silver, Strontium, Zinc; Urethane. 
Incompatible with Charcoal are all Oxidizers, as Potassium Chlorate, Potassium Permanga- 
nate, Chlorine, Hydrochloric Acid, etc. 

Physiological Action and Therapeutics. 

Charcoal is an efficient deodorant and disinfectant, as it absorbs and con- 
denses many gaseous bodies and vapors. It is evacuated unchanged by the 
bowel and exerts no specific action on the body. 

Charcoal is used in pharmacy for decolorizing vegetable principles, remov- 
ing alkaloids from infusions of plants, and making several preparations, as 
acidum sulphurosum, potassii iodidum, etc. Externally it is an efficient dis- 
infectant, absorbent and deodorant application to cancerous discharges, foul 
ulcers and gangrenous wounds. Having no odor it is not open to the charge 
of substitution of one smell for another. A small quantity added to water will 
keep it sweet for a long time. It is an excellent dentifrice if finely powdered. 
Internally, it is used for the same purpose, namely to absorb gases and offend- 
ing products of indigestion. In flatulent dyspepsia, gastralgia, pyrosis, diar- 
rhea, nausea of pregnancy, epidemic cholera, and constipation, it has warm 
advocates. When used internally for any time, an occasional purgative should 
be given to prevent its accumulation in the intestines. It has been proposed 
as an antidote for several alkaloidal poisons on theoretical grounds, but its effi- 
cacy in this respect is doubtful. 

Carbon Dioxide is highly antiseptic and preservative. D'Arsonval employs 
it, under 30 atmospheres pressure, for the sterilizing of orchitic extract. Beef 
will remain perfectly fresh and its taste unchanged for eight days if hung in a 
chamber filled with the gas. Externally, applied to the skin, mucous mem- 
branes or wounded tissues, the undiluted gas produces slight hyperemia, with 
prickling and a sense of heat, followed by a certain degree of local anesthesia. 
Internally, given by the stomach in aqueous solution, it is refreshing and quenches 
thirst, slightly stimulates the heart's action, quickens respiration and causes 
a brief sense of exhilaration. It increases somewhat the gastro-intestinal secre- 
tions and excites peristalsis,- but diminishes the sensibility of the mucous lin- 



202 CARBONEUM. 

ing of the alimentary canal. Inspired, the gas is highly toxic, a proportion of 
5 per cent, in the air being irrespirable and fatal. Even a tenth of i per cent, 
produces headache, sleeplessness and depression; 2 per cent, causes throbbing 
headache, fulness and tightness across the temples and giddiness; and a larger 
quantity profoundly affects the nervous system, inducing fainting, muscular 
weakness, somnolence or insensibility, and coma or convulsions. The in- 
halation of the undiluted gas at first excites irritation and sometimes spasmodic 
closure of the glottis with consequent asphyxia, but in any case it soon arrests 
the respiration. It hinders the exhalation of the carbon dioxide normally ex- 
isting in the blood, and is itself absorbed in small quantity, inducing dyspnea, 
cyanosis, slow and labored pulse, and ultimately arrest of the heart's action. 
In toxic quantity it abolishes the functions of nerve and muscle by combining 
with the hemoglobin of the blood, rendering it incapable of carrying oxgyen, 
and thereby stopping the process of oxidation in the tissues. The carbonic 
oxide hemoglobin so formed is not a very stable substance, and persons deeply 
poisoned may be resuscitated by artificial respiration. 

The symptoms of Carbon Dioxide poisoning may be divided into three 
stages, which are the stages of Asphyxia. They are: (1) that of excitement, 
in which the blood pressure rises from excitation of the centres in the medulla 
by the venous blood; the vessels of the surface become dilated, the skin takes 
on the cherry-red color of carbonic oxide hemoglobin, and insensibility begins ; 
(2) the convulsive stage, in which the respiratory movements become more vio- 
lent and spread to all the muscles of the body; (3) that of paralysis, in which 
the convulsions cease, the blood pressure falls, the respiration gradually fails, 
and finally the heart stops. The autopsy shows great venous congestion every- 
where, the right side of the heart distended with blood, the brain much con- 
gested, with exudation, and even extravasation of blood, into its substance. 

Carbon Monoxide is the poisonous constituent of illuminating gas,* 
smoke in burning buildings, fumes from furnaces and of the " after damp" in 

* "Illuminating gas is composed in varying amounts (depending chiefly on the price 
of petroleum) of 'water gas/ 'coal gas,' and the vapor from superheated or 'cracked' 
petroleum. So-called 'water gas' contains about 30 per cent, of carbon monoxide. It 
is comparatively cheap to manufacture, and is produced bv blowing live steam over hot 
coal with the general reaction C + H 2 = CO + H 2 . The gas formed by the destructive 
dry distillation of coal, technically called 'coal gas,' contains only about 6 or 8 per cent, 
of carbon monoxide. It is therefore far less poisonous than 'water gas.' The hydro- 
carbons which it contains, which give the gas flame its luminosity, and which have to be 
supplied to 'water gas' from petroleum vapor, are toxicologically practically negligible. 
'Coal gas' is chiefly used in European cities, while 'water gas' is the chief ingredient 
in America. Yet in many European cities, particularly in England, the price of gas to the 
consumer is only 50 or 60 per cent, of that usual in American cities. Owing to the greater 
proportion of 'coal gas' and less 'water gas,' the leakage of the same amount into a 
bedroom in England will cause the occupant merely a bad headache, while in America 
death or serious injury results. There is an intimate causal connection between inflated 
capitalization, a large proportion of water gas, and the high death rate from carbon monox- 
ide poisoning in American cities. Few facts are more significant than this in indicating 
how deeply we must cut into social problems in order to apply preventive medicine." 
(Yandell Henderson on "Carbon Monoxide Poisoning," Jour. Amer. Med. Assoc, 1916, 
LXVII, 580.) 



CAHBONEUM. 203 

mine explosions. It is responsible for more deaths than the total of all other 
gases (Yandell Henderson). Carbon Monoxide is almost odorless and is 
non-irritating when inhaled, in fact, it is without action on the tissues except 
in one respect and that is a marked affinity for hemoglobin with which it 
combines 250 times more readily than oxygen. The combination is not a per- 
manent one, as some believe, but readily broken up when the patient is given 
oxygen or simply removed to the fresh air. The danger to the tissues is that 
due to deprivation of oxygen. When the patient is found to be suffering with 
Carbon Monoxide poisoning the damage has already been done and the sub- 
sequent recovery depends on the degree of degenerative change in the tissues 
which the deprivation of oxygen has caused. There is no rational basis, 
therefore, for either bleeding or transfusion, because removal to the fresh air 
with oxygen inhalations are promptly effective in breaking up the Carbon 
Monoxide hemoglobin combination and restoring the oxygen-carrying 
property of the blood. The greater part of the Carbon Monoxide is elim- 
inated and the oxygen-carrying power restored to the patient's needs in about 
an hour. The hemoglobin is fully restored in three or four hours. When 
coma continues and the patient dies after several days, death is due to the 
degenerative changes induced, and not due to retention of the gas. Hen- 
derson states very tersely the conditions upon which the severity of the imme- 
diate and after effects depend. "Ina normal man at rest the tissues consume 
only a little over one-third of the oxygen which the blood brings to them, 
while during muscular exertion nearly two-thirds are utilized. Accordingly 
the blood of a man at rest may become nearly one third saturated with Carbon 
Monoxide without his realizing that anything is wrong. His judgment, tem- 
per and behavior, however, are often affected in ways similar to alcoholic 
intoxication. Such behavior is often seen' in city firemen and in the men of a 
mine rescue crew after breathing smoke. Similar behavior occurs frequently 
among transient visitors to the summit of Pike's Peak, and is clearly due to 
deficiency of oxygen. 

"If a man in this condition tries to make any considerable exertion, the 
fraction of his hemoglobin uncombined with Carbon Monoxide may be in- 
sufficient to transport the oxygen needed, and he is liable to collapse. When 
more than half saturated, he is liable to collapse even at rest. If he remains 
for a considerable time in this condition, the delicate nerve cells of the brain, 
and less often also other organs, are injured by the insufficient supply of the 
oxygen which the blood is able to transport to them, and unconsciousness 
(coma) results. As a rough estimate, it may be stated that usually a man will 
die who has breathed 0.2 per cent, of Carbon Monoxide mixed with air which 
is in other respects normal, for four or five hours, or 0.4 per cent, for one 
hour. With from 2 to 5 per cent, of Carbon Monoxide, as after an explosion of 
coal dust, nearly all of the hemoglobin is combined by the first few breaths 
drawn, and death follows almost as quickly as in drowning. This is the case 
also when illuminating gas only slightly diluted with air is inhaled." 



204 CARDAMOMUM CARDUUS. 

Solid Carbon Dioxide or " snow" has a wide range of usefulness in skin dis- 
eases, lupus vulgaris, lupus erythematosus, rodent ulcer, warts, pigmented 
types of vascular nevi and certain forms of senile keratoses and degenerations 
of the skin. 

Carbonated water, or Soda-water as it is popularly named, is a grateful 
beverage in warm weather, especially when flavored with syrups and fruit- 
juices. It is a useful drink in febrile affections, as it relieves thirst, allays nausea 
and gastric irritability, and is both diaphoretic and diuretic in slight degree. 
It is an efficient remedy for vomiting and in the form of iced champagne is one 
of the numerous agents which have proven efficacious in the vomiting of preg- 
nancy. It forms an excellent vehicle for the administration of saline cathartics, 
the various carbonates and piperazin. At many European spas the course of 
treatment is largely based on the use of carbon dioxide, administered in the 
forms of baths and inhalations as well as by the ingestion of the waters con- 
taining it. Bathing in the natural carbonated waters is sometimes beneficial 
in catarrh, gout, rheumatism, anemic amenorrhea and leucorrhea, the gas 
acting as a gentle stimulant of the cutaneous circulation and promoting slight 
diaphoresis. 

Carbon Disulphide is largely used in the arts, hence its effects are frequently 
observed. Persons exposed to its fumes are affected by headache, vertigo, 
over-excitement of the nervous system, emaciation, incoordination of move- 
ment, depression of all the special senses with impairment of sensation and 
motility and perhaps insanity. Inhaled directly, it excites violent coughing, 
and produces anesthesia characterized by great muscular rigidity. Being a 
powerful cardiac paralyzant, it is a dangerous anesthetic. In 3-drop doses it 
produces nausea and vomiting, with a sense of heat in the stomach and a weak 
and rapid action of the heart. It is practically never used in medicine today. 

CARDAMOMUM, Cardamom, — is the dried fruit of Elettaria repens, a plant of the 
nat. ord. Zingiberacea;, cultivated in Malabar. It contains 4% per cent, of a Volatile Oil, 
C 10 H 16 , isomeric with Oil of Turpentine, the oil being the active principle; also a fixed oil, 
coloring matter, etc. It is an ingredient of Pulvis Aromaticus and of Fluidextractum Aro- 
maticum (See under Cinnamomum), as well as several compound preparations. Dose, 
gr. x-xx [av. gr. xv.] 

Tinctura Cardamomi, Tincture of Cardamom, — 20 per cent. Dose, 5ss-jss [av. 5jd 

Tinctura Cardamomi Composita. Compound Tincture of Cardamom, — has of Carda- 
mom 25, Cinnamon 25, Caraway 12, Cochineal 5, Glycerin 50, Diluted Alcohol to 1000 parts. 
Dose, 5ss-jss [av. 3j-] 

Infusum Cardamomi, Infusion of Cardamom (Unofficial), — may be made in the strength 
of 3ij to the pint, and used in wineglassf ul doses. 

Cardamom is aromatic, carminative and stomachic, and is used as an agreeable flavoring 
for bitter mixtures in dyspepsia and other gastric affections. It makes the best flavoring 
addition to saline solutions or mineral waters, and is particularly efficient to correct flatulence 
and griping when combined with purgatives. Acids, Ferrous Sulphates, and Mercuric 
Chloride are incompatible with the preparations of cardamom. 

CARDUUS (Unofficial), — the seeds of Carduus marianus, or St. Mary's thistle, an annual 
European plant of the nat. ord. Compositae. A decoction (oij ad Oj) is the preparation 
usually employed. It is an old remedy revived as a hemostatic, and reported as being very 
efficient in hemoptysis, uterine hemorrhage, melena and amenorrhea connected with derange- 



CARUM CARYOPHYLLUS. 205 

ment of the portal circulation. It has proved curative in congestion of the liver and simple 
jaundice and in Germany it has long been popularly deemed efficacious in gall stones and 
liver affections generally. Dose of the decoction, 5j - 5ss, of a tincture ttjjx-xx. 

Carduus Benedictus, the "blessed thistle," also called Cnicus benedictus and Centaurea 
benedicta, is another plant of the same order, formerly held in high esteem as a popular "cure- 
all." It contains Cnicin, an amorphous bitter principle, which has been used as an anti- 
periodic in doses of gr. v-x, but generally produces burning sensations and pharyngeal con- 
striction, with nausea, vomiting, colic, and diarrhea. It acts chiefly as a bitter tonic, resem- 
bling Calumba and Taraxacum most closely. 

CARUM, Caraway, — is the dried fruit of Carum Carvi, a European plant of the nat. 
ord. Umbelliferae. Its odor and taste are aromatic and agreeable. The active principle 
is the Volatile Oil, which is also official. Caraway is an ingredient of Tinctura Cardamomi 
Composita. Dose gr. x-xx [av. gr. xv.] 

Oleum Cari, Oil of Caraway, — is the volatile oil distilled from Caraway, and is resolvable 
into Carvene, C 10 H 16 , isomeric with Turpentine, and Carvol, C 10 H n O, isomeric with Thymol. 
It is an ingredient of Spiritus Juniperi Compositus. Dose, ttrj-v [a v. T$iij.] 

Infusum Cari, Infusion of Caraway (Unofficial), — 5j-ij ad Oss. Dose, Sss-ij. 

The Oil of Caraway is fatal to small animals, and in one case 5j produced cerebral 
congestion, delirium and rigors in man. The chief use of Caraway is as a flavoring agent, 
but it is efficient in the flautulent colic of children, and to prevent griping from the use of 
purgatives. 

CARYOPHYLLUS, Cloves, — are the dried flower buds of Eugenia aro- 
matica, a handsome evergreen tree of the nat. ord. Myrtacese, cultivated in the 
East and West Indian Islands. They exude oil when scratched, have an aro- 
matic odor and a pungent, spicy taste, and are contained in Tinctura Lavan- 
dulae Composita and Tinctura Rhei Aromatica. They yield a heavy Vola- 
tile Oil, which is official; and contain Eugenol, C10H12O2, a crystalline body; 
Caryophyllin, CioHi 6 0, a camphor; Caryophyllic Acid, and tannin, gum, etc. 
Dose, gr. j-vj [av. gr. iv.] 

Preparations. 

Oleum Caryophylli, Oil of Cloves, — a volatile oil distilled from cloves, soluble in alcohol, 
and of sp. gr. 1.038 to 1.060, yielding not less than 82 per cent, by volume of Eugenol. 
Dose of the oil, TTjrj-iv [av. njmj.] 

Infusum Caryophylli, Infusion of Cloves (Unofficial), may be made of strength 1 to 
40 and used in doses of one to two fluid ounces. 

Eugenol, Eugenol, Ci Hi 2 O 2 , — an unsaturated, aromatic phenol, miscible with alcohol 
in all proportions. Dose, Tijrj-v [a v. Trjjiij.] Eugenol-acetamide is a powerful local anesthetic, 
analogous in its action to cocaine. 

Physiological Action and Therapeutics. 

Cloves may be considered as a type of several agents yielding aromatic 
oils, which as a rule consist of terpenes with camphors, resins, fatty and other 
acids, and are closely allied to phenol and benzoic acid, the balsams and gum- 
resins. Such are Orange, Lemon, Allspice, Cajuput, Caraway, and Peppermint. 
Their oils are antiseptic, locally anesthetic, stimulant and irritant, antispasmodic, 
stomachic and carminative. Internally they increase the circulation and tem- 
perature, promote digestion and nutrition (though in quantity they may cause 
inflammation), relieve pain and spasm, and are excreted by the kidneys, skin, 
liver and the bronchial mucous membrane, stimulating these structures in 
their routes throughout the organism. 



206 CASCARA CATECHU. 

These agents are used to flavor pharmaceutical preparations, to correct 
the griping tendency of many purgatives, to correct flatulence, to relieve pain 
in the stomach and bowels, and to promote the flow of saliva and gastric juice. 
As external applications they are efficiently employed for anesthetic and counter- 
irritant purposes, to relieve pain in chronic rheumatism, myalgia, lumbago, 
superficial neuralgia, and toothache. The Oil of Cloves is valuable in pul- 
monary tuberculosis to lessen excessive cough and expectoration. It is a 
good application to a painful tooth, and is occasionally applied over the 
course of an aching nerve with relief to the pain. 

CASCARA AMARGA, Honduras Bark (Unofficial),— is the bark of a Mexican tree 
of the nat. ord. Simarubaceae, which was formerly used as an alterative tonic and diuretic 
in syphilis and various chronic skin affections. A Fluidextract is on the market, of which 
the dose is 3 ss-j thrice daily. 

CASCARA SAG RAD A, See Rhamnus Purshiana, p. 400. 

CASCARELLA (Unofficial), — is the bark of Croton Eluteria, a shrub or small tree of the 
nat. ord. Euphorbiacese, growing in the Bahamas. It contains Cascarillin, a crystalline 
principle, two resinoid extracts, aromatic volatile oils, with tannic acid, etc. An Infusion 
(1 to 10) or a Tincture (1 to 10) may be prepared and given in doses of 5j-5j. 

Cascarilla is an aromatic bitter. It increases appetite and digestion, the mucous secre- 
tion, the flow of saliva and gastric juice, stimulates the intestinal secretions, and acts as a 
mild astringent by the influence of its tannin. Large doses produce nausea, vomiting and 
diarrhea, and in medicinal doses continued it will set up gastric catarrh and consequently 
indigestion. It has been used in flatulent dyspepsia, debility and chronic bronchitis. It 
is difficult to dispense, as the infusion decomposes quickly, and acids precipitate the resin 
from the tincture. 

CASSIA FISTULA, Purging Cassia (Unofficial) ,— is the dried fruit of Cassia Fistula, 
a tree of the nat. ord. Leguminosae, growing in tropical regions of Asia, Africa and America. 
No active principle has been isolated as yet. 

Cassia-pulp is laxative in doses of 5j-ij, and purgative in larger quantities, producing 
nausea, flatulence and griping. It is rarely prescribed alone, owing to its tendency to cause 
colic and flatulence. Dose, 3ss-ij [av. 5 J-] 

CATECHU (Unofficial), — is an extract prepared from the wood of Acacia 
Catechu, a tree of the nat. ord. Leguminosae, native of the East Indies. It 
occurs in irregular masses, bark brown and brittle, nearly inodorous, but of 
astringent and sweetish taste, soluble in alcohol, and partly so in water. It 
contains Catechatannic Acid 50 per cent.; also Catechuic Acid, which is con- 
verted into the former by heat. Dose, gr. j-5 ss - Formerly official, it is now 
replaced in the U. S. Pharmacopoeia by — 

Gambir, Gambir {Pale Catechu), — an extract prepared from the leaves and 
twigs of Ourouparia Gambir, nat. ord. Rubiaceae. It occurs in irregular, red- 
dish-brown masses, of which not less than 60 per cent, should be soluble in 
alcohol. Dose, gr. x-xx [av. gr. xv.] 

Preparations. 
Tinctura Gambir Composita, Compound Tincture of Gambir, — has of Gambir 5, 
Cinnamon 2 J, in Diluted Alcohol to 100. Dose, oss-jss [a v. oj-] 

Incompatibles. 
Incompatible with Catechu and Gambir are: Acids (mineral), Albumin, Alkalies, Calcium 
salts, Cinchona infusion, Ferric and Ferrous salts, Gelatin, Lime-water, Mercuric Chloride, 
Zinc Sulphate. 



CATJLOPHYLLUM CERA. 207 

By virtue of their tannic acid Catechu and Gambir are powerfully astrin- 
gent, and their therapeutic employment depends entirely on this quality. In 
the diarrhea of children the tincture with chalk-mixture is very serviceable, and 
with opium it is efficient in dysentery. It is used as a gargle and mouth-wash 
in relaxed conditions of the pharyngeal mucous membrane, as an injection in 
leucorrhea, and to control passive hemorrhages, and to harden spongy gums. 

CAULOPHYLLUM, Blue Cohosh (Unofficial),— is the rhizome and rootlets of Caulo- 
phyllum thalictroides, a plant of the nat. ord. Berberidaceae growing in Canada and the 
northern United States, and contains Saponin, a glucoside, and two resins. Dose, gr. v-xx. 
The eclectic preparation Caulophyllin is a resinous precipitate obtained by pouring an 
alcoholic extract into water. 

Caulophyllum has not yet been made the subject of experimental work by reliable 
observers. It was much used by the aborigines of this country in all affections to which their 
women were peculiarly subject, and was known among them by the name "squaw-root." 
It is said to produce intermittent contractions of the gravid uterus, to have diuretic, emmena- 
gogue, and antispasmodic powers; and is used as a remedy for deficient labor-pains, spas- 
modic after-pains, spasmodic pains in the uterus at any time, spasmodic dysmenorrhea, 
and pains in other organs seemingly in sympathy with uterine affections. 

CERA, Wax, — a mixture of Myricin, C erotic Acid and Cerolein, is formed 
by the honey-bee, and exists in the pollen and leaves of many plants, particularly 
in Myrica cerifera, the wax myrtle. That produced by the bee is alone official, 
in two forms, viz. — ■ 

Cera Alba, White Wax, — is yellow wax bleached. 

Cera Flava, Yellow Wax, — is a solid substance prepared from the honey-comb of the 
bee, Apis mellifera. It is a yellowish solid, of agreeable odor, and faint balsamic taste, insoluble 
in water, sparingly soluble in cold alcohol, but soluble in ether, chloroform, fixed and vola- 
tile oils. 

Ceratum, Cerate, — consists of White Wax 30, Benzoinated Lard 70. 

Unguentum, Ointment, — consists of White Wax 20, Benzoinated Lard 80. 

Wax is also a constituent of the 2 compound Cerates and 3 of the 19 compound Ointments. 

Wax owes its value to its power of resisting decomposition and many chem- 
ical agents. Its fusibility at a moderate degree of heat and its 'solidity at the 
temperature of the body, together with its unirritating quality, make it a val- 
uable ingredient of the cerates and ointments to give them consistence. Cer- 
atum and Unguentum may be used as simple protective applications. 

CERII OXALAS, Cerium Oxalate, — consists chiefly of a mixture of the oxalates of 
cerium, didymium and lanthanum, and other rare earths of this group. It occurs as a fine, 
white powder, odorless and tasteless, permanent in the air, insoluble in water, alcohol or 
ether. Dose, gr. ss-v [av. gr. iij], in pill or powder. 

Cerium oxalate is a gastric sedative, and is thought to possess selective action as such on 
the motor distribution of the pneumogastric nerve. It is considered to be particularly useful 
in vomiting of reflex origin, especially in the vomiting of pregnancy, but it often fails, probably 
because not given in sufficient doses. To be effective, at least 4 or 5 grains should be given 3 
times a day to adults, and no results promised until after it has been used several days. It is 
also recommended in the vomiting of phthisis and bronchitis, cough with vomiting, chorea, 
and diarrhea. 



208 CHAULMOOGRA OIL CHENOPODIUM. 

CHAULMOOGRA OIL (Unofficial) ,— is a fixed oil expressed from the 
seeds of Gynocardia odorata, an East Indian tree of the nat. ord. Bixaceae. 
It is nauseous and bulky, and soluble in alcohol, either, chloroform, etc. 
Dose, gtt. v-Xj in capsules. 

Therapeutics. 

Chaulmoogra Oil is extensively used in the treatment of leprosy. Dyer 
states that more cures have resulted from its use than any other remedy, 
and within a few weeks after its use amelioration is noted, even in advanced 
cases. The drug to be effective should be increased to ioo to 150 drops 
per dose or 300 to 450 drops per day. It may be given in capsule, in pill 
form with tonics such as arsenic or strychnine, or in coffee or milk. 

CHELIDONIUM, Celandine (Unofficial), — is the plant Chelidonmm majus, nat. ord. 
Papaveraceae, which grows in Europe and N. America, about rocky places. Dose of the 
plant, gr. v-xxx; of the fresh juice, tijv-xx. 

Chelidonium used externally is irritant, internally it is a drastic purgative but an un- 
reliable one. It is also perhaps diuretic, diaphoretic and expectorant. In overdoses it is 
considered poisonous. It is an old remedy for jaundice and liver affections, but has been 
obsolete for some time. 

CHENOPODIUM, American Wormseed (Unofficial),— is the fruit of 
Chenopodium ambrosioides, var. anthelminticum, a plant of the nat. ord. 
Chenopodiaceas, indigenous to the United States. Its active principle is a 
Volatile Oil. 

Oleum Chenopodii, Oil of Chenopodium (Official), — a thin, colorless or 
yellowish liquid, of aromatic odor and pungent, bitter taste. Dose, tij?v-x 
[av. TTRiij.] 

The Oil is the only preparation used and that rarely, its odor and taste 
being very disagreeable. It is an efficient anthelmintic against the round 
worm in doses of gtt. x three times a day for two days, followed by a cathar- 
tic. Recently chenopodium has attracted attention by reason of its use in the 
treatment of the Hook Worm. Three doses of 16 minims of the Oil are given 
at two hour intervals followed in two hours by a tablespoonful of castor oil. 
The chenopodium narcotizes the parasite and the cathartic expels it. Care 
must be exercised in the use of this drug as several cases of poisoning have 
been reported. 

CHIMAPHILA, Chimaphila, (Pipsissewa) (Unofficial), — the leaves of Chimaphila um- 
bellata, or Prince's Pine, an evergreen plant of the nat. ord. Ericaceae, indigenous to all 
parts of the United States. It contains Chimaphilin, a yellowish crystalline principle, 
Arbutin, also crystalline but colorless, with tannic acid, etc. 

Fluidextractum Chimaphilae, Fluidextract of Chimaphila (Unofficial), — Dose, ttrx-oJ 

[av. TTJ7XXX.] 

Chimaphila is a tonic and diuretic, belonging to the same class as Buchu, Uva Ursi, 
Pereira and Scoparius. It is an agreeable tonic, excites the appetite and promotes diges- 
tion. The fresh leaves, bruised and applied to the skin, are rubefacient and vesicant, show- 
ing the presence of some irritant principle. It was formerly used in several forms of chronic 
kidney disease with albuminuria, and in chronic catarrhal affections of the urinary pas- 
sages, as hematuria, ischuria, dysuria and gonorrhea. It is only rarely used now, having 
been replaced by more efficient drugs. 



CHIRATA CHLORALUM HYDRATUM. 20Q, 

CHIRATA, Chirata (Chiretta) (Unofficial), — is the Indian plant Swertia Chirayita, nat. 
order Gentianacese, occurring in bundles, composed of all but the coarser woody stems. 
It is inodorous, but intensely bitter, and contains two amorphous bitter principles, named 
Chiratin and Ophelic Acid, but no tannin. Dose of the powdered plant, gr. x-xx [av. gr. xv.] 

Fluidextractum Chiratae, Fluidextract of Chirata (Unofficial) ,— made with diluted alco- 
hol. Dose, TTj7x-xx [av. ttrxv.] 

The action of this plant is that of a simple bitter, like its congener Gentian. It is an 
excellent tonic, in this respect rivalling Cinchona, and is used in India as a substitute for the 
latter. It is laxative and stomachic, diminishes flatulency and acidity, and is particularly 
serviceable in the dyspepsia of gouty subjects. As it contains no tannin, it may be adminis- 
tered with preparations of Iron. 

CHLORALUM HYDRATUM, Hydrated Chloral (Chloral Hydrate), C 2 H- 
C1 3 + H 2 0, — is a crystalline solid, composed of trichloraldehyde (chloral) with 
one molecule of water. It occurs in colorless, transparent, rhomboidal crystals, 
slowly volatilizing when exposed to the air; of aromatic, penetrating and slightly 
acrid odor, bitterish, caustic taste, and neutral reaction. It is freely soluble 
in water, alcohol, ether, chloroform, oils, etc.; liquefies when triturated with 
about an equal quantity of camphor, menthol, thymol or phenol ; and is decom- 
posed by alkalies into chloroform and a formate of the base. Its aqueous 
solution becomes acid, but the alcoholic solution remains neutral. Dose, gr. 
x-xxx [av. gr. viij.] 

Chloral itself (Trichloraldehyde, C 2 HC1 3 0), is an unstable, oily, color- 
less fluid, formed by the action of chlorine upon alcohol, whence its name, 
Chlor-al. 

The Dose varies much with individual susceptibility and with the presence or absence of 
cardiac and pulmonary disease. Death has been caused in several instances by gr. xxx, in 
one case by gr. x, and in another gr. vijss produced alarming symptoms, all being in adults. 
On the other hand, recovery has occurred after the ingestion of an ounce, several hundred 
grains have been taken at a time in more than one instance without fatal results, and where 
tolerance has been established by habitual use 5ij~3iij are frequently taken without poisonous 
symptoms. An average dose for a healthy adult is gr. xx, for a child gr. j for each year of age 
up to gr. vj. It is best given in Syrup of Tolu, or in Peppermint water. 

Incompatibles. 

Incompatible with Hydrated Chloral are: Acetanilid, Alcohol, Alkalies, Ammonium salts, 
Benzamide, Borax, Borneol, Camphor, Camphora Monobromata, Diuretin, Euphorin, Exalgin, 
Glycerin (with heat), Lead Acetate, Menthol, Mercuric Nitrate, Mercuric Oxide, Methacetin, 
Phenacetin, Phenol, Piperazin, Potassium Cyanide, Potassium Permanganate, Potassium 
Iodide, Pyrocatechin, Quinine Sulphate, Saligenin, Salocoll, Salol, Sodium Phosphate, Thymol, 
Urea, Urethane. Physiologically incompatible are: Ammonium Chloride, Atropine, Brucine, 
Caffeine, Cocaine, Codeine, Digitalis, Phenol, Physostigmine, Picrotoxin, Strychnine, 
Thebaine. 

Hydrated Chloral should not be prescribed with preparations containing alcohol, as the 
Chloral is liable to separate as an alcoholate, especially if the Bromide of Potassium or Sodium 
is used in the same mixture and if the solutions are at all concentrated. In this way great 
danger is incurred of giving a heavy overdose, as the alcoholate floats on the surface of the 
mixture, and the entire amount of Chloral contained therein may be taken at a single dose. 

Derivatives of Chloral. 

Chloralformamidum, Chloralformamide (Chloralamide (Unofficial) C3H4G3NO2, — is a 
crystalline solid, made by the direct union of formamide with anhydrous chloral. It occurs 
in lustrous crystals, which are soluble in about 20 of water and in i| of alcohol, also in 
glycerin, ether, etc.; and is decomposed in warm or hot solutions, also by alkalies, alkaline 
carbonates and silver nitrate. Dose, gr. x-xxx [av. gr. xv.], in whisky, brandy, or other 
alcoholic preparation. 



2IO CHLORALTJM HYDRATUM. 

Chloralose, Anhydro-Gluco-chloral, C S H U C1 3 6 (Unofficial), — is formed by heating 
together anhydrous Chloral and Glucose. It occurs in small crystals, of bitter taste, freely 
soluble in hot water, slightly in cold water. Dose, gr. ij-v, in capsule. 

Hypnal (Unofficial), — is the trade name of a combination of Chloral and Antipyrine, 
occurring as tasteless and odorless rhombic crystals, soluble in 6 of water, and credited with 
simultaneous action as a hypnotic and an analgesic. Dose, gr. xv-xxx in aqueous mixture 
with some alcohol, flavored with syrup of orange. 

Somnal (Unofficial), — is the suggestive name given to a liquid preparation formed by the 
union of Chloral, Alcohol and Urethane, described as Ethylirtes Chloral-ur ethane, represented 
by the formula C 7 H 12 C1 3 3 N, and claimed to be a complex body, not a simple mixture of its 
constituents. It occurs as a colorless liquid, resembling chloroform in its behavior with cold 
water, with which it forms globules and refuses to mix or dissolve. It is soluble in hot water, 
in alcoholic solutions, and in alcohol, 3 parts in 1. Dose, ttjxx-3 j, in whisky or syrup of tolu. 

Official Analogue. 

Paraldehydum, Paraldehyde, C 6 H ]2 3 , — is a polymeric modification (polymer) of acetal- 
dehyde. It occurs as a colorless liquid, of strong and characteristic odor, and a burning and 
cooling taste; soluble in 8 \ of water, miscible in all proportions with alcohol or ether. Dose, 
T$xx-5ij [av. ttjjxxx] in simple elixir. The doses usually given are too small for efficiency, 
5j will usually be required, especially in cases of drug-habit. Incompatibles are Alkalies, 
Hydrocyanic Acid, Iodides, Oxidizers. 

Sulphonme thane (Sulphonal), Sulphonethylme thane {TrionaV), Ethyl Carbamate 
{Urethane), also the unofficial Veronal and Tetronal, are described under the title 

SULPHOMETHANUM. 

Unofficial Analogues. 

Butyl-chloral Hydras, Butyl-chloral Hydrate, Croton-chloral Hydrate, — is a crystalline 
hydrate obtained by the addition of water to the liquid Butyl-chloral produced by the 
action of Chlorine gas on Aldehyde. It occurs in white laminae, of pungent odor, and acrid, 
nauseous taste, soluble in 50 of water, and in its own weight of glycerin or of alcohol. Dose, 
gr. v-xx, in syrup or pill; but the best method is to give 5 grains every half hour, until 20 grains 
have been taken or until relief is afforded. Incompatibles are Alkalies, Camphor, Ethyl 
Carbamate, Exalgin, Menthol, Phenol, Piperazin, Pyrocatechin, Thymol. 

Amylene Hydrate, Dimethl-ethyl Carbinol, C5H12O — is a tertiary amylic alcohol, pro- 
duced by the action of Sulphuric Acid on Amylene. It occurs as a limpid, colorless, oily 
fluid, of peculiar odor, soluble in 8 of water, miscible in all proportions with alcohol. Dose, 
3 ss-jss. 

Amylene-chloral, — is a mixture of equal molecules of Chloral and Amylene Hydrate, 
forming a colorless, oily fluid. Dose, ttjjx-xIv of a 50 per cent, aqueous solution, in which 
form it is marketed. 

Methylal, Methylene-dimethyl-ether, — a product of the oxidation of methylic alcohol, is a 
volatile, mobile liquid, soluble in water or alcohol. Dose, TT£iij-v, repeated thrice at short 
intervals. 

Physiological Action. 

Hydrated Chloral is a powerful hypnotic, also an antispasmodic, an anti- 
septic, a preventive of the coagulation of fibrin, indirectly an anesthetic, and 
a direct depressant of the cerebral, medullary and spinal centres and of the 
cardiac muscle. It is more hypnotic than chloroform but less anesthetic. Ap- 
plied to the skin or mucous membranes a 1 per cent, solution (gr. v ad oj) is 
antiseptic, but strong solutions are irritant and vesicant, may produce slough- 
ing ulcers, and if taken internally may excite gastritis with nausea and vomiting. 

After a brief period of stimulation a medicinal dose depresses the heart, 
dilates the peripheral vessels and lowers arterial tension, diminishes oxidation 



CHLORALUM HYDRATUM. 211 

and decreases the body-temperature. On the brain cells it has a selective action, 
producing a deep sopor very like normal sleep, from which the patient may 
be awakened, but immediately falls asleep again, and which is not followed 
by headache or depression. This effect is considered by most authorities to 
be the result of cerebral anemia produced by the drug. In some persons, in- 
stead of sleep it causes headache, insomnia and delirious excitement. It is 
not an anodyne, as it does not affect the conductivity of the sensory nerves, 
and does not interrupt the transmission of pain; but by overwhelming the cen- 
tres it drowns the consciousness of pain, and is therefore indirectly anesthetic. 
A toxic dose produces profound narcotism, abolishment of reflexes and sensibil- 
ity, complete muscular relaxation, and a great fall of body-temperature. Death 
may result in the chloral sleep from paralysis of the respiratory centre or the 
cardiac motor ganglia, or by sudden failure of the heart-muscle in cases of fatty 
degeneration or in chronic drunkards. 

On the blood its action is to increase the fluidity, to crenate the red cor- 
puscles, and to destroy the leucocytes if used in large quantity. It is rapidly 
diffused and is excreted by the kidneys partly unchanged, but chiefly as uro- 
chloralic acid, producing some diuresis; also by the skin, causing various erup- 
tions if used for any lengthened period. It has been held that the blood, being 
an alkaline fluid, decomposes it, setting free chloroform, but there are many 
facts against this theory. Von Mering states that it is decomposed in the blood 
into trichlor- ethyl alcohol, to which its hypnotic action is due. 

The Chloral habit produces a state of marked anemia and muscular weak- 
ness,, especially of the legs; its subject presenting a weak, irritable, often irregular 
heart, deranged hepatic functions, jaundice, bileless stools, congestion of the 
face and the bronchial mucous membrane, perhaps purpura and sloughing 
of a finger from decreased blood-supply. Its votaries are on the border -of 
insanity, excitable, uncontrollable in speech and action, talking in a silly man- 
ner and very volubly, and showing a marked loss of power of the limbs, so 
much so as to simulate paralysis thereof. Many cases of insanity have their 
origin in chloralism. In some persons a very few doses of chloral will produce 
bileless stools. 

Chloral and Atropine, though antagonistic in their action on the spinal, 
cord, both produce motor paralysis, the former by paralyzing the cord, the 
latter by direct paralysis of the motor nerves. 

Therapeutics. 

Hydrated Chloral is of great value as a hypnotic and antispasmodic, but 
must be cautiously used if at all in persons with weak or fatty heart, atherom- 
atous vessels or advanced pulmonary disease. In combination with Potas- 
sium Bromide it is much used in asylum and general practice, and equally 
abused, both drugs being active cardiac poisons. It is by far the best hypnotic 



212 CHLORALTJM HYDRATUM. 

in acute mania and in delirium tremens, but has been too incautiously em- 
ployed therein. The condition of acute alcoholic intoxication seems, however, 
to antagonize its depressant action on the heart to a great extent, even in old 
topers, for 30-grain doses, repeated twice within 7 or 8 hours, are commonly 
used in inebriate asylums and by police surgeons, for the purpose of straight- 
ening up a case of acute alcoholism, with no fatal effects resulting from its 
direct action. Chloral possesses marked power to relax spasmodically con- 
tracted unstriated muscle and to dilate the peripheral vessels, properties which 
govern its employment in many morbid conditions. Associated with Potas- 
sium Iodide it is of service in bronchial asthma. Chloral is exceedingly effi- 
cient as a gastric antiseptic and sedative in the so-called nervous dyspepsia of 
neurotic persons, characterized by severe pain in the cardiac region of the 
stomach. It is very serviceable in fevers, when high temperature exists with 
excitement, restlessness and a sthenic condition, as it lowers temperature and 
prevents the coagulation of fibrin. In typhoid fever, owing to the marked 
alkalinity of the tissues, small doses manifest the same effects as those pro- 
duced only by large doses in other diseases; while in gout even large doses do 
not cause the desired results, as alkali is lacking in the blood for its decom- 
position (Liebrich) . In the algid stage of cholera and in violent cases of cholera 
morbus it has been injected hypodermically in 15-grain doses with extraordi- 
nary efficacy. In sea-sickness, small doses (gr. v) two or three times a day- 
are generally very efficient. In obstetrics it is used to relieve suffering, relax 
the os uteri, palliate convulsions and relieve afterpains. For nocturnal 
epilepsy a full dose at bedtime is a useful palliative. In neuralgia it may be 
triturated with Camphor and applied over the course of the affected nerve, 
and the same mixture is efficiently employed as a local application for tooth- 
ache and earache. 

Hydrated Chloral is well borne by children, and is an excellent remedy for 
infantile convulsions and colic, chorea, whooping-cough, laryngismus stridulus 
and the first stage of diphtheria, but it should not be used when the first sound 
of the heart becomes dull and weak. It is highly efficient for the purpose of 
calming children in scarlet fever. In these affections it may be given with 
paregoric, as its combination with opium enhances its value and guards the 
patient against its dangers. Its hypnotic power in adults is much increased 
by the conjoint administration of laudanum or morphine, and this combina- 
tion is an excellent remedy in colic, cholera and cholera morbus. Tetanus 
is well treated by this agent and Potassium Bromide given together in full doses. 
In strychnine-poisoning Hydrated Chloral is the antagonist. It is generally 
given by the mouth in very dilute solution with some simple elixir, syrup of 
tolu, or cinnamon-water, but is well absorbed by the rectum. Its hypodermic 
administration is liable to result in great local irritation and even sloughing ulcers. 

Hydrated Chloral may be applied to the skin as an antipruritic in the erup- 
tive diseases, for which purpose it is well combined with Phenol, ten grains 



CHLORALUH HYDRATUM. 213 

of each to an ounce or two of water or oil. It is said to be the best of all local 
applications for boils, 3 jss in §iv each of glycerin and water, constantly applied 
to the boil by a tampon of cotton. For ulcers and cancers a 25 per cent, solu- 
tion is a good antiseptic and anodyne application. 

The chief contra-indication to the use of Chloral is the presence of a cardiac 
affection, although it may be prescribed with much benefit in neurotic pal- 
pitation of the heart and in pseudo angina pectoris. Other contra-indications 
are rosacea, or a tendency to it, and hysteria of grave character. It readily 
produces congestion of the face, and in hysterical subjects it may excite parox- 
ysms of delirium and hallucinations. 

Butyl-chloral Hydrate closely resembles Chloral in action, but is feebler 
as a hypnotic, less depressant to the heart, and generally less poisonous, but 
more disagreeable to the taste. It has a specific paralyzant power over the 
fifth nerve, and over its distribution causes an anesthetic condition long before 
it produces general anesthesia (Liebreich). It has been used with benefit in 
various neuralgise, especially tic-douloureux, also in sciatica and dysmenorrhea. 
All statements concerning the action and therapeutics of this drug are to be 
received with hesitation, as wide differences therein are reported by the best 
authorities. 

Paraldehyde is a reliable hypnotic, almost equal in this respect to Chloral, 
though its hypnotic action is not so persistent as that of the latter drug, and 
it requires more frequent repetition to produce sustained sleep. It is also 
antispasmodic and diuretic but not diaphoretic, and is unquestionably safer 
than chloral, strengthening and slowing the heart's action, instead of weak- 
ening it. Its administration is followed by a well-marked stage of excitement, 
after which it produces a sound sleep which is described as refreshing. It 
does not interfere with the appetite or digestion, but occasionally causes an 
erythematous eruption; and may give rise to salivation, cerebral congestion, 
and vaso-motor paralysis, if used for any long period of time. A toxic dose 
paralyzes the medulla and the respiratory centre therein. 

Paraldehyde is used as a hypnotic in fevers, rheumatism, acute mania, hys- 
teria and insomnia from various causes, also as an antispasmodic in asthma. 
Several cases of tetanus have been treated successfully with it, and it has been 
found useful as a diuretic and hypnotic in a case of senile arterial degeneration 
with double aortic and mitral regurgitant murmurs, mental depression and 
very marked insomnia and restlessness. 



Cases of Paraldehyde habit are occasionally seen, and exhibit a train of symptoms similar 
to those observed in delirium tremens. There is great emaciation and anemia, weak and 
irregular action of the heart, a soft and intermittent pulse, general muscular weakness, tremu- 
lousness and restlessness, the gait feeble and unsteady, mental anxiety, agitation and confusion, 
temporary loss of memory and incoherent speech, also hallucinations of sight and hearing and 
delusions, all of an unpleasant kind. There is marked gastric derangement, but an abnormally 
large appetite, excessive flatulence and constipation. The treatment of such a case generally 
takes about three months, and should be conducted in an inebriate asylum. 



214 CHLOROFORMUM. 

Chloralformamide (Chloralamide) is an excellent hypnotic in solution, given 
about an hour before its action is required, and is usually efficient in simple 
insomnia, not due to pain, excitement or hallucinations. It does not seem to 
have cumulative action on repetition, or any tendency to induce a habit. It 
has given satisfaction as an analgesic in carcinoma of the stomach, dysmenor- 
rhea, and other painful diseases; and is reported as having cured several cases 
of chorea. The effects of large doses are vertigo, thirst, nausea, vomiting, 
dryness of the mouth, anorexia, restlessness, slight delirium, and a weak and 
rapid pulse. 

Amylene Hydrate stands between chloral and paraldehyde in hypnotic power, but is 
more agreeable to the taste. In dose of 3j it is usually efficient, has no perceptible influ- 
ence on the heart or respiration, and leaves no unpleasant after-effects. The mixture of 
this agent and chloral, known as Dormiol, is said to be an efficient and safe hypnotic, but 
should be used as carefully as hydrated chloral. 

Chloralose is a prompt hypnotic, producing sound sleep in which sensibility is not lost, 
and leaving no unpleasant after-effects. It depresses the cerebral functions, but excites the 
spinal cord, so that reflex activity is exalted by it. A dose of 10 grains has produced profound 
unconsciousness. The maximum dose is 5 grains, in capsule, and this may have to be repeated 
in not less than an hour. 

Methylal is a local anesthetic and an efficient hypnotic, producing a deep sleep of brief 
duration, with some general anesthesia and lowered reflex excitability. Large doses are de- 
pressant to the heart, respiration, and body temperature. 

CHLOROFORMUM, Chloroform, Trichloro-methane, CHC1 3 . Absolute 
Chloroform is formed by the substitution of 3 atoms of chlorine for 3 of hydrogen 
in marsh-gas, methyl hydride, CH 4 , and is obtained by the action of chlorinated 
lime on ethylic or methylic alcohol, or by that of an alkaline hydroxide on chloral. 
If prepared from methylic alcohol (wood-spirit) it is called Methylic Chloro- 
form, and is purified with great difficulty. The object of its purification is the 
removal of the chlorinated pyrogenous oil. The official form is — 

Chloroformum, Chloroform, — a liquid consisting of 99 to 99.4 per cent, 
by weight of absolute Chloroform, and 0.6 to 1 per cent, of alcohol. A heavy, 
clear, colorless, mobile and diffusible liquid, of characteristic ethereal odor, a 
burning, sweet taste, neutral reaction; volatile, not inflammable; soluble in 
210 volumes of water, freely so in alcohol and in ether, also in oils, benzol and 
benzin. Sp. gr. 1.474 to 1.478 at 25 C. Dose, internally, m>ij-x [aw njjv], 
for inhalation drop by drop until the desired effect is produced. 

Chloroformum Venale, Commercial Chloroform, (Unofficial),- — is a liquid containing at 
least 98 per cent, of Chloroform, and having a sp. gr. not lower than 1.470. It contains sundry 
Hydrocarbons, free Chlorine, Aldehyde and Hydrochloric Acid, and is used only for external 
applications, or to make the purified article. 

Preparations. 

Aqua Chloroformi, Chloroform Water, — a saturated solution, prepared by agitating an 
excess of chloroform in distilled water and pouring off the needed quantity of the solution. 
Dose, 3j-oj [av. 3iv.] 

Spiritus Chloroformi, Spirit of Chloroform, — has of Chloroform 6, Alcohol 94. Dose, 
n£x-3j, [av. ttjxxx], well diluted. 






CHLOROFORMUM. 21 5 

Linimentum Chlorofonni, Chloroform Liniment, — has of Chloroform 30, Soap Lini- 
ment 70. 

Linimentum Chlorofonni Compositum, Compound Chloroform Liniment, (Unofficial), — 
has of Chloroform § j, Oil of Turpentine § j, Tincture of Opium §ss, Tincture of Aconite 5ij, 
Soap Liniment oij. 

Tinctura Chlorofonni et Morphinae Composita, Compound Tincture of Chloroform and 
Morphine (B.P.), — contains in each 10-minim dose Chloroform ttjj§, Diluted Hydrocyanic 
Acid, ttj$, Morphine Hydrochloride, gr. - x \. A substitute for Chlorodyne (see below). Dose, 
njjv-xv. 

Chlorodyne, (Unofficial), — is a celebrated secret mixture, put forth by Dr. J. Collis 
Browne, of London, and since imitated by many others. It contains Morphine, Chloroform, 
Ether, Cannabis Indica, Hydrocyanic Acid, Capsicum, etc., and is powerfully anodyne, anti- 
spasmodic and narcotic, and therefore highly dangerous in non-professional hands. Of the 
original preparation each 10-minim dose contains gr. f of Morphine Hydrochloride, and the 
quantity of that alkaloid or its salts in the various imitations varies from gr. T ^ 2 to gr. £ in 
the same dose. In the Therapeutic Gazette for October, 1883, twenty-five different formulas 
or Chlorodyne were published. 

Anesthetic Mixtures containing Chloroform, — are described under the title ^Ether, on 
page 83. 



Incompatible with Chloroform are: Caustic Alkalies, Aqueous fluids. Physiologically 
incompatible are: Amyl Nitrite, Atropine, Morphine, Oxygen, Strychnine. 

Official Chlorinated Compound.. 

iEthylis Chloridum, Ethyl Chloride, Monochlor-ethane (Kelene), C 2 H 5 CL— is a haloid 
derivative prepared by the action of hydrochloric acid gas upon absolute ethyl alcohol. It is 
a rapid, efficient and safe anesthetic for short operations, if used with exclusion of atmospheric 
air. 

Unofficial Chlorinated Compounds. 

Chloretone, Acetone Chloroform, — is a Trichlor-tertiary Butyl-alcohol, obtained by the 
action of Caustic Potash on equal weights of Acetone and Chloroform. It occurs as a white, 
crystalline powder, of camphoraceous odor, sparingly soluble in water, very soluble in alcohol, 
in ether, and in chloroform. Dose, gr. v-xxx. 

Ethylene Bichloride, Dutch Liquid, Chloric Ether, C 2 H 4 C1 2 , — is a rapid and powerful 
anesthetic, probably safer than Chloroform and less so than Ether. It always paralyzes the 
respiratory centre before the heart, so that its effects may be easily watched and controlled. 
This is the substance which Guthrie supposed he had obtained when he discovered Chloro- 
form. 

Ethylidene Chloride, Chlorinated Muriatic Ether, CH 3 ,CHC1 2 , — is a mixture of varying 
sp. gr., and is not inflammable. It closely resembles Chloroform both physically and physio- 
logically, but is less depressant to the heart, and recovery from its effects is very prompt. 

Methyl Chloride, CH 3 C1, — a colorless gas, slightly soluble in water, of sweetish odor and 
taste, inflammable, burning with a greenish flame. Cold liquefies it, and the liquid boils at 
— 7. 6° F. It is used locally in neuralgia to produce intense cold, and with remarkable success. 

Methylene Bichloride, Dichloro-methane, CH 2 C1 2 , — is an effective anesthetic which it 
was supposed would displace Chloroform as being much safer. Dr. Richardson introduced 
it and Sir Spencer Wells advocated its use, but though little used as compared with other an- 
esthetics several deaths have occurred from its employment. It kills by paralyzing the heart. 

Carbon Tetrachloride, CC1 4 , — is less irritant than Chloroform, but far more dangerous 
to the heart. 

Somnoform, — is the trade name of a mixture of Ethyl Chloride 60, Methyl Chloride 35, 
and Ethyl Bromide 5. It is said to be more rapid in action than ethyl chloride. 

Schleich's Narcotic Mixture, — contains Ethyl Chloride 2, Chloroform 3, and Ether 12. 
Its inhalation is employed for the rapid relief of local pain, as in gastralgia, colic, and uterine 
spasm, without producing unconsciousness. 



21 6 CHLOROFORMUM. 



Physiological Action. 

The action of Chloroform is similar to that of Ether (see page 82), with 
several important differences. It is more irritant to the mucous membranes, 
and if swallowed undiluted it produces violent gastro-enteritis, which becomes 
apparent after the subsidence of the profound narcotism which at first follows 
its ingestion in quantity. A dose of §j internally may cause death, though 
recovery has taken place after the ingestion of one, two and even three ounces 
(Wood). It clots the blood outside the body, converting it into a mass resem- 
bling sealing-wax. 

The inhalation of Chloroform produces sensations which are rather agree- 
able than otherwise, and many persons acquire a liking for it. After a few 
whiffs the patient experiences noises in the ears and flashes of light before the 
eyes, also a feeling of weight upon the chest; the heart is felt to be beating 
wildly and a throbbing sensation is experienced in the carotid arteries. In this 
first stage hysterical symptoms may become manifest, the patient laughing, 
crying, screaming or swearing. The pulse is at first quite rapid from nervous- 
ness, but soon falls in frequency and gains in force. In a short time all sensa- 
tion of discomfort passes away, the patient becomes quiet, breathes easily, 
and is evidently comfortable. The consciousness is soon affected, questions 
being heard but not fully understood, and answered hesitatingly and slowly 
and in an irrelevant manner. After a brief period of repose there may be an- 
other spell of excitement, during which the patient may struggle and endeavor 
to get up; but this soon passes away, the muscles, which were contracted, be- 
come flaccid, and the patient gradually assumes a condition of complete insen- 
sibility. In this state all reflex action is abolished and pain is not experienced; 
the pupils are contracted, and the limbs, when raised and let go, fall heavily. 
Dangerous symptoms are: — respiration becoming stertorous or shallow, sudden 
dilatation of the pupils, signs of cardiac failure. 

As compared with Ether the inhalation of Chloroform is less stimulating, 
more irritant to the kidneys, more depressant to the vital functions, and much 
more dangerous on account of its direct paralyzant action on the heart. Its 
vapor is less irritant to the air-passages, non-inflammable, more agreeable, 
more prompt in action, produces much less subsequent vomiting, a shorter 
stage of excitement and a more profound degree of narcosis; and should be 
diluted freely with air to produce anesthesia with safety, according to the 
general teaching on this subject. Its mortality is much greater, being about 
1 in 3,500, against one in 15,000 for Ether, and fatal cases continue to be 
reported, though none of these have occurred in obstetrical practice. 

Chloroform may produce delayed toxemia, with fatty changes in the liver 
and decreased elimination of by-products by that organ and by the kidneys, 
with symptoms of acidosis. 



CHLOROFORMTJM. 21 7 

The Hyderabad Chloroform Commission's investigations, conducted under the direction 
of Dr. T. Lauder Brunton, led to the conclusion that Chloroform and Ether act in the same 
manner upon the heart and respiration, both paralyzing the respiratory centre before the 
heart, and Chloroform acting more quickly and powerfully than Ether in both directions. 
Prior to this investigation it was taught that death from Chloroform is almost always sudden 
and occurs by cardiac paralysis, while from Ether it is slow and usually by paralysis of respira- 
tion. The subsequent researches of Gaskell, McWilliam and others tend to sustain the 
latter view, and show that the verdict of the commission cannot be accepted as conclusive. 
There is very little doubt but that Chloroform may paralyze the heart without first affecting 
the respiration; and it is probable that the paralysis of the vaso-motor centre, and the conse- 
quent withdrawal of blood from the heart and brain to the dilated splanchnic area, may be an 
important factor of a fatal result. Another view is that the early action of the anesthetic is to 
stimulate the cardio-inhibitory centre, causing the sudden death which has frequently occurred 
in the early stage of Chloroform anesthesia. Chloroform undoubtedly exerts a powerfully 
depressant action on the heart. Injected into the jugular vein it instantly arrests the cardiac 
action and destroys its muscular irritability. Its vapor, applied to the exposed heart, para- 
lyzes it, and even when artificial respiration is maintained the effect is very apparent. There 
can be no doubt but that Chloroform destroys the contractile power of the cardiac muscle 
(Murrell). 

Modes of Dying in Anesthesia are detailed under ^Ether, on page 84. 

Therapeutics. 

Besides its use as an anesthetic Chloroform has a large field of therapeutic 
action. It is frequently employed in liniments as a rubefacient and anodyne 
application, also to promote the passage of other agents through the epider- 
mis, and to relieve itching. The vapor may be directed onto the raw surface 
of an ulcer or a superficial burn in order to relieve pain; and that arising from 
a few drops placed in the hand and held close to the eye will relieve photophobia. 
Internally it is administered with great benefit in vomiting, colic, dysmenor- 
rhea, and cholera morbus; also in true cholera, in which disease it has prob- 
ably been more efficient than any other single remedy, and in gastric ulcer, 
gastralgia and other painful affections of spasmodic character. In three to 
ten drop doses well diluted it markedly improves all the functions of the stom- 
ach, and is a valuable remedy for many gastric disturbances, especially acute 
dyspepsia. In sciatica, tic-douloureux and other neuralgiae of important nerves 
the deep injection of rrix-xv of pure Chloroform in the vicinity of the nerve is 
highly recommended, though it may cause dangerous local disturbance. In 
several cases of severe supra-orbital neuralgia, the writer has injected two or 
three minims of Chloroform into the vicinity of the supra-orbital nerve just 
above its foramen of exit, with the most gratifying permanent results, though 
severe local pain and considerable swelling were experienced for several days. 

The vapor of Chloroform inhaled in small quantities from warm water or 
from a handkerchief is a very useful remedy in many neuroses, as hay-fever, 
spasmodic asthma and reflex cough. It is one of the best palliatives in the 
cough of phthisis, as was long ago pointed out by Spencer Wells. It may be 
used with much benefit as a pulmonary antiseptic in many affections of the 
air-passages, as acute nasal catarrh, influenza and bronchitis; and has promptly 
checked a severe case of catarrh extending into the antrum and causing great 
pain. Carried to the production of muscular relaxation it is often used as an 



2lS CHLOROFORMUM. 

aid to diagnosis, especially in cases of malingering, in suspected disease of the 
abdominal viscera, and to aid in reducing dislocations and herniae. It is used 
with great benefit in parturition, decreasing the sensibility to pain, relaxing 
the passages, and easing the labor, while it does not interfere with the uterine 
contractions, nor predispose to inflammation, hemorrhage or convulsions. In 
such cases the quantity needed is very small, a few whiffs from time to time 
being quite sufficient. In some cases, as in acute mania, a patient may require 
to be kept under the influence of chloroform for a long time, for hours, days, 
or even weeks; and this has been done in the digital treatment of subclavian 
and other aneurisms. The writer, on one occasion, kept an insane woman 
continuously under its influence for a period of three weeks, except during 
the time necessary for taking food. 

For the production of complete anesthesia the use of Chloroform is steadily 
decreasing in favor of Ether, except for young children and in obstetrical prac- 
tice. Its vapor being four times denser than air, and the rule for its effective 
use requiring fully 96^ per cent, of air with it, its administration according 
to the orthodox fashion requires most careful management, and should never 
be attempted in any but the recumbent posture. An ounce of brandy and a 
hypodermic injection of morphine, gr. J, with atropine, gr. y^, given 20 minutes 
before commencing the inhalation, are means of great utility in sustaining the 
heart and respiration and in rendering the anesthesia more profound ; but this 
hypodermic injection should not be employed as a routine practice for all cases. 
It is contraindicated in weak subjects, in those who are particularly susceptible 
to the action of morphine, for operations likely to be attended with excessive 
hemorrhage, and in cases presenting any degree of respiratory insufficiency. 

The mortality under chloroform anesthesia, formerly stated at 1 in 5,000, 
is now placed at about 1 in 3,500; yet Luckett in ten years administered it in 
4,263 cases with only one death, and Syme used it in 5,000 cases without a single 
death. The latter ascribed his excellent record to his adherence to the follow- 
ing rule: "Never mind the pulse, never mind the heart, leave the pupil to it- 
self, but keep your eyes on the breathing, and if it becomes embarrassed to a 
grave extent, pull the tongue well out with an artery forceps." The Edinburgh 
rule is practically this: "Watch the respiration, the heart will take care of it- 
self"; but Professor Stewart suggests that a second one should be inculcated, 
namely — "Watch both the breathing and the pulse; and if the heart threatens 
to fail for want of blood, fill it by raising the legs and compressing the abdo- 
men." No operation, especially on parts supplied by the fifth nerve, should 
be undertaken during partial chloroform anesthesia, for the reasons given on 
page 84. For the Schleich method with a mixed anesthetic see under ^Ether, 
page 86. 

The purest Chloroform in prolonged contact with damp air has a tendency 
to decompose, forming the dangerous gas Phosgene, COCl 2 ; hence chloroform 
in partially filled bottles, or in bottles rilled in the drug-store by drawing from 



CHLORUM. 219 

larger vessels, should not be used for anesthesia. Te'moin states that chloroform 
may be preserved indefinitely without decomposition by the addition to it of 
Sulphur in the proportion of about 4 grammes (3j) to each kilogramme (Ibij). 
At a certain stage of chloroform anesthesia women often exhibit marked 
signs of sexual excitement, and on recovery it is not uncommon for them to 
bring charges of improper conduct against some one present, with no false 
intention but in the belief that impropriety actually occurred. It is never safe 
to administer an anesthetic to a woman without the presence of a third party 
(Murrell). 

Dr. Sayre the celebrated New York surgeon, used only ten or twenty drops of chloroform 
at a time, but he excluded all air not impregnated with the anesthetic on the principle that 
oxygen is the antidote to its action. He stated that with this small quantity he produced 
immediate and profound anesthesia in several thousand cases, without the least sign of dan- 
ger, and without the struggling usually seen when the anesthetic is given in the ordinary 
manner. 

Ethyl Chloride is increasing in popularity as a general anesthetic for minor 
operations, dental surgery, reduction of fractures and luxations, curettement, 
parturition, and examinations of sensitive subjects, especially children; also 
as a preliminary inhalation to prevent the early excitant effects of ether or chloro- 
form. It acts rapidly, anesthesia being usually complete within a minute or 
two, and its risks are considered slight, even in patients with unsound heart 
or lungs. It does not relax the muscles, and in operations requiring complete 
relaxation its use should be followed by that of ether or chloroform. Its mor- 
tality is stated at 1 in 8,800 cases. It may give rise to erotic sensations re- 
sulting in false accusations, and should not be used for women except in the 
presence of a witness. 

Chloretone is hypnotic, antispasmodic, anesthetic, and antiseptic, also narcotic in over- 
dose. In moderate doses it promptly relieves gastric irritability, and prevents the nausea 
and vomiting due to ether or chloroform inhalation. As a hypnotic it is valuable in insanity 
and in cases of insomnia unattended with pain, high fever, or much nervous excitement. In 
tetanus it is considered to be very efficient. In epilepsy it has been used with benefit, and it is 
frequently employed with Cocaine for the production of spinal anesthesia by sub-arachnoid 
injection, also in a 1 per cent, solution as a local anesthetic application in ulcers and wounds. 
While large doses, ( 3 j-5vj) have been taken without ill effects, it is considered by many author- 
ities to be a dangerous narcotic in doses over 30 grains. 

CHLORUM, Chlorine, CI, — is a greenish-yellow gas having a suffocat- 
ing odor, belonging to the Halogen group of elements; and though not official 
itself is represented in medicine by several of its compounds, also by several 
preparations which furnish it. 

Chlorine Compounds, described under the titles of their respective metal- 
lic bases, are: the Chlorate of Potassium; the Chlorides of Ammonium, Cal- 
cium, Sodium, Mercury, Gold, Iron, Zinc, etc.; also Hydrochloric Acid, 
classed with the mineral acids, and Chloroform, Ethyl Chloride, Chloral and 
Butyl-chloral. 



220 CHL0RUM. 

Preparations. 

Calx Chlorinata, Chlorinated Lime, Chlorinated Calcium Oxide, (often improperly called 
Chloride of Lime), — is a compound resulting from the action of chlorine upon calcium hydrox- 
ide, containing not less than 30 per cent, of available Chlorine. It occurs as a white or grayish- 
white, granular powder, of repulsive taste, partially soluble in water or alcohol, but when dis- 
solved in diluted Acetic Acid gives off an abundance of chlorine gas. Dose, gr. iij-vj [av. 
gr. iv] in water; for external use a 1 to 3 per cent, solution. The Liquor Calcis Chlorinate 
of the B. P. is a solution of 1 to 10 of distilled water. 

Liquor Sodas Chlorinatae, Solution of Chlorinated Soda (Labarraque's Solution), — is an 
aqueous solution of chlorine compounds of sodium, containing at least 2.5 per cent, by 
weight, of available Chlorine; prepared by adding together Monohydrated Sodium Car- 
bonate 70, and Chlorinated Lime 100, then adding water to 1000. Dose, tijx-xxx [av. 
ttrxv] in 20 parts of water. (The composition and preparation of Dakin's solution, together 
with its application according to the technic of Carrel, is described in Part III of this 
book under Wounds.) 

Liquor Chlori Compositus, Compound Solution of Chlorine, Chlorine Water (Unofficial), — 
is an aqueous solution containing about 0.4 per cent, of Chlorine, with some oxides of 
chlorine and potassium chloride. It is prepared by adding Potassium Chlorate 5, Hydro- 
chloric Acid 18, and Distilled Water 20, heating the mixture on a water-bath for two or 
three minutes, adding Distilled Water to 1000 and agitating. It should be freshly made 
when wanted. Dose, TT£xx-5ij [av. 5 j] in water; as a lotion or spray 5 j - 5iv, well diluted. 

Chlorine Water may be extemporaneously prepared by mixing in a mortar Chlorate of 
Potassium 40 grains and Hydrochloric Acid 5ijss, adding a pint of distilled water by agita- 
tion during the evolution of the vapors. If done in a closed vessel danger may arise from 
the explosive gas, C1 2 4 , which is liberated at the same time. It should be quickly bottled. 

Incompatibles. 

Incompatible with Chlorine-water are: Alkalies, Ammonium salts, Arsenous salts, Bro- 
mides, Ferrous salts, Hypophosphites, Iodides, Lead salts, Lime-water, Mercurous salts, 
Oxalic Acid, Silver salts; with Chlorinated Lime are Fats, Glycerin, Iodides, Oils; with Chlo- 
rides are Hydrogen Peroxide, Lead, Mercurous, and Silver salts, Nitric Acid, Sulphuric Acid. 

Incompatible with Chlorates are Ammonium Picrate, Arsenites or Bromides in acid solu- 
tion, Charcoal, Cyanides, Ferrous salts in acid solution, Gallic Acid, Glycerin, Honey, Hydro- 
chloric Acid, Hypophosphites, Hypopsulphites, Iodides in acid solution, Iodine, Iron (reduced), 
Lycopodium, Mercurous salts in acid solution, Oxalic Acid, Phenol, Phosphorus (amorphous) 
Salicylic Acid, Shellac, Starch, Sugar, Sulphides, Sulphites, Sulphuric Acid. 

Physiological Action. 

In the presence of moisture Chlorine is one of the most powerful of dis- 
infectants and deodorants, also an antiseptic and antifermentive agent of the 
highest activity; its power in these respects being due to its affinity for hydro- 
gen, decomposing all bodies which contain hydrogen as a molecular constituent, 
forming hydrochloric acid and setting oxygen free in its nascent form (ozone). 
Administered internally, it is converted, on reaching the stomach, into hydro- 
chloric acid and chlorides, losing all action on the organism in its own char- 
acter. Locally applied, it is irritant to the skin and mucous membranes, pro- 
ducing a sense of heat, with a burning sensation and even vesication. Inhaled 
in any quantity, it causes cough, sneezing and spasm of the glottis, also inflam- 
mation of the mucous lining of the air-passages and the lungs. 

Therapeutics. 

The Chlorinated preparations are used as disinfectants and deodorizers of 
rooms, drains, and discharges from the body. They are rarely used about 
the person or clothing of patients by reason of the irritation produced by them 



CHROMII TRIOXIDUM. 221 

when inhaled, and their power to destroy the color of fabrics. In dilute solu- 
tion they are well employed as local applications in aphthae, gangrene, scarlet 
fever and diphtheria, in which their principal action is to destroy fetor. The 
same may be said of their use in sloughing ulcers, gangrenous wounds and foul 
discharges, as they are rarely employed about the person in sufficient strength 
to have any destructive effect on disease germs. A strong solution of Chlori- 
nated Soda is a good application to bites of serpents and insects, to wash the 
hands after contact with infectious material, and so prevent infection by the 
syphilitic poison. 

The well-known solution of Potassium Chlorate and tincture of Ferric 
Chloride in glycerin and water (see formula under the title Diphtheria in Part 
III), which was devised by Dr. Jacobi many years ago, has in diphtheria a high 
reputation which rests on a sound scientific basis. If properly prepared, by 
dissolving the potassium chlorate in water before adding the other ingredients, 
it contains some undecomposed Chloric Acid, HC10 3 . This at a higher tem- 
perature and in contact with organic matter is split up into perchloric acid and 
chlorine peroxide, which are fatal to bacteria, and especially to the bacillus 
diphtherias. It is said that the glycerin in this mixture has occasionally caused 
a violent explosion, but the preparation has been used for many years with great 
satisfaction. 

Chlorine gas is a powerful local stimulant, and has been used with benefit 
to promote healing in old ulcers. Absorbent cotton may be exposed to the 
gas extemporaneously prepared as directed on page 220, and bandaged on the 
surface of the ulcer. 

Chlorinated Lime, freshly prepared, in solutions of varying strength, from 
1 in 60 to 1 in 12, is used by hypodermic injection in Australia as an antidote 
to serpent venom. The solution is injected into several points above the wound, 
20 to 100 minims being inserted at each place. In some cases this procedure 
causes great pain, but it does not seem to induce any local inflammation, and 
it is highly efficient for the purpose for which it is used. A common method 
of disinfecting a sick-room is to place a pound of Chlorinated Lime into a can- 
vas bag and immerse it in a mixture of common hydrochloric acid, 1^ pint, and 
water, 4J pints, allowing it to remain for 24 hours. A still better method is to 
mix common salt, manganese dioxide and sulphuric acid in a saucer. The 
chlorine generated is heavier than atmospheric air, so that the vessel should 
be placed on a high shelf and not on the floor, in order that it may be diffused 
throughout the room. 

CHROMII TRIOXIDUM, Chromium Trioxide {Chromic Acid) , Cr0 3 — is 
obtained by the action of sulphuric acid on potassium dichromate. It occurs 
in small, crimson, needle-shaped crystals, deliquescent in moist air, very solu- 
ble in water. True Chromic Acid, H 2 Cr0 4 , does not occur in the free state. 
Chromic Trioxide should be kept in glass-stoppered bottles, and great caution 



222 CHRYSAROBINUM. 

should be observed to avoid bringing it in contact with organic substances, 
such as cork, tannic acid, sugar, alcohol, glycerin, etc., as dangerous accidents 
are liable to result. It is not used internally. 

Potassii Dichromas, Potassium Dichr ornate, K^C^Oz, (Unofficial), — large, orange-red 
prisms of disagreeable, metallic taste and acid reaction, soluble in 10 of water at 59 F., 
and in ih of boiling water, insoluble in alcohol. It is used locally in aqueous solution 
(gr. v-5j to the §), and internally in doses of gr. y^-gr. ss [av. gr. i] in trituration. 

Chromii Sulphas, Chromic Sulphate, Cr 2 (S0 4 ) 3 + H 2 0, (Unofficial), — is obtained by dis- 
solving chromium hydroxide in sulphuric acid. Dose, gr. iij-v in powder or tablet. 

Incompatible with Chromic Trioxide are: Alcohol, Bromides, Chlorides, Ether, Glycerin, 
Hypophosphites, Iodides, Oxalates, Sulphides, Tartrates; with Chromates are the salts of 
Barium, Bismuth, Lead, Manganese, Mercury, Silver, and Strontium; with Bichromates 
are many alkaloids, also Tannic Acid, Sugar, and other oxidizable substances. 

Physiological Action and Therapeutics. 

Chromic Trioxide is a powerful escharotic and penetrates deeply, but it 
is slow of action and is not very painful. It coagulates albumin and parts read- 
ily with its oxygen, oxidizing organic matter and decomposing ammonia and 
sulphuretted hydrogen; and is therefore an energetic disinfectant and deo- 
dorizer. When used as a caustic it is mixed with sufficient water to make a 
paste, which may be employed for the destruction of warts, hemorrhoids 
and superficial growths; the neighboring parts being protected by cotton 
soaked in a strong alkaline solution. For syphilitic warts and condylomata, 
lupus, tinea tonsurans, etc., a solution of 100 grains to the § of distilled water 
is generally used. A solution of 1 in 40 is an excellent and inexpensive anti- 
septic lotion for putrid sores and wounds, syphilitic affections of the tongue, 
mouth and throat, ozena, leucorrhea and gonorrhea. 

Potassium Dichromate is a good antiseptic and escharotic of milder action 
than the trioxide. It ought never to be used internally. In doses of 5 ij— iv 
it has proved fatal to life in adults, with symptoms of gastro-enteritis, sup- 
pression of urine, and cardiac paralysis. It is sometimes employed as a 
local application in saturated solution to warts and venereal condylomata; 
and in dilute solution (gr. j-x to the 5 ) for catarrhal conditions of the nasal, 
buccal or vaginal mucous membrane. 

CHRYSAROBINUM, Chrysarobin, C30H26O7, — is a mixture of neutral principles ex- 
tracted from Goa Powder, a substance found deposited in the wood of Vouacapoua Araroba, 
a Brazilian tree of the nat. ord. Leguminosae. It is commonly misnamed Chrysophanic 
Acid (one of the constituents of Rheum) — though easily converted into that substance. 
Occurs as an orange-yellow powder, odorless and tasteless, nearly insoluble in water and 
in alcohol, but readily soluble in ether, solutions of alkalies, and sulphuric acid. Dose, 
gr. f-j [av. gr. ss.] 

Unguentum Chrysarobini, Chrysarobin Ointment, — Chrysarobin 6, Benzoinated Lard 
94 parts. Should be diluted for average use from 1 to 3 times. 

In 20-grain doses Chrysarobin is a gastro-intestinal irritant, producing large, watery, 
bilious stools, with repeated vomiting, but not much nausea. Locally it produces diffuse 
dermatitis, often followed by follicular and furuncular inflammation. It stains the skin a 
dark yellowish-brown color, which may be removed by a weak solution of chlorinated lime. % 
The use of this remedy is confined to superficial parasitic skin diseases of vegetable origin, 
and for psoriasis, in the latter affection being the best remedy known. 



CIMICIFUGA CINCHONA. 223 

CIMICIFUGA, Cimicifuga, (Black Cohosh) — is the dried rhizome and 
roots of Cimicifuga racemosa, a plant of the nat. ord. Ranunculaceae, native in 
the United States. It contains a Volatile Oil when fresh, resin, tannic and 
gallic acids, also an acrid, crystallizable, neutral principle. Cimicifugin or 
Macrotin is an impure resin obtained by precipitation from a concentrated 
tincture by the addition of water. The active principle has not been isolated. 
Dose, gr. x-xx [av. gr. xv.] 

Preparations. 

Extractum Cimicifugae, Extract of Cimicifuga. — Dose, gr. j-vj [av. gr. iv.] 

Fluidextractum Cimicifugae, Fluidextract of Cimicifuga. — Dose, ttjtv-xx [av. njjxv.] 

Maciotinum, Macrotin, (Unofficial). — Dose, gr. ss-ij. 

Physiological Action and Therapeutics. 

Cimicifuga is stomachic, antispasmodic, diaphoretic, diuretic and expec- 
torant. Its taste is bitter and nauseous, resembling that of Opium. Small 
doses stimulate digestion and secretion, the generative function and the 
menstrual flow, and the secretions of the bronchial mucous membrane and the 
kidneys. Full doses stimulate uterine contraction. Large doses dilate the 
pupils and produce dimness of vision, vertigo, intense headache, nausea, 
vomiting, and in some persons soporific and anodyne effects. 

Cimicifuga is sometimes used in cardiac diseases, especially in weak or 
fatty heart where Digitalis would be dangerous. It is a good stomachic 
tonic, particularly in the irritable dyspepsia of alcoholism. As an expecto- 
rant it is used in acute and chronic bronchitis. In rheumatoid arthritis and 
rheumatism of the localized muscular variety, as lumbago, torticollis, and 
intercostal rheumatism, it is one of the most efficacious remedies. Neuralgias 
of various kinds are benefited by it, particularly ovarian neuralgia. Chorea 
about the age of puberty is one of the affections in which it is most useful, and 
the same may be said of the hysterical form of this disease. 

Many uterine disorders are benefited by Cimicifuga, such as amenorrhea, 
neuralgic and congestive dysmenorrhea, passive menorrhagia, subinvolution, 
spinal irritation due to some obscure sympathetic or neuralgic affection of the 
womb, sympathetic pains and neuralgias arising from the so-called irritable 
womb. In obstetrics it is occasionally used to initiate uterine contractions, 
to check hemorrhage, and to allay af terpains and nervousness after delivery, 
but is inferior to other and more reliable drugs. 

CINCHONA, Peruvian Bark. — The Cinchona tree belongs to the nat. 
ord. Rubiaceae and is a native of the eastern slope of the Andes, but has been 
largely planted in India, Ceylon, Java and Burmah, with the result of improv- 
ing the quinine-yielding value of many species by cultivation. In late years 
the test of appearance has given way to that of assay in judging of the various 
barks of commerce, and only those are official which yield 5 per cent, of total 
alkaloids. The official species are: — 



2 24 CINCHONA. 

Cinchona, Cinchona, Yellow Cinchona, — the dried bark of Cinchona Led- 
gcriana, Cinchona Calisaya, and of hybrids of these and of other species of 
Cinchona, yielding, when assayed by a prescribed process, not less than 5 per 
cent, of total alkaloids. From it are prepared the Fluidextract and Tincture 
of Cinchona. 

Cinchona Rubra, Red Cinchona, — is the bark of Cinchona Succirubra or 
of its hybrids, containing not less than 5 per cent, of red cinchona alkaloids. 
From it is prepared the Compound Tincture of Cinchona. 

Bark may be administered in doses of gr. x-xxx [av. gr. xv], but it is never 
used now in substance, being bulky and very disagreeable to the taste. 

The principal varieties of the sub-order Cinchoneae, the barks of which are found in 
commerce and are used by manufacturers of the alkaloids, are — Cinchona Calisaya, Cinchona 
Flava, Yellow Bark, from Peru, Bolivia and India; C. Succirubra, Red Bark, from Ecuador, 
Java and Ceylon; C. Condaminea, Pale Bark, from Ecuador and Peru; C. Pitayensis, Pitaya 
Bark, from New Granada; C. Micrantha, Gray Bark, from Peru and Bolivia. Altogether 
there are some 31 species acknowledged by botanists, and the list is constantly increasing, 
from the tendency of the different trees to hybridize. Several trees formerly acknowledged 
as Cinchonas are now placed in the genus Cascarilla, but their barks are to be found on the 
market. Cuprea bark is from trees of the genus Remijia, growing in Columbia; it contains 
Quinine and a peculiar alkaloid, Cinchonamine, but no Cinchonidine. 

Composition of Cinchona. 

Cinchona bark contains more than 20 alkaloids, 3 of which are official, 
2 simple acids, 2 tannic acids, a resinoid and a coloring matter, as follows : — 

Quinine, C 20 H 24 N 2 O 2 , — a strong base, fluorescent, the most valuable of all the alkaloids; 
heated with glycerine to 374 F., it is converted into the isomeric base, Quinicine. 

Quinidine, C 20 H 24 N 2 O 2 , — isomeric with Quinine, fluorescent, probably the most power- 
ful as an antiperiodic, but existing in very small quantity. 

Cinchonine, C 19 H 22 N 2 0, — the least active of the official three, having about half the 
therapeutic power of quinine. Not fluorescent. 

Cinchonidine, C 19 H 22 N 2 0, — isomeric with Cinchonine, not fluorescent, one of the most 
powerful of the alkaloids. 

The other alkaloids are of no interest medicinally. 

Kinic and Kino vie Acids, — are combined in the bark with the alkaloids. The former 
is used to make a Kinate of Quinine, and the latter occurs in non-official pharmacy as Kino- 
vate of Lime, an ingredient in Deloudre's Extract, which is used in Europe and India for 
dysentery. 

Kino-tannic and Kinovo-tannic Acids, — give to bark its peculiar and powerful astrin- 
gent qualities. They have not been fully studied. 

Kinovin, — is a bitter, amorphous resinoid, which is resolvable into Rinovic Acid and 
sugar. It is soluble in alcohol, but not in water. 

Cinchona Red, — a reddish-brown, insipid, inodorous substance. 

Preparations of the Bark. 

Fluidextractum Cinchonae, Fluidextract of Cinchona. — Dose, ttj? x-xxx [a v. ttjjxv.] 

Tinctura Cinchonae, Tincture of Cinchona, — has of Cinchona 20, in Alcohol 67^, Water 
25 and Glycerin 7^. Dose, 5ss-ij, [a v. 5j.] 

Tinctura Cinchonas Composita, Compound Tincture of Cinchona, — has of Red Cinchona 
to, Bitter Orange Peel 8, Serpentaria 2, in Alcohol, Water, and Glycerin; and is intended to 
replace Huxham's Tincture of Bark (see below). Dose, 3 ss— ij [av. 5j-] 



CINCHONA. 225 

Huxham's Tincture of Bark, 1788 (Unofficial), is still used occasionally. Red Cinchona 
§iv, Orange-peel giij, Serpentaria gr. lxxx, Spanish Saffron gr. clx, Cochineal gr. lxxx, 
Brandy §xl, digested for 4 days, expressed and filtered. Dose, 5 ss— i j . 

Quinine and its Salts. 

Quinina, Quinine, C 20 H 24 N 2 O 2 + 3H 2 O, — a white, amorphous or minutely crystalline 
powder, of alkaline reaction and very bitter taste, soluble in 1560 of water and in 0.8 of 
alcohol at 25 C. and readily in dilute acids. Dose, gr. j-xx [av. gr. iv], or gr. xl in special 
cases. Is insoluble in saliva. 

Quininas Sulphas, Quinine Sulphate, (C 20 H 24 N 2 O 2 ) 2 .H 2 SO 4 + 7H 2 O, — very light, snow- 
white, flexible crystals, of bitter, persistent taste, soluble in 725 of water and in 107 of 
alcohol at 25 C, more soluble in acidulated water. Dose, gr. j-xx, or even gr. xl in special 
cases, av. gr. iv.] 

Quininae Bisulphas, Quinine Bisulphate, C 20 H 24 N 2 O 2 .H 2 SO 4 + 7H 2 O, — clear, colorless 
efflorescent crystals or small needles, of very bitter taste and strongly acid reaction, soluble in 
9 of water with blue efflorescence, and in 23 of alcohol, at 25 C. Dose, gr. j-xx, or even 
gr. lx in special cases [av. gr. iv.] 

Quininae Dihydrochloridum, Quinine Dihydrochloride, C2oH2 40 2 N 2 (HCl)2, — white, 
odorless powder with a bitter taste, soluble in 0.6 of water and 12 of alcohol at 25° C. 
Dose, gr. j-xx [av. gr. iv.] 

Quininae et Ureae Hydrochloridurn, Quinine and Urea Hydrochloride, C20H24O2N2.HCI.- 
C0(NH 2 )2HC1+5H 2 0, — colorless prisms or white granular powder, odorless, bitter in 
taste, soluble in 0.9 of water and 2.4 of alcohol at 25 C. Dose, gr. xv. 

Quininae Hydrobromidum, Quinine Hydrobromide, C2oH 2 4N 2 02HBr+H 2 0, — white 
needles, of very bitter taste, soluble in 40 of water and in 0.9 of alcohol at 25 C, very sol- 
uble in boiling water and in boiling alcohol. Dose, gr. j-xx [av. gr. iv.] 

Quininae Hydrochloridurn, Quinine Hydrochloride, C20H24N2O2HCI+2H2O, — white 
needles in tufts, of very bitter taste, soluble in 18 of water and in 0.8 of alcohol at 25 C, 
in 1 of boiling water or alcohol. Dose, gr. j-xx [av. gr. iv.] An excellent salt which should 
be more generally used. 

Quininae Salicylas, Quinine Salicylate, — is slightly soluble in water, in 14 of alcohol, in 
25 of chloroform, and in 160 of ether, at 25 C. It contains 70 per cent, of quinine. Dose, 
gr. j-xx [av. gr. iv.], in pill or capsule. 

Quininae Tannas, Quinine Tannate, — a yellowish white, amorphous powder, odorless 
and tasteless, or only slightly bitter and containing 30 to 35 per cent. Quinine. It is slightly 
soluble in water. Quinine tannate is less than half the strength of other salts of Quinine 
and must therefore be given in larger doses. 

Tinctura Pyrexialis, Tinctura Antiperiodica, Warburg's Tincture (Unofficial), — was 
formerly a celebrated and secret preparation. The formula, published in 1875 by the 
originator, includes 16 ingredients, one of which (ConfeCtio Damocratis) contained many 
drugs which are not now obtainable. The tincture contained Quinine Bisulphate, 2 per 
cent., with Aloes, Rhubarb, Camphor and several aromatic herbs. Dose, §j (about g\ 
grains of Quinine Bisulphate) in 2 doses given 3 hours apart. Hager's modification of the 
original formula is — Quinine Sulphate 1, Spt. Camphorae 2, Tinct. Aloes et Myrrhae 22, 
Alcohol 16. Dose, as above. Some of the preparations now sold under this name contain 
few, if any, of the original ingredients. The so-called Warburg's Pill is a most irrational 
form in which to administer this complex medicine, even if it contains the proper con- 
stituents. 

Unofficial Derivatives of Quinine. 

Aristochin, Diquinine Carbonic Ester, — occurs as a white, tasteless powder, insoluble 
in water, soluble in alcohol and in chloroform, and contains 96 per cent, of quinine. It 
is said to be free from the unpleasant effects of quinine, though as efficient in malarial fever. 
Dose, gr. viij-xv, thrice daily; gr. j-v for children, according to age. 

Euquinine, Quinine Carbonic Ether, — occurs in light, fleecy, white needles, soluble in 
alcohol, ether, and chloroform, very slightly soluble in water. Is tasteless in substance, 
though decidedly bitter in solution; and is claimed to have no unpleasant gastric effects, 
to cause cinchonism less frequently and less intensely than quinine sulphate, though equally 
efficient as an antimalarial, antispasmodic and antineuralgic. Dose, gr. v-xx. 

15 



2 26 CINCHONA. 

Saloquinine, — is a salicylic acid ester of quinine, and occurs as a tasteless, crystalline 
powder, insoluble in water. It is said to be free from the cerebral effects of ordinary quinine 
salts, and to have been used with satisfaction in malarial fevers, sciatica, rheumatism, dys- 
menorrhea, and nervous headaches. Dose, gr. v-xx or more. 

Salts of Other Cinchona Alkaloids. 

Cinchoninae Sulphas, Cinchonine Sulphate (C 19 H 22 N 2 0) 2 H 2 S0 4 + 2H 2 0, — white, shin- 
ing prisms, of very bitter taste, soluble in 60 of water and in 12.5 of alcohol at 25 C, and 
readily soluble in dilute acids. Dose, gr. v-x or more [av. gr. ijss.] 

Cinchonidinae Sulphas, Cinchonidine Sulphate (C 19 H 22 N 2 0) 2 H 2 S0 4 +3H 2 0, — white, 

silky crystals, of bitter taste, soluble in 65 of water and in 90 of alcohol at 25 C, freely 
soluble in acidulated water. Dose, gr. j-x or more [av. gr. ijss.] 

Cinchonidinae Salicylas, Cinchonidine Salicylate (Unofficial), — has antimalarial prop- 
erties which are but slightly inferior to those of the quinine salts. Dose, gr. v-xx or more. 

Unofficial Preparations. 

Chinoldinum, Chinoidin, Quinoidin, — a mixture of alkaloids, mostly amorphous, ob- 
tained as a by-product in the manufacture of the crystallizable alkaloids from Cinchona. A 
black solid when cold, plastic when warmed, of bitter taste, almost insoluble in water, freely 
soluble in alcohol and in dilute acids. It contains the 4 alkaloids in amorphous condition, 
and has about \ the therapeutic power of Quinine. Dose, gr. v-xxx or more. 

Quinquinina, Quinetum, — is an Indian preparation containing the total alkaloids ex- 
tracted from bark by acidulated water, then precipitated by soda and dried. In India it is 
called "febrifuge." 

Incompatibles. 

Incompatible with Cinchona are Acids (mineral), Alkalies, Carbonates, Alkaloidal pre- 
cipitants (see page 6), Ferric and Ferrous salts, Lead Acetate, Lime-water, Magnesia, Mercuric 
Chloride, Rhubarb infusion, Silver Nitrite, Tartar Emetic, Zinc Sulphate; with Quinine as 
for other alkaloids (see page 6). 

Physiological Action. 

Cinchona is an astringent bitter and a stomachic tonic. At first it pro- 
motes appetite, digestion, the flow of saliva and of gastric juice; long continued 
it sets up a gastric catarrh, impeding digestion and causing constipation. The 
action of Cinchona in sufficient dose is generally that of its alkaloid Quinine, 
except that the bark is decidedly astringent, more of a gastric irritant, and its 
active principles are more slowly absorbed by reason of its bulk. In large 
doses (3ij) the powdered bark has produced flatulence and eructation, and in 
many well-authenticated instances has apparently caused a well-marked febrile 
paroxysm, beginning with chill, then fever and headache, which gradually sub- 
sided with slight perspiration. So also, Quinine, while incapable of produc- 
ing intermittent fever in a healthy person, if taken in large doses unneces- 
sarily, may throw the nervous system into high commotion, and if untimely used 
by a malarial subject may reproduce the paroxysm with greater or less severity. 

Quinine is a bitter tonic, an antiseptic, antiperiodic and antipyretic, a di- 
minisher of reflex action, a local anesthetic, a protoplasmic poison and in large 
doses a cardiac depressant. It is rapidly diffused and slowly excreted, being 
found in the urine in 15 minutes after its administration and for two or three 
days afterwards. Its action on the stomach is similar to that of cinchona, 
small doses having tonic effects, while large doses are irritant. The heart and 



CINCHONA. 227 

arterial tension are somewhat stimulated by small doses, but depressed by 
large ones (gr. xl-lxxx), which slow and enfeeble the pulse by direct action on 
the cardiac muscle. The brain is rendered hyperemic and exhilaration is 
caused by small or moderate doses, but large ones produce a train of conges- 
tive cerebral symptoms, collectively termed cinchonism, and including a sense 
of fulness and constriction in the head, tinnitus aurium, vertigo, staggering 
gait, amblyopia and deafness, great headache, dilated pupils, delirium, coma, 
and in the lower animals convulsions. The eyes and ears, though suffering 
severely, are rarely injured permanently. In very large doses it abolishes the 
cerebral functions. 

Quinine reduces the size of the spleen when enlarged, and lowers the tem- 
perature of pyrexia by lessening oxidation, though it does not depress the body- 
temperature in health. Large doses lower the reflex function of the spinal 
cord. It depresses the retrograde metamorphosis of the tissues, and lessens 
the formation of the nitrogenous excretory products, the elimination of uric 
acid and urea being decidedly decreased during its administration. It arrests 
the movements of the white blood-corpuscles and decreases their number, 
though at first a temporary rise in the lymphocytes was noted by Roth. It is 
actively destructive to lowly organized life, a solution of 1 in 800 killing the 
larger infusoria immediately, 1 in 1,000 after some minutes, and 1 in 20,000 
after some hours. Upon the higher infusoria and mould penicillium much 
stronger solutions are required for its fatal action, while vibrios and bacteria 
resist solutions weaker than 1 in 100. The ameboid movements of human 
white blood cells are arrested by a solution of 1 in 4,000. 

Individual idiosyncrasies are frequently observed with regard to the action 
of Quinine. In some persons even small doses produce a severe erythema or 
urticaria, with subcutaneous edema, often followed by desquamation of the 
cuticle, and accompanied by pronounced disturbance of the nervous system and 
the circulation. In one case the symptoms simulated those of strychnine poi- 
soning. Occasionally it produces renal and vesical irritation, and in some per- 
sons it causes sexual excitement. It acts as a uterine stimulant in labor, and is 
used as an oxytocic, but its power to initiate uterine contractions is strenuously 
denied by many investigators. 

The fatal dose of Quinine is undetermined. In one case five ounces taken 
in the course of ten days caused death; in another 7.7 grains (gramme 0.5) 
given hypodermically caused profound toxic symptoms which terminated in 
death after seven days. On the other hand an ounce of the sulphate has been 
taken without causing more than a mild stupor, and in another case half an 
ounce produced neither vomiting nor other ill effects. Surgeon Roberts of the 
Indian army has recorded a case in which a woman aged 35 years took 6 drachms 
of the sulphate at one dose, and survived, after profound coma for several hours, 
also slow and shallow respiration, slow pulse, abolished reflexes, deafness and 
blindness. The hearing was restored within a week, but the blindness was 



228 CINCHONA. 

absolute for two weeks, when light began to be distinguished. Objects 
were not perceived until after three or four weeks, and then indistinctly 
for several months, the vision remaining greatly impaired for a long time. 

Cinchonine and the other alkaloids closely resemble quinine in their physi- 
ological and therapeutical properties, in doses about one-third larger. In 
large doses Cinchonine has some and Cinchonidine has a very strong tendency 
to produce epileptiform convulsions, while small quantities of the latter given 
to epileptics will increase the number of their attacks. Cinchonine produces 
greater headache than quinine, also much precordial pain and muscular weak- 
ness, but is asserted to have little effect on the sight or hearing. By some au- 
thorities it is said to be the least active of the four alkaloids; by others Cin- 
chonidine is considered to be the most poisonous, Quinine coming next in rank, 
then Cinchonine, and lastly Quinidine. 

Therapeutics. 

Cinchona is used as a tonic, and has many applications. The infusion or 
compound tincture with a mineral acid is serviceable in atonic dyspepsia, gas- 
tric catarrh of alcoholics, adynamia, and convalescence; also in asthma, chronic 
bronchitis, and generally in weak subjects of flabby flesh and freely perspiring 
skin. Quinine in small doses is much employed as a tonic, usually in con- 
junction with iron. Its tonic power is believed by some to be due entirely to 
the improvement of the appetite and not to any direct effect upon tissue met- 
abolism or increase in the red cells as formerly taught. It does, however, les- 
sen tissue waste; the nitrogenous content of the food remaining the same the 
urine contains first an increase then a decrease in the urea and uric acid which 
suggest that after the initial effect of quinine there is a storing-up of proteins. 

Quinine finds its principal field of action in the malarial diseases, over which 
its influence is specific, by reason of its power to prevent the development of 
the plasmodium to which malaria is due. In Panama, according to Stitt, the 
standard treatment consists of an initial purge with calomel and magnesium 
sulphate followed as soon as the diagnosis is made, by quinine in 15 grain doses 
three times daily for a week or until the temperature has been normal five or 
six days, then 10 grains, three times daily for ten or twelve days. That 
quinine can prevent an oncoming paroxysm is disputed by Osier although 
Ricketts states that if it is given in time before segmentation occurs the par- 
oxysm can be prevented. Hatcher and Wilbert state that there can be no 
doubt that a large dose given four hours before the expected paroxysm may 
prevent it but it has no influence on a paroxysm which is just beginning. As 
a prophylactic against malarial fevers the use of small doses of quinine, 3 to 5 
grains daily, has been universally approved until recently, especially in trop- 
ical countries. Professor Koch considers this to be dangerous practice and to 
be responsible for the increased death-rate in certain parts of West Africa 
during late years. He holds that the indiscriminate use of quinine as a pro- 



CINCHONA. 229 

phylactic in malarial countries is in many cases the indirect cause of the per- 
nicious "blackwater" fever, one of the most virulent forms of malarial dis- 
ease; also that this drug seriously weakens the action of the heart when taken 
regularly in excessive doses, and will so inure the system to its influence that 
it becomes useless as a remedy when required for this purpose. 

As a general antipyretic large doses of Quinine were in common use before 
the introduction of the modern synthetical antipyretics, to which it is inferior 
for this purpose. Its power of lowering temperature in non-malarious fevers 
is decided, and is especially manifested at the beginning of a natural remission 
of the fever. In the exanthemata and typhoid fever, after the use of the cold 
bath, a 20-grain dose of quinine will usually delay the return of high tempera- 
ture, but the large dose necessary causes much discomfort by its action on the 
brain and the hearing. Quinine has been employed as an antipyretic and anti- 
septic in typhus and typhoid fevers, variola, pneumonia, acute rheumatism, 
surgical fever, septicemia, pyemia, hectic fever, scarlet fever, measles and ery- 
sipelas, in many of which it has enthusiastic advocates, who recommend its 
administration throughout the course of the disease. In exhausting suppura- 
tions it is generally employed, and in some skin diseases, particularly erythema 
nodosum, it is said to be very efficient. It is used in conjunction with mor- 
phine, a full dose of each, at the commencement of acute inflammations, with 
the object of aborting them; also in acute tonsillitis and acute coryza for the 
same purpose. Quinine is a routine remedy with many persons to break up 
a cold, but there is no evidence, clinical or experimental, that it has any such 
power, and its only effect in these cases probably depends upon its anodyne 
and antipyretic action. Neuralgia of malarial origin, and that of the ophthal- 
mic division of the fifth nerve, are decidedly amenable to it. In whooping- 
cough the internal administration of Quinine, also its inhalation in the form of 
a sprayed solution, have been employed with asserted benefit. In hay-fever, 
the application of a weak tepid solution of the hydrochloride, gr. iij to the 5, 
was recommended by Helmholtz, who was benefited thereby, but it has not 
proved generally efficacious in this affection. The Salicylate is an efficient 
antirheumatic and intestinal disinfectant, and has been used with benefit in 
acute and subacute rheumatism, influenza, pneumonia, diphtheria, typhoid 
fever, erysipelas and other exanthemata, also in chlorosis. The Sulphate, in 
dose of gr. viij followed by gr. iv an hour later, is effective in uterine inertia, 
and is used by many practitioners in labor to increase the expulsive power of 
the uterus. It acts by strengthening the intermittent contractions and does 
not produce the tetanic contractions of Ergot and Pituitary Extract. 

Quinine sulphate was at one time highly recommended in Asiatic Cholera; 
and in amebic dysentery the use of high intestinal irrigation with a solution of 
the sulphate, 1 in 3000, has been successful in many cases, the drug having 
destructive action on the ameba coli. However, at the present time in both 
cholera and amebiasis, other methods of treatment have first place. 



230 CINNAMOMUM. 

Quinine is contraindicated in patients who have any idiosyncrasy in regard 
to it, also in gastritis, cystitis, epilepsy, meningitis, cerebritis, and otitis media, 
on account of its congestive action upon the regions affected in these diseases. 

A dministration. 

It is said that Quinine is tasted by the posterior part of the tongue and not 

by its tip. Its persistendy bitter taste is best obviated by administering it in 

capsules, or in pills made with glycerin as an excipient. If given as a powder 

or in solution, Licorice or Chocolate may be used to cover the taste. 

The Hypodermic Injection of Quinine is advocated by many authorities as more effectual 
in obstinate cases than any other method of administration. The best salts for hypodermic 
injection are the hydrochloride and the double salt of quinine and urea. It becomes neces- 
sary in malarial fevers when vomiting is persistent and the rectum irritable, if the patient 
is insensible and cannot swallow, also when life is in imminent danger and the earliest 
possible action of the drug is important (Manson). Subcutaneous injection is undesirable 
because of the liability to necrosis and abscess formation. Intramuscular injection, if 
given under aseptic conditions and deep into the gluteal muscles, does not produce local 
necrosis and is preferable to the subcutaneous method. Intravenous injection is advocated 
by Bass and others when quinine cannot be taken by mouth. It is the most rapid way to 
obtain the quinine effect and does not produce a local inflammatory reaction. Bass thinks 
that 10 grains at one time is sufficient, and that larger doses are not without danger. It 
may be repeated in 8 hours and to increase its efficiency in "cerebral types" with blocking 
of the capillaries, Bass thinks that amyl nitrite is of value, relaxing the vessels and allow- 
ing greater penetration of the quinine. When quinine is administered intravenously it may 
be given by Bacelli's method — 15 grains of a soluble salt in 10 mils of water; or by the gen- 
erally accepted method according to the Stitt — 15 grains of a soluble salt in 250 mils ad- 
ministered by the "Salvarsan Technic." 

CINNAMOMUM, Cinnamon, — is official under two titles, viz. — Cin- 
namomum Saigonicum, Saigon Cinnamon, the bark of an undetermined species 
of Cinnamomum, nat. ord. Lauraceae; and Cinnamomum Zeylanicum, Ceylon 
Cinnamon, the inner bark of the shoots of Cinnamomum Zeylanicum. The 
official Oil is distilled from Cassia Cinnamon, an undetermined species. The 
first named is a constituent of the compound tinctures of Cardamom, Gambir, 
and Lavender. Their taste is warm and aromatic, and their odor is very fra- 
grant. Their active principle is the Volatile Oil, which contains Cinnamic 
Aldehyde. Dose, gr. j-x [av. gr. iv.] 

Official Preparations. 

Oleum Cassiae, Oil of Cinnamon, Oil of Cassia, — a volatile oil distilled from Cassia 
Cinnamon. A yellowish liquid, soluble in 2 of 70 per cent, alcohol. Becomes darker and 
thicker by age and exposure to air. Dose, TUjss-iv [av. njiiij.] 

Aqua Cinnamomi, Cinnamon Water, — has of the Oil 2, triturated with Talc 15, and 
Distilled Water to 1000. Dose indefinite (av. 3iv.] 

Spiritus Cinnamomi, Spirit of Cinnamon, — has 10 per cent, of the oil in Alcohol to 100. 
Dose, TTj?v-5j [av. ttjjxxx.] 

Tinctura Cinnamomi, Tincture of Cinnamon, — has of Cinnamon 20, Glycerin 7^, Alcohol 
and Water to 100. Dose, ttjjxx-5J [av. ttjjxxx.] 

Pulvis Aromaticus, Aromatic Powder, — has of Cinnamon 35, Ginger 35, Cardamon 15, 
Nutmeg 15, triturated together to a fine powder. Dose, gr. x-xxx [av. gr. xv.] 

Fluidextractum Aromaticum, Aromatic Fluidextract, — has of Aromatic Powder 100 
per cent, in Alcohol. Dose, ttj>x-xxx [av. tirxv.] 

Cinnaldehydum, Cinnamic Aldehyde, C 9 H 8 (Unofficial) , — is an aldehyde obtained 
from Oil of Cinnamon or prepared synthetically; soluble in alcohol, ether, and fixed and 
volatile oils. Dose, njss-ij [av. ttjjj.] 



COCA. g 23I 

Cinnamon is an agreeable carminative, somewhat astringent and stimulant, 
also highly aromatic and antiseptic. The Oil is not astringent, but is a stimu- 
lant to the nervous and vascular systems, and seems to have the specific action 
of a uterine hemostatic. In overdose it acts as an irritant and narcotic poison. 
The various preparations are in general use as flavoring excipients, and the 
Water is a pleasant vehicle for extemporaneous mixtures. The Bark and its 
preparations, in combination with opium, chalk, or some vegetable astringent, 
are used to check diarrhea. 

Oil of Cinnamon is a good remedy for flatulence, cramp of the stomach 
enteralgia, and is sometimes used to check nausea and vomiting. It has an 
ancient reputation for healing and antiseptic properties, especially on the 
mucous membranes, and has been employed as an injection in gonorrhea. 
Cinnamic Acid, derived from the oil, has been lauded in the treatment of 
tuberculosis, but its value is unproved. 

COCA, Coca (Unofficial) , — the dried leaves of Erythroxylon Coca, or of E. 
Truxillense, shrubs of the nat. ord. Erythroxylaceae, indigenous to the mountains 
of Peru and Bolivia, and cultivated in those and other S. American states, also 
in India and Java. Their odor is tea-like, taste slightly bitter and aromatic. 
They contain a crystalline alkaloid, Cocaine, C17H21NO4, resembling Atro- 
pine, which when heated with HC1 is split up into methylic alcohol, benzoic acid 
and a base called Ecgonine, sl pyridine derivative, resembling tropine very 
closely in composition. The Java leaves furnish another alkaloid, Tropa- 
cocaine, which is also a compound of benzoic acid, with a base pseudotropine. 
The leaves should contain about 0.5 per cent, of the ether-soluble alkaloids. 
Coca should not be confounded with Cocoa, the seed of the chocolate-tree. 

Alkaloids and their Preparations. 

Cocaina, Cocaine, C17H21NO4, — large colorless prisms or white powder, odorless, and 
soluble in 600 of water, in 5 of alcohol, and in 3.8 of ether at 25 C, very soluble in chloro- 
form, soluble in 12 of olive oil, in 4 of oleic acid, insoluble in glycerin. Dose, gr. f-j [av. 
gr- !■] 

Cocainas Hydrochloridum, Cocaine Hydrochloride, C 17 H 21 N0 4 .HC1, — occurs in color- 
less prisms or a white, crystalline powder, of slightly bitter taste, producing on the tongue a 
tingling sensation followed by numbness; soluble in 0.4 of water and in 3.2 of alcohol at 
25° C. Dose, gr. f-j [av. gr. £]; by hypodermic injection gr. J-|. 

Injectio Cocainae Hypodermica, Hypodermic Injection of Cocaine (B.P.), — is a 5 per 
cent, solution in Distilled Water. Dose, by subcutaneous injection, ttjjv-x. 

Schleich's Solutions for infiltration anesthesia. No'. 1, Strong, has of Cocaine Hydro- 
chloride gr. iij, Morphine Hydrochloride gr. ss. Sodium Chloride gr. iij, Distilled Water, steri- 
lized §iij 3 iij, of which 3vj may be used during one operation. No. 2, Normal, — Cocaine, 
Hydroch. gr. jss, Morph. Hydroch. gr. ss, Sod. Chlor. gr. iij, Distilled Water, sterilized, §iij 
3 iij, of which §lijss may be used at one operation. No. 3, Weak, — Cocaine Hydroch. gr. £, 
Morph. Hydroch. gr. ss, Sod. Chlor. gr. iij, Distilled Water, sterilized, §iij 3 iij, of which a 
pint may be used at one operation. 

Betaeucainae Hydrochloridum, Betaeucaine Hydrochloride, C15H21O2NHCI, — is a syn- 
thetic derivative of piperidine, closely allied to cocaine and prepared artificially as a sub- 
stitute and occurs as a white, crystalline, odorless powder, soluble in 30 of water, 35 of 
alcohol at 25° C It is much less poisonous than cocaine, does not produce mydriasis or 
contract the vessels. It is very stable even on prolonged boiling. It is a very desirable 



232 t COCA. 

local anesthetic, especially in Ophthalmological work. It is used in 2 per cent, solution 
in the eye, 5 to 10 per cent, solution for nose and throat or other mucous membrane 
applications. 

Tropacocaine, Benzoyl Pseudotropeine (Unofficial), — is an alkaloid obtained from the 
Java coca leaves, now made synthetically. It is only half as toxic as cocaine and is used 
as a succedaneum therefor, as it may replace the latter in every case as an anesthetic. 
By many operators it is considered the best of all spinal analgesics, being neutral, devoid 
of irritant effect, maybe boiled without injury, and is the least productive of undesirable 
after-results. The Hydrochloride is applied in 3 to 10 per cent, solution in 0.6 per cent, 
sodium chloride solution. Dose, gr. §-j; by spinal injection for general anesthesia, gr. jrro' 

Incompatibles. 

Incompatible with Cocaine are: Acids (concentrated), Alkaloidal precipitants (see page 6), 
Alkalies, Hot Water; with the Hydrochloride are: Calomel, Chloroform water, Mercuric Oxide, 
Silver Nitrate. Physiologically incompatible are: Alcohol, Amyl Nitrite, Caffeine, Chloral 
Hydrate, Digitalis, Morphine. 

Unofficial Analogues. 

Alypin, — is the trade name of the monochloride of benzoyl, a white and crystalline powder, 
closely related to Stovaine, readily soluble in water and in alcohol. As an anesthetic it 
acts fully as well as Cocaine and in smaller doses, and has all the advantages and none of 
the disadvantages of the latter agent. It acts as a vaso-dilator, and its toxic dose is about 
double that of Cocaine, and slightly less than that of Stovaine. Dose, externally in the 
form of a 10 per cent, solution; hypodermically in 1 to 4 per cent, solutions; for the eye in 
1 to 2 j»er cent, solution. 

Anesthesin, — is the ethyl-ester of paramido-benzoic acid, and occurs as a white powder, 
soluble in ether, alcohol, fatty and ethereal oils, insoluble in water. It is used as an anesthetic 
for minor injuries, painful skin affections and those of mucous membranes, carcinomatous 
ulcers, etc., as a dusting powder, also in throat and nose practice. Its anesthesia lasts longer 
than that of Cocaine, and it is nontoxic. The anesthesia produced does not extend be- 
neath mucous membrane and because of the insolubility of anesthesin it cannot be used 
hypodermically. It is used internally in gastric hyperesthesia and ulcer, in doses of gr. 
v-vij. Doses of 30 grains have not proved toxic. 

Propaesin, — is the propyl ester of para-aminobenzoic acid. It is a fine, white powder, 
slightly soluble in water. It is a local anesthetic which is similar to anesthesin. It is 
practically non-toxic and may be given internally in dose from 4 to 8 grains to daily amounts 
of 30-45 grains. 

Cycloform, — is the isobutyl ester of para-aminobenzoic acid. It is a fine, white powder, 
slightly soluble in water. It is a local anesthetic not unlike the two preceding esters of 
para-aminobenzoic acid. Dose, gr. j-iij, and locally as a dusting powder or 5-20 per cent, 
ointment. 

Beta-Eucaine Lactate, — is prepared in the same way as the official hydrochloride, lactic 
acid being substituted for hydrochloric. Its action and uses are the same. It possesses 
the advantage of greater solubility. 

Euphthalmin, — the hydrochloride of the mandelic acid derivative of Eucaine-B, is a 
brief and efficient mydriatic, but not an anesthetic. Two drops of a 5 per cent, solution cause 
maximal dilatation of the pupil in 35 minutes, without any raise of tension or appreciable effect 
on accommodation, the patient being able to read as usual. The effect passes off in 2 to 4 
hours. It is a satisfactory mydriatic for ophthalmoscopy, being safe in glaucomatous 
cases, and of rapid and short action. 

Holocaine, — is a synthetic product prepared by the interaction of Phenacetin and Para- 
phenetidin. The Hydrochloride is soluble in 50 of water and in 6 of alcohol. It is highly 
toxic and cannot be used hypodermically, but is employed by ophthalmologists in a 1 per 
cent, solution. It produces complete and rapid anesthesia and neither dilates the pupil 
nor affects the blood-vessels. 

Novocaine, — a synthetic product, is of equal and probably of greater value than Cocaine for 
subcutaneous use to produce local anesthesia. It is very soluble and its solutions are stable 
and may be repeatedly sterilized by boiling without injury. With Strychnine (gr. T \j) it is 



COCA. 233 

the safest and best combination for producing spinal anesthesia (Ryall). For infiltration 
anesthesia a 1 to 400 solution in normal salt solution with 1 drop of the 1 to 1000 Adrenalin 
Chloride solution to every 2 or 3 drachms of the solution used. Dose, gr. j-iij. 

Orthoform, Orthoform New, — is the methylester of amido-oxybenzoic acid, and has no 
chemical relation to cocaine, which it resembles only in its action on the sensory nerve termina- 
tions. It occurs as a white, crystalline, odorless and tasteless powder, almost insoluble in 
water. It is efficient as a local anesthetic only when it comes in contact with exposed sensory 
nerves, and has been used chiefly as a dusting powder or ointment for painful abrasions, ulcers, 
or burns. Applied in powder to raw surfaces, as burns, and excoriated nipples, it produces 
no irritation except slight corrosion around the point of application. Internally it has 
been given in doses of gr. viij-xv for the pain of gastric ulcer and cancer. It does not re- 
lieve the pain of simple gastralgia, and hence it has been employed as a test for gastric 
ulcer. A saturated solution in collodion may be used as a paint, and an emulsion in glycerin 
is employed during operations within the uterus. The Hydrochloride is more soluble in 
water and may be used for internal administration or urethral injection, but is too acid 
for hypodermic injection or eye application. Its Incompatibles are Antipyrine, Bismuth 
Subnitrate, Silver Nitrate. 

Stovaine, — is the trade name of a synthetic derivative of the amino-alcohols, chemically 
a Hydrochloride of Benzol-Dimethylaminopropanol. It is more stable than Cocaine, though 
decomposed by the least trace of an alkali, and its aqueous solutions are sterilizable by heat 
below 248 F. It is less than one-third as toxic as Cocaine, though equally powerful as an 
anesthetic, and has the great advantage of being a vaso-dilator, Cocaine being a vaso- 
constrictor. As a substitute for the latter it is used with great satisfaction for local and 
spinal anesthesia. It is more toxic than Novocaine and more irritant (Le Brocq). In 50 
cases of death ascribed to spinal anesthesia 35 at least occurred under the use of Stovaine 
(McCardie). It has produced severe headache, also cramps in the legs. For anesthesia 
of the skin it should be injected under the epidermis or into the derma, not subcutaneously, 
and when employed in the cephalorachidian fluid (which is alkaline), sodium chloride should 
be added to it in the proportion of 5 per cent. Dose, gr. 3V-SS, in pill; for intramuscular 
or epidural injection ngxxx of a 1 per cent, solution; for spinal injection, gr. ss-f (Babcock) 
in the spinal fluid. 

The relative toxicity of the various substitutes for cocaine is summarized briefly in 
the following table taken from New and Non-official Remedies, 1916. 
Anesthesin Non-toxic 

Propsesin Practically non-toxic 

Cycloform Soluble with difficulty; practically non- toxic 

Orthoform-new Practically non-toxic 

Stovaine From one-third to one-half as toxic as cocaine 

Alypin One-half as toxic as cocaine 

Novocaine Less toxic than stovain or alypin 

Beta-eucaine hydrochloride Much less poisonous than cocaine 

Beta-eucaine lactate 
Tropacocain hydrochloride One-half as toxic as cocaine 

Physiological Action. 

Cocaine acts upon the lower animals as a marked stimulant and finally 
depressant to the nervous system inducing restlessness, excitability, convul- 
sions of cortical origin, rapid pulse, rapid respirations and elevated temper- 
ature followed by coma with loss of sensibility and power and death from 
respiratory and vaso-motor failure. In proper doses it raises arterial tension 
by stimulating the vaso-motor and accelerator centres. An effect of cocaine, 
observed in mice, is a wide-spread destruction of the hepatic cells, which 
become vacuolated and frequently necrosed, and the liver is much enlarged 
and pale from fatty infiltration. 

On man, in small doses Cocaine is a cerebral, cardiac, respiratory and 



234 COCA. 

nervous stimulant, a vaso-constrictor, and a prompt diuretic. It improves di- 
gestion, stimulates respiration, increases the heart's action, raises the arterial 
tension and exalts the irritability of the sensory nerves. It stimulates the brain 
directly and by increasing its blood-supply, producing wakefulness and 
marked diminution of the senses of fatigue and hunger. Though decidedly 
diuretic, it lessens the quantity of urea by checking the processes of waste, 
thus enabling the body to maintain its energy on a lessened supply of food. 
It first decreases and then increases the cutaneous circulation, flushing the 
surface, exciting perspiration and a sense of heat, and raises the body-tem- 
perature. It dilates the pupil, both when locally applied and when taken 
internally, and stimulates intestinal peristalsis as well as the evacuation of the 
bladder in a few minutes after its ingestion. 

An overdose produces symptoms of cardiac and respiratory embarrassment 
in a very short time. The pulse, at first quick and forcible, becomes small, 
rapid and intermitting, the heart apparently standing still in systole once in 
every 10 or 12 beats. Experimentally, in cold-blooded animals, Leib has 
been able to produce heart block repeatedly with cocaine. Respiration is 
slow and shallow, and a sense of tightness about the chest is often very 
marked; the blood pressure falls, the skin becomes cold and clammy, and the 
subject is seized with a sense of impending dissolution. Death occurs in 
animals by paralysis of the respiration, but in man a circulatory failure is 
equally dangerous to life. Other symptoms are impairment of coordination, 
convulsions, hallucinations and delirium, dilated pupils, prominence of eye- 
balls, nausea, pain around heart, Cheyne-Stokes breathing and collapse. 

In general action, Cocaine resembles Atropine very closely, especially in 
its influence upon the pulse and blood-pressure, the respiration, pupils, salivary 
glands, sweat-glands and intestinal peristalsis. It is the most complete 
antagonist to the effects of Morphine, stimulating the respiration, heart, 
vaso-motor system, general metabolism, the muscular system, and the psy- 
chic functions, increasing arterial pressure and the body temperature, all of 
which are profoundly depressed by morphine in the second and third stages of 
its toxic action. 

Several years ago, Satterwhite, as a result of the study of one hundred cases of poisoning 
by this alkaloid, called attention to the dangers attending the use of even very small doses, 
and at about the same time another author, after summarizing the records of fifty cases, made 
a similar announcement. A case is reported by Broughton in which unconsciousness, an 
irregular, slow respiration, and a slow pulse, followed the application of three minims of a 
twenty per cent, solution within the cavity of a tooth. Whistler, after the application of a 
four per cent, solution to the nasal cavity, noted vertigo and threatening syncope. In a case of 
glossitis, Ricket states that the patient became moribund after the use of a similar solution. 
Myrtyle dropped three minims of a three per cent, solution into each eye, which immediately 
caused a sense of numbness in the back of the tongue and throat, palpitation, threatened syn- 
cope and nausea. Bettleheim records that in one case the hypodermic injection of one-sixth 
of a grain induced alarming symptoms; and in another, one-eighth of a grain similarly injected 
caused unconsciousness, congestion of the face, irregular breathing and trismus. Baker men- 
tions a case in which one grain injected into the gums by a dentist produced death in a few 
minutes, and Haenel records the case of a man in whom the injection of ij grains was followed 
by a fatal result. 



COCA. 235 

As a. Local Anesthetic the power of Cocaine is very great over a limited area. 
Applied to such structures as the Schneiderian membrane, and the mucous 
covering of the glans penis, or injected hypodermically in other locations, it 
blanches the structures and causes a profound but temporary anesthesia through- 
out a small space. Applied to the tongue it temporarily destroys the sense of 
taste for bitter substances completely, sweet and sour substances less com- 
pletely and salt not at all; to the ocular conjunctiva, it produces profound 
anesthesia of that membrane, together with dilatation of the jpupil, enlarge- 
ment of the palpebral fissure, slight lachrymation, and sometimes temporary 
ptosis. This profound degree of anesthesia is thought by some to be caused 
by its paralyzing the terminal twigs of the sensory nerves — by others to be 
due to vaso-motor stimulation rendering the nerves bloodless and therefore 
unable to transmit sensory impressions. It produces mydriasis by stimula- 
tion of the ends of the sympathetic in the iris, but does not affect the third 
nerve or the sympathetic centre. 

As a General Anesthetic Cocaine is remarkably efficient when injected into 
the spinal canal. After the administration of gr. \ by this method complete 
anesthesia usually follows in the lower extremities within ten minutes, in the 
upper parts of the body within twenty or thirty minutes, and lasts from one to 
four hours, with no effect on consciousness. The after-effects in many cases 
include vertigo, headache, nausea and vomiting. This procedure is not free 
from danger, mental shock, circulatory disturbances, and profound collapse 
being frequently experienced, and death has occurred in several cases. Tropa- 
cocaine, in dose of about gr.f , is equally efficient and much less toxic, and is 
preferred for this purpose by many operators. 

The Cocaine-Habit. 

Cocainism, the Cocaine-habit is now presenting itself to observation, numerous instances 
of persons addicted to its excessive use being met with. Loss of digestive power, absolute 
insomnia, enfeeblement of the intellect, great emaciation, ascites, general marasmus, nausea, 
decay of the teeth, an excessively fetid breath, amblyopia, visual hallucinations and complete 
anorexia, form a consensus of symptoms which rival the worst effects of the opium habit. 
Peculiar hallucinations are characteristic of the action of cocaine. One patient was always 
scraping his tongue to extract from it little black worms; another made his skin raw in the 
endeavor to draw out cholera microbes; a third was constantly looking for crystals in his 
skin. Two of these subjects suffered from epileptic attacks and the third from cramps. 
(Magnan and Saury.) Some observers report the most extraordinary mental changes re- 
sulting from cocainism, exceeding those produced by any other drug. Intense selfishness, 
utter disregard of all social and domestic duties, the most debasing habits, complete destruc- 
tion of all noble qualities, and a general condition of depravity, are some of the results which 
are charged to this drug. The author's experience with a large number of such cases con- 
vinces him that a cocaine habitue who has used the drug daily for a month is practically an 
insane individual while under the influence of the drug; but that the mind may resume its 
normal condition after withdrawal, unless the drug has been used in overwhelming doses 
or continued for some time when a state of hopeless irresponsibility occurs which even 
strict deprivation of the drug fails to relieve and which inevitably lead sback to the drug 
and a life of immorality and crime. 

Many nasal applications contain cocaine, and their use may cause the cocaine-habit, 
which, however, is in most cases acquired by morphine habitues who go to cocaine in the 
expectation of finding help in their struggle against the tyranny of the former drug. In 
this hope, however, they are always disappointed when the drugs are in their own hands. 



236 COCA. 

The victim soon finds that one of these agents antagonizes the other to a great extent, 
while, at the same time, it sets up peculiar troubles of its own; and that there is a constant 
need of more morphine to counteract the cocaine-symptoms, and of more cocaine to an- 
tagonize the symptoms due to the increased amount of morphine. The result is that one 
who is using only a moderate daily amount of morphine, if cocaine be added will soon be 
using a very great amount of morphine, as well as of cocaine, and "the last state of that 
man is worse than the first." Drug fiends who use both drugs frequently state that cocaine 
is not a habit in the sense applied to morphine. The latter when once started requires 
daily use; cocaine, however, is used more for periodic debauches — the "coke sprees" and 
"coke parties," etc.- 1 — in the intervals of which there may be little or no craving. Cocaine 
can therefore be removed promptly in the treatment and with less suffering than in the 
case .of morphine. 

As the stimulant effect of a single hypodermic injection passes off very quickly, within 
about 15 or 20 minutes, the cocaine habitue is under the necessity of constantly injecting the 
drug, so that, as one expressed it, "I had no time to go home, — no time to do anything except 
to prepare and take one 'shot' after another." The effect of such repeated puncturing of the 
skin is very disastrous to that tissue, causing great induration and numerous sloughing sores. 

Therapeutics. 

Coca-leaves are chewed by the Peruvians for the purpose of sustaining 
them during arduous labors and long journeys, and are so highly esteemed as 
to be represented on their national coat-of-arms, the people using them much 
as we do tea, coffee or tobacco. This example was imitated by Weston, the 
pedestrian, who is said to have been detected chewing the coca-leaf during one 
of his protracted walks. Although Cocaine was formerly used as a stimulant 
to the brain and the nervous system in many morbid conditions, particularly 
cerebral anemia, neurasthenia, melancholia, hysterical and hypochondriacal 
insanity, and in protracted mental depression with suicidal tendency, it has 
been supplanted by more efficient and less dangerous drugs. It is very bene- 
ficial in some cases of the vomiting of pregnancy, in stomatitis and gastralgia. 
An ointment of Cocaine is an efficient palliative application to painful 
hemorrhoids, fissures of the anus, burns, boils, and irritable ulcers; also in 
pruritus pudendi et ani and skin diseases attended with intolerable itching. 

Cocaine Hydrochloride has achieved celebrity as a local anesthetic, and 
is of great value in many operations on the eye and ear, nasal passages, uterus 
and urethra. A 2 to 4 per cent, solution is brushed lightly over the mucous 
surface or injected into the urethral canal, the application being repeated within 
5 or 10 minutes if profound local anesthesia is required. After about fifteen 
minutes any superficial operation may be performed without giving the slight- 
est pain. It is used in the same manner with decided benefit in congestion 
of the nasal passages from acute catarrh and hay-fever; and is applied to the 
ear for tinnitus aurium, and by inhalation to strengthen the vocal cords, to 
relieve hoarseness and cough, and to improve the quality of the voice. It 
may be injected into the bladder before lithotrity and into the urethra before 
the passage of sounds or catheters or to relieve chordee. To be efficient it 
must reach the terminal filaments of the sensory nerves in sufficient concen- 
tration. Rhus poisoning, by either the oak or ivy, is promptly controlled by 
the application of a 5 per cent, solution or oleate, freely over the affected 



COCA. 237 

surface. It gives instant relief from the burning and itching, and speedily 
reduces the dermatitis. It is injected hypodermically around the prepuce to 
prevent pain during circumcision, into the vicinity of the supra-orbital and 
infraorbital foramina to cut short neuralgia of those nerves, into hemorrhoids 
previous to their ligation, into the peritonsillar tissues allowing painless 
tonsillectomy, and into the skin and the subcutaneous tissues to produce 
local anesthesia in many minor operations. The conjoined use of Epinephrine 
with cocaine (ttliij of the ordinary solution of epinephrine chloride with ITlxvij 
of a 1 per cent, solution of cocaine hydrochloride), diminishes the toxicity of 
the latter and increases its anesthetic power in duration, intensity and area. 

The Infiltration Method of Schleich is the injection in quantity (up to 100 Cc.) of very 
dilute solutions (1 in 10,000, 1 in 1,000 and 1 in 500), at first superficially into the epidermis 
and then deeper, by long, fine needles, so as to produce a local edema over the field of opera- 
tions (see page 231 for the solutions used). The Intraneural Method is the injection of a 2 per 
cent, solution into the nerve-trunk supplying the region to be anesthetized, but this has pro- 
duced neuritis. The Paraneural Method is the injection of the same solution in the immediate 
vicinity of the nerve-trunk. 

The rapid accumulation of cases in which alarming symptoms followed the local applica- 
tion of small quantities of cocaine, together with the fact that these untoward effects are due 
to individual idiosyncrasy and do not invariably occur immediately, is a positive warning to 
the profession that this powerful substance should not be used in any case for the first time 
without the proper antidotes at hand and the patient being kept under surveillance for 
at least a half hour. There seems to be no doubt that cocaine is absorbed with extraordinary 
rapidity and that the stronger the solution which is locally applied, the greater the danger of 
toxic symptoms, but whether the latter are to be attributed merely to the larger dose or to some 
obscure action, is not apparent. Falk has found that the rapidity of absorption varies in the 
different tissues — absorption taking place most rapidly through the conjunctiva, then in the 
following order: nose, larynx mouth, and ear. 

For the purpose of general anesthesia without loss of consciousness the 
injection of Cocaine into the spinal canal was introduced by Corning in 1884, 
but received little attention at that time. It was revived fifteen years later 
by Bier, and has been employed by many surgeons in major operations on all 
parts of the body, also by physicians in cases of labor, for the cure of sciatica, 
and the relief of eclampsia. Unpleasant and even dangerous symptoms are 
occasionally experienced, and as a rule this method of producing anesthesia 
is to be used only in exceptional cases. Ten or fifteen minims of a freshly made 
and sterilized solution (gr. -J- to \) of Cocaine Hydrochloride, (or gr. J to -fa of 
Tropacocaine Hydrochloride), are injected through a long needle inserted 
between the 2nd and 3rd or the 3rd and 4th lumbar vertebrae into the spinal 
subarachnoid space. A more recent method of preparing the injection is to 
dissolve the proper quantity of the drug in the cerebro-spinal fluid which 
escapes from the needle. The maximum quantity of Cocaine is stated by 
Bier at gr. J, that of Tropacocaine gr. f (Schwarz), gr. ■£$ (Neugebauer) . 
Betaeucaine has been used alone, as well as in combination with cocaine, and 
is considered to be as efficient as the latter, and less toxic. Stovaine is 
equally efficient, much less toxic, and has the advantage over cocaine in being 
a vaso-dilator. Complete anesthesia occurs in the lower extremities usually 



238 coccus. 

within ten minutes, in the upper parts of the body within twenty or thirty 
minutes, and lasts from one to four hours. During its continuance any surgi- 
cal operation may be performed, with no sensation of pain being experienced 
by the patient, who is entirely conscious of his surroundings. Contraindica- 
tions are tuberculosis, syphilis, renal disease, advanced arteriosclerosis, age 
below 15 years, neuro- or psychopathic conditions, brain and spinal cord 
affections and septic diseases. Employed in a proper manner and in appro- 
priate cases, spinal anesthesia offers many advantages, but the method is 
never without danger. 

Tuffier has reported 1,300 cases with only one death, Hahn 1,700 with 8 deaths, and 
Morton states that he has used this method in over 1,000 cases, 80 of which were for operations 
above the diaphragm, including excision of the tongue and the maxillary bones. Murphy 
reports 631 cases, in 21 of which the injection failed of effect. Tropacocaine was used by 
Schwarz in 100 cases, by Kopfstein in 40, by Neugebauer in 60 cases, and is preferred to 
cocaine or eucaine by Morton, Kozlowski, and Schwarz. 

As a mydriatic for ophthalmological use, Cocaine has peculiar qualities 
which make it one of the most serviceable agents of the class. The dilatation 
produced by it is great, is quickly attained, lasts only 12 to 20 hours, is promptly 
overcome by physostigmine, and is not accompanied by much photophobia, 
due to the fact that the cocainized pupil is not rigidly dilated (as with atropine) , 
but reacts to light. The accommodation, moreover, is greatly reduced, but not 
paralyzed, and is quickly regained. 

As an antagonist Cocaine is of especial value in narcotic poisoning by chloral 
or opiates, where depression of the cardiac and respiratory centres exists. It 
is an antagonist to morphine, but has no value in the treatment of morphine 
addiction except to antagonize certain heart symptoms, for which purpose it 
should be administered only by the physician in charge of the case; but never 
as a regular remedy, at regular intervals of time, even by him. It is indi- 
cated in chronic depressant poisoning from the bromides, and in spinal par- 
alyses, in which it has all the advantages of strychnine without its poisonous 
character. 

Various substitutes for Cocaine (see page 232) have been introduced with 
the view to overcoming the following disadvantages: (1) toxicity, (2) insta- 
bility when heated, preventing effective sterilization, and (3) tendency^to 
habit formation. They have largely replaced cocaine in many conditions in 
which it was formerly thought indispensable. 

COCCUS, Cochineal, — is the dried female insect Pseudococcus cacti, nat. ord. Hemiptera, 
which feeds on the cactus plants of Mexico and Central America. It is of ovate, plano- 
convex form, of a purple-gray or purple-black color, yielding when crushed a dark-red powder, 
which contains Carminic Acid, or Carmine, the red coloring-matter, which is soluble in water 
and in alcohol, but not in oils. Cochineal is an ingredient of Tinctura Cardamomi Composita, 
and is used in pharmacy solely as a coloring material. 

The only therapeutic use of Cochineal is in whooping-cough and neuralgia, in which 
affections it s supposed to have considerable influence, especially in the former. Its dose for 
an infant is about gr. £ thrice daily. 



COLCHICUM. 239 

COLCHICUM, Meadow Saffron, — is the corm and seed of the Colchicum 
autumnale, a European plant of the nat. ord. Liliaceae. It contains an intensely 
bitter, poisonous alkaloid, Colchicine, C 22 H 25 N0 6 , which by the action of acetic 
and mineral acids is converted into Colchiceine and a resin; also tannic and 
gallic acids, resin, starch, sugar, etc. It is official in two forms, namely — 

Colchici Cormus, Colchicum Corm, — the dried corm, about an inch long, 
white internally, grooved on one side, inodorous, taste sweetish, bitter and 
acrid; and yielding not less than 0.35 per cent, of colchicine. Dose, gr. 
ij-viij [av. gr. iv.] 

Colchici Semen, Colchicum Seed, — the dried seeds, about yV inch thick, 
sub-globular, resembling black mustard seed but larger, very hard and tough, 
inodorous, of bitter and acrid taste; and yielding not less than 0.45 per cent, 
of colchicine. Dose, gr. j-v [av. gr. iij.] 

Preparations. 

Extractum Colchici Cormi, Extract of Colchicum Corm, — contains from i| to \\ per cent, 
colchicine. Dose, gr. §-ij [av. gr. j.] 

Fluidextractum Colchici Seminis, Fluidextract of Colchicum Seed. Dose, nj?j-v [av. 

TTRiij.] 

Tinctura Colchici Seminis, Tincture ofC. Seed, 10 per cent. Dose, n^x-5j [av. ttjjxxx.} 

Colchicina, Colchicine, — a white or yellowish, amorphous powder, of saffron-like odor 
and bitter taste, soluble in water and in alcohol. Dose, gr. T^o—gV [ av « g r - 120O I s suitable 
for hypodermic injection. 

Colchicine Salicylate (Unofficial), — is marketed in capsules, each capsule containing 
Colchicine, gr. 240 an d natural Methyl Salicylate (Oil of Wintergreen), gr. iij. Dose, 1 
capsule every 2 hours, up to 10 or 15 daily. 

Incompatible with Colchicine are: Acids, Alkalies, and the Alkaloidal precipitants (see 
page 6) 

Physiological Action and Therapeutics. . 

Colchicum is emetic, diuretic and diaphoretic, a drastic purgative, a gastro- 
intestinal irritant and a cardiac depressant. In full doses its action is emeto- 
cathartic, producing profuse watery discharges, great nausea and extreme 
muscular feebleness. In large doses it is a powerful irritant of the gastro- 
intestinal tract, causing severe griping, choleraic discharges, lowered arterial 
tension and depression of the heart by reflex action over the distribution of 
the pneumogastric, — then great prostration, convulsions and collapse, death 
occurring from respiratory failure as a rule, although Dixon and Molden 
state that it results from paralysis of the vaso-motor centres. The extent of 
its influence on the excretion of uric acid and urea is very much disputed, 
but it probably increases the flow of bile, and certainly unloads the portal 
circulation. 

Colchicum is a specific palliative in acute gout, in which it should be given 
with an alkali, and kept short of emeto-catharsis. It does not prevent relapses, 
and its power in this disorder is weakened by repetition. Its use in gout is 



24O COLOCYNTHIS. 

based upon empiricism rather than sound scientific grounds. It does do 
good, but how it does good is still a matter of conjecture. While useful in 
acute gout, it is without value in the intervals between the attacks and in the 
chronic and atypical forms of the disease. It is often used with marked success 
in chronic rheumatism, but frequently fails, and in no case should it be con- 
tinued long in this affection. The alkaloid is probably the best preparation 
for general use, and is admittedly superior to the other preparations in gout. 
The preparation known as Colchicine Salicylate is a solution of colchicine in 
oil of wintergreen. 

COLOCYNTHIS, Colocynth,— is the dried fruit of Citmllus Colocynthis, 
deprived of its rind. The plant is a native of Spain and Asiatic Turkey and 
belongs to the nat. ord. Cucurbitaceae. The fruit is of the size of a small orange 
white, light, spongy, inodorous, very bitter, containing many fiat, brown seeds 
which should be rejected before the pulp is used. Its active principle is Colo- 
cynthin, C 56 H 84 23 , an amorphous but crystallizable bitter glucoside, readily 
soluble in water. Dose, gr. ss-jss [av. gr. j.] 

Preparations. 

Extractum Colocynthidis, Extract of Colocynth— Dose, gr. £-j [av. gr. J.] 

Extractum Colocynthidis Compositum, Compound Extract of Colocynth, — contains 
of the preceding 16 parts, Aloes 50, Cardamom 5, Resin of Scammony 14, Soap 15. Dose, 
gr. ij-xx [av. gr. iv.] 

Pilulae Catharticae Compositae, Compound Cathartic Pills, — have of the preceding 8, 
Calomel 6, Resin of Jalap 2, Gamboge i£, Water to make 100 pills. Dose j-iij [av. ij pills.] 

Pilulae Catharticae Vegetabiles, Vegetable Cathartic Pills (Unofficial), — have of Com- 
pound Extract of Colocynth 6, Extract of Hyoscyamus 3, Resin of Jalap 2, Extract of 
Leptandra i|, Resin of Podophyllum 1^, Oil of Peppermint 0.8, Water to make 100 pills. 
Dose, j-iij pills [av. ij.] 

Incompatibles. 

Incompatible with Colocynth are: Alkalies, Ferrous Sulphate, Lead Sulphate, Lime- 
water, Mercuric Chloride, Silver Nitrate. 

Colocynth is classed among the hydragogue purgatives. In moderate 
doses it increases peristalsis and the intestinal glandular secretions, producing 
bilious, watery evacuations with much colicky, griping pain. Its purgative 
action is specific, and may be obtained by its application to the skin over the 
abdomen. In large doses it is a violent irritant of the gastro-intestinal tract, 
and has frequently produced fatal gastro-enteritis. It is popularly supposed 
to be abortifacient, but this is true only of quantities sufficient to endanger 
life. It is an indirect diuretic. 

Colocynth is too severe an agent to be administered alone for constipation, 
but it makes a useful factor in compound purgatives, as the compound 
cathartic pills. In cerebral congestion it may be used to produce rapid deriva- 
tion, and in ascites to set up a profuse drain from the intestinal canal. In certain 
cases of chlorotic amenorrhea it stimulates the pelvic nerves and vessels with excel- 
lent results and tends to correct the constipation which is so frequently an 
obstinate part of this condition. 



CONIUM. 24I 

CONIUM, Hemlock (Unofficial), — is the full-grown, unripe fruit, of Co- 
nium maculatum, the spotted hemlock, nat. ord. Umbelliferae. It contains 3 
alkaloids, C online, C 8 Hi 5 N, liquid and volatile, Methyl-coniine, CgHuNCHs, 
and Conhydrine, C 8 Hi 7 NO, solid and volatilizable; also coni'ic acid and a vola- 
tile oil. Paraconi'ine is an artificial substance produced by the reaction 
between butyric aldehyde and an alcoholic solution of ammonia, and is iso- 
meric with conime but not identical with it. Dose, gr. j-v [av. gr. iij.] 

Fluidextractum Conii, Fluid-extract of Conium (Unofficial), — Dose, ttj>j-x or more 
[av. TTjjiij.] 

Conii'na, Coniiine, C 8 H 15 N (Unofficial), — an oily, limpid, volatile liquid, of acrid taste, 
alkaline reaction, and an odor comparable to that of the urine of mice. It is quickly decom- 
posed by heat, and if exposed to the air soon becomes inert. Dose, gr. -^-^0, or in minim 
doses, TTj^-ij. Is too irritant for hypodermic use, unless carefully neutralized by acetic 
acid. The Hydrobromide in watery solution of gr. viij to the §, of this Ti#x=gr. ^, is a good 
form for subcutaneous or stomachal administration, and may be given in doses of gr. ^ t0 
gr. j, as it is not actively toxic. 

All the preparations of Conium are uncertain in action, as the active principle is very 
volatile. Any specimen must be carefully tested before deciding on its dosage, and if the 
powerful mouse-like odor of the drug is absent, the preparation is probably worthless. 

Incompatibles. 

Incompatible with Conium are: Vegetable Acids, Alkalies, Tannic Acid; with Coniine 
are: Albumin, Aluminum salts, Alkaloidal precipitants (see page 6), Chromic Trioxide; Cop- 
per, Iron, Manganese, and Zinc salts. Physiologically incompatible are: Nux Vomica and 
its alkaloids, also Picrotoxin, and other tetanizers. 

Physiological Action and Therapeutics. 

The action of Conium is that of its principal alkaloid Conime, which causes 
motor paralysis without loss of sensation or consciousness. It progressively 
paralyzes the motor nerves, the action commencing at the peripheral end-organs 
and extending upward, involving the nerve-trunks and finally the centres, but 
the muscular irritability remains unaffected. Methyl-coniine, on the contrary, 
stimulates the spinal cord, and produces the convulsions often seen in conium- 
poisoning. The sensory nerves are slightly affected, and the general sensi- 
bility is impaired, a feeling of numbness being experienced in the extremities. 

Gastric irritation is usually the first sensation produced by a full dose of 
Conium, nausea and vomiting being its symptoms. Then occur weakness of 
the legs, numbness and fatigue, drooping eyelids, diplopia, slightly dilated pupils, 
vertigo, impaired utterance, slow and labored breathing, and if the dose be 
lethal, paralysis of the voluntary muscles occurs, those of the lower limbs being 
first affected ; speech and vision are lost, and finally death occurs from paralysis 
of the muscles of respiration. The heart is not affected and the mind remains 
clear but torpid and indifferent, until carbonic acid narcosis sets in. Muscular 
movement counteracts the effects of the drug to a great extent. 

Conium is believed to have been the state poison of the Athenians, by the 
juice of which Socrates and Phocion died. It is closely allied in its physio- 
logical action to Curare. 
16 



242 CONVALLARIA. 

Conium is rarely used, although occasionally recommended in diseases 
characterized by excessive motor activity. Large doses are required, as some 
physiological action is necessary. Children bear it well, their constant activ- 
ity preventing its full action. In chorea and paralysis agitans it palliates, by 
depressing the motor nervous system. In acute mania and delirium tremens, 
to quiet motor excitement and prevent exhaustion, it is remarkably efficient, 
especially when given conjointly with morphine. The pain of cancer seems to 
be especially amenable to its influence when locally applied, and Conime 
vapor is an admirable palliative of the tickling cough of phthisis and the irri- 
tability of the air-passages in acute bronchitis. 

CONVALLARIA (Unofficial), — is the dried rhizome and roots of Conval- 
laria majalis, Lily of the Valley, a stemless perennial of the nat. ord. Liliaceae, 
indigenous to Europe, northern Asia and the southeastern portion of the 
United States. The preparations in the market vary in action, according to 
the quantity of the resin present, it being erne to-cathartic. Convallaria 
contains two glucosides, namely — Convallamarin, on which the cardiac action 
depends, and Convallarin, a crystalline, purgative principle, insoluble in 
water; also an acrid Resin which probably contains the latter glucoside. 
Dose, gr. ij-x [av. gr. vijss.] 

Physiological Action. 

Convallaria has long been known as a decided cathartic and a prompt and 
powerful diuretic, and in recent studies of its effect upon the circulation it 
has been found to be closely allied to Digitalis since which it has been included 
in the pharmacological group known as the "Digitalis Bodies" or " Digitalis 
Allies." (See Digitalis.) Preparations of the root are powerfully emeto- 
cathartic, probably due to a preponderance of the resin. Those freed from 
this ingredient correspond in action to Convallamarin, stimulate the appetite 
without impairing digestion, increase peristalsis without producing catharsis, 
slow the heart and raise the arterial tension, also slowing and deepening 
respiration. Lethal doses at first produce irregularity of the cardiac action and 
spasm of the respiratory muscles, high arterial tension and a very rapid pulse, 
followed by lowered blood-pressure, very slow and deep breathing, and finally 
arrest of the heart in systole. Its mode of action is by direct stimulation of 
the pneumogastric, the motor and sensory nerves retain their irritability, 
the muscles preserve their contractility, the cerebral functions and the pupil 
are unaffected. 

Convallarin is a drastic purgative in 3 -grain doses. Convallamarin is an 
emetic even in small quantity, and the powdered root is sternutatory. 

Therapeutics. 

Convallaria is a heart-tonic like Digitalis, although less certain in its 
action, and is indicated in the same class of cases as the latter drug, with the 



COPAIBA. 243 

advantage that having no cumulative action it is not dangerous to the heart 
in medicinal doses, and does not disturb the stomach or the functions of the 
cerebro-spinal axis. In doses of gr. xv-xxv of the extract it slows the action 
of the heart and increases the force of its contractions, raises slightly the 
arterial tension, augments the force and volume of the respiration, and pro- 
duces prompt diuresis without altering the composition of the urine. It is 
often a valuable remedy in mitral stenosis or insufficiency with venous stasis, 
dilatation of the heart, palpitation, vehement cardiac action or disordered 
rhythm, and in all valvular affections accompanied by dropsy and a weak 
heart. 

COPAIBA, Copaiba, — is an oleoresin derived from one or more South 
American species of Copaiba, nat. ord. Leguminosse, growing chiefly in the 
valley of the Amazon. It is a translucent, viscid liquid, of yellow color, aro- 
matic odor, acrid and bitter taste, sometimes fluorescent, soluble in alcohol, 
ether and chloroform. It is not a balsam as it contains no cinnamic acid. Its 
constituents are a Volatile Oil and a Resin in about equal proportions, the latter 
containing nearly 99 per cent, of Copaibic Acid. Dose, rr^x-xxx [av. rn_xv.] 

Preparations. 

Mistura Copaibae Composita, Compound Copaiba Mixture, Lafayette Mixture (Unoffi- 
cial). — 1$. Copaibae Sj, Spiritus iEtheris Nitrosi 5j, Liq. Potassae 3ij. Mix with constant 
stirring, then add: Tinct. Lavandulae Co. §j, Syrupi §ijss, Mucil. Dextrini (N. F.) q. s. ad 
5viij. Mix the whole thoroughly by shaking. Of this each 3 contains TTjjvijss of Copaiba 
{National Formulary). Dose, 5j-iv. 

Incompatibles. 

Incompatible with Copaiba are: Mineral Acids, Caustic Alkalies, Calcium Hydrate 
Magnesia, Water. 

Physiological Action and Therapeutics. 

Copaiba is a stimulant diuretic, expectorant, and a gastro-intestinal irri- 
tant. Its taste is bitter and nauseous. In the stomach it causes heat, eruc- 
tations, heaviness, frequently anorexia and diarrhea and if continued for any 
length of time gastro-intestinal catarrh and desquamative nephritis may 
result. The oil and resin diffuse into the blood and are excreted by the bron- 
chial mucous membrane, skin and kidneys, producing increased secretion at 
the points of elimination. The various secretions have the odor of the drug, 
especially the urine. In medium doses it increases the quantity of urine and 
its solid constituents, but large doses will cause scanty urine, containing albumin, 
casts and blood, with pain in the loins and other signs of renal congestion. On 
the skin it often produces itching and several forms of eruption. 

Copaiba has been largely used in gonorrhea after the acute symptoms have 
subsided, also in chronic cystitis, acute and chronic bronchitis. In all these 
affections it is a useful remedy but its nauseous taste and irritant effects on 
the stomach are driving it out of fashion, especially in private practice. One 



244 CORIANDRUM CREOSOTUM. 

eminent surgeon declares not only that it is useless in gonorrhea but that it 
does more harm than good, often prolonging the disease beyond its natural 
limit. In psoriasis and urticaria, and in cutaneous affections characterized by 
torpid peripheral circulation, this drug has been administered internally with 
excellent results. 

CORIANDRUM, Coriander, — is the fruit of Coriandrum sativum, a plant of the nat. ord . 
Umbelliferae. It contains a volatile and a fixed oil. Dose, gr. v-xx [av. gr. viij.] 

Oleum Coriandri, Oil of Coriander, — a volatile oil distilled from Coriander. A colorless 
liquid, of aromatic, bitter and pungent taste; soluble in 3 volumes of alcohol, forming a slightly 
turbid liquid neutral to litmus paper. Dose, n^ij-v [av. ir^iij.] 

Coriander is stimulant, aromatic and carminative. It is used almost wholly as a flavoring 
to other remedies, or as a corrective against the griping effects of certain purgatives. Its flavor 
covers the taste of Senna and Rhubarb. 

CORNUS, Dog-wood (Unofficial), — is tne bark of the root of Cornus florida, a small tree 
of the nat. ord. Cornaceae, indigenous to the U.S. It contains a bitter principle named Cornin, 
which is crystallizable and soluble in water and in alcohol; also a resin and tannic acid. 

Cornus is a simple bitter, having stomachic and other qualities similar to those of Ca- 
lumba (which see). Heat destroys its active principle, consequently a decoction is a use- 
less preparation. A fluidextract is on the market, the dose of which is n£x-5j. 

COTO, Coto Bark (Unofficial), — is the bark of some unknown tree growing in Bolivia. 
It contains an acrid, bitter principle, of yellow color, crystalline and soluble in hot water and in 
alcohol, named Cotoin, C 22 H ls O s ; also Piperonylic Acid, C s H 6 4 , and a volatile oil, resin, etc., 
but no tannin. Dose, gr. j-xv. 

Paracoto Bark, False Coto. — Its principle, Paracotoin, C 19 H i2 6 , has a strong similarity 
to Cotoin therapeutically, but is less active. 

A fluidextract is prepared, also a tincture (10 per cent.), which may be administered in 
doses of from tt^j-xx. Cotoin is used in doses of gr. j-iv, and Paracotoin in somewhat 
larger quantities. 

The physiological action of Coto has not been studied, all that is known about it being that 
it is decidedly irritant to the skin and mucous membranes. After its internal administration 
the urine takes a dark-red color with nitric acid. Ferric Chloride blackens a dilute solution 
of Cotoin, but has no reaction with Paracotoin. 

The bark and both principles are recommended in diarrheas of various forms, especially 
those of phthisis, typhoid fever, and cholera. In Asiatic cholera Paracotoin has been 
used hypodermically in 3-grain doses with success. When there is any tendency to acute 
inflammation of the gastro-intestinal tract this agent must be used with caution. 

CREOSOTUM, Creosote, — is a mixture of phenols and phenol derivatives, 
chiefly Guaiacol and Creosol, obtained during the distillation of wood-tar, pref- 
erably that derived from the beech (Fauns sylvatica). It occurs as an almost 
colorless, or yellowish, inflammable, oily liquid, of smoky odor, caustic taste, 
and neutral reaction; soluble in about 150 of water, and in all proportions in 
absolute alcohol, ether, chloroform, carbon disulphide, acetic acid, and fixed 
and volatile oils. It does not coagulate albumin or collodion though Phenol 
does. It was named from its remarkable preservative power over meat 
Kpeas, flesh, c^enr, to preserve). Much of the commercial Creosote is an 
impure phenol, or a heavy oil distilled from coal-tar and containing phenol 
andcresylic acid. Dose lTjy-v [av. TTjnV] well diluted, in wine or whisky. 

Aqua Creosoti, Creosote Water, — is a 1 per cent, solution, containing nearly 5 minims of 
Creosote in each fluid-ounce. Dose, 5j~5j [av. 3ijss.] 



CREOSOTUM. 245 

Creosoti Carbonas, Creosote Carbonate (Creosotal), — is a mixture of the carbonates of 
various constituents of creosote, chiefly guaiacol and creosol. It occurs as a thick, color- 
less or yellowish, inodorous liquid, insoluble in water. Dose, gr. v-xx [av. gr. xv.] 

Guaiacol, Guaiacol, C7H8O2, — is one of the chief constituents of Creosote, and is pre- 
pared synthetically. It occurs as a colorless solid or liquid, of agreeable and aromatic 
odor, soluble in alcohol, ether, acetic acid and glycerin. Dose, ttjjv-xv [av. ngviij], in 
capsule, pill, or whisky. 

Guaiacolis Carbonas, Guaiacol Carbonate,— occurs as an almost tasteless and odorless, 
white, crystalline powder insoluble in water. Dose, gr. v-xx or more [av. gr. xv.] 

Unofficial Derivatives. 

Benzosol, Guaiacol Benzoate, — is prepared by heating Guaiacol with Benzoic Acid, and 
occurs in small, colorless, odorless, and almost tasteless crystals, practically insoluble in 
water. Contains 54 per cent, of Guaiacol. Dose, gr. iij-x. 

Guaiamar, Guaiacolglycerylester , — is a white, crystalline powder having a bitter aromatic 
taste. It liberates guaiacol in the stomach and in the intestine and is said not to inter- 
fere with digestion. Dose, gr. v-xx. 

Monatol, Guaiacol Methylgly colas, — is a colorless oil of aromatic odor, soluble in alcohol, 
soluble with difficulty in water. It is used as a substitute for Guaiacol and is said to give 
the systemic effects without its caustic and toxic action. It is easily absorbed by the skin. 
Dose, Trgxxx-f 5j applied locally over affected area once or twice daily. 

Incompatibles. 

Incompatible with Creosote or Guaiacol are: Acacia, Albumin, Nitric Acid, Oxidizers, 
also Cupric, Ferric, Gold and Silver salts. 

Physiological Action. . 

Creosote is styptic, escharotic, antiseptic, anesthetic, expectorant, astrin- 
gent, and narcotic in overdose. Its action is practically the same as that of 
Phenol (see under that title), especially upon the nervous system, the heart, 
and the respiration; but it differs therefrom in not causing convulsions, and 
in being much less toxic and in having a greater range of usefulness. It is 
rapidly absorbed and eliminated, its excretion occurring by the kidneys and 
the bronchial mucous membrane, which it stimulates, being quite a good 
expectorant. In small doses it seems to have a selective sedative influence 
on the terminal nerve-filaments in the gastric mucous membrane. In large 
doses it is a powerful poison, resembling Phenol in its symptoms, except that 
its nervous effects are even more marked. It explodes when combined with 
silver oxide, unless previously diluted with an inert powder. 

Guaiacol, locally applied, is rapidly absorbed by the skin, and appears in 
the urine fifteen minutes after its application. Applied by painting it over 
the skin of the thigh, abdomen or chest, in quantity of 20 to 50 minims, it causes 
a rapid reduction of body-temperature, and thereby the temperature in malarial 
fever, typhoid fever and pneumonia falls as much as 7 in the course of an hour 
or two, but soon rises again (Da Costa). This rapid antipyretic action is 
accompanied by signs of depression with profuse sweats, if frequently used, 
also slight chilliness is sometimes experienced. Guaiacol is a local anes- 
thetic, equal in some respects to cocaine and much safer. Internally the 
action of Guaiacol is similar to that of creosote, and in overdose it may prove 
equally fatal. 



246 creosotum. 

Therapeutics. 

Creosote, being a very complex substance of varying composition, has been 
almost entirely supplanted in therapeutics by Phenol for external use, and by 
Guaiacol for internal administration. As an astringent it has been employed 
in intestinal hemorrhage, gonorrhea and gleet, and generally in the same affec- 
tions as phenol. Externally it is a good application in eczema, pruritus, ulcers 
and scaly skin diseases, and it effectually relieves the pain of an exposed dental 
nerve if applied thereto. It is a good agent by inhalation in chronic bronchitis 
and gangrene of the lung, and it has been administered internally with decided 
benefit in abnormal fermentative processes in the stomach and intestines, in 
reflex nausea and vomiting, as from sea-sickness, and pregnancy; also as an 
expectorant in chronic basillar cavity, in which it seems to have greater 
efficacy than any other remedy, and in bronchitis, pneumonia, pulmonary 
gangrene, carcinoma of the stomach, and diabetes. 

In pulmonary tuberculosis when well borne by the stomach, and continued 
over a long period of time, it has probably proved more efficient than any other 
remedy. Its employment in this disease by Guttmann was based on the 
belief that tubercle bacilli were destroyed by blood containing one part of 
creosote in 2000, and that even one-half that proportion arrested their devel- 
opment. This was denied by many observers, and later researches by 
Hoelscher and Seifert indicated that the good effects of this treatment were 
due to the formation of soluble compounds between the remedy and the toxic 
albuminous by-products of the tubercle bacillus, which were then eliminated 
from the blood. These observations have likewise failed of confirmation and 
at the present time the value of creosote in tuberculosis is simply that of an 
agent which seems to benefit the associated bronchitis, lessening the cough and 
expectoration due to it, and thereby indirectly benefiting the local tuberculous 
process. The commencing daily dose of Creosote or Guaiacol is 2 or 3 
minims, largely diluted to prevent irritation, taken after meals, and increased 
by the addition of one minim daily until a maximum daily dosage of 15 to 18 
minims is reached, at which rate it should be continued for several months. 
Under this treatment cough is relieved, expectoration diminished, night- 
sweats are stopped, the fever is lowered, while body-weight and appetite are 
increased in most cases; and in many even the local conditions are decidedly 
improved, as shown by the physical signs. Creosote is not applicable to 
every case, in fact, it is of value only exceptionally and then when the stom- 
ach tolerates it. To give it to the point of disordering digestion is to do more 
harm than good. 

Creosote was advocated for phthisis by Reichenbach in 1833, and its use was revived by 
Bouchard and Gimbert in 1877, since which time it has been tried and approved by a long list 
of authorities, including Jaccoud, Dujardin-Beaumetz, Dieulafov, Germain See, Sommer- 
brodt, Von Brun, Guttmann, Douglas Powell, Burney Yeo, J. Solis-Cohen and many others, 
who all agree as to its utility, though differing as to its mode of action, its dosage, and the 
methods of administration. The number of cases dealt with by some of these observers is so 



CREOSOTUM. 247 

considerable that there is at least strong primd facie evidence in favor of this drug and its 
derivatives. Bouchard reported on 93 cases at first, and on more subsequently; Sommer- 
brodt's report included over 5,000 cases, treated during more than nine years; and Von Brun 
dealt with 1,700 cases. Professor Sommerbrodt contends that it is possible to administer the 
quantity necessary to inhibit the growth of the bacilli, and believes that he did so in many 
cases. He had the most gratifying success with this medication, and states that the more creo- 
sote the patient could bear the better was the result. Lepine uses creosote dissolved in 
oil, and finds that a much larger quantity can be used hypodermically than the stomach will 
tolerate. Picot injects a mixture of sterilized olive oil containing 1 per cent, of Iodoform and 
5 per cent, of Guaiacol, beginning with 1 mil. of the mixture and increasing the dose to 3 mils. 

Guaiacol is preferred by many for internal administration instead of creo- 
sote, being the principal ingredient of the latter, and of more definite chem- 
ical composition, though nearly or quite as irritating to the stomach. It may 
be given in mixture with wine or brandy, in capsules, or hypodermically in 
combination with cod-liver oil. When neither these agents agrees with the 
patient, useful and efficient substitutes are their carbonates or one of the 
unofficial derivatives. These preparations are well borne as they do not 
irritate the gastric mucous membrane or disturb the digestion. Creosote 
Carbonate is highly recommended in acute pulmonary inflammations by 
many clinicians, especially in pneumonia. 

The antipyretic power of Guaiacol, when painted on the surface of the 
body, was formerly utilized in the treatment of several diseases accompanied 
by hyperpyrexia. It has been replaced, however, by the application of the 
various methods of hydrotherapy with better results. The local application 
of Guaiacol is also decidedly anesthetic in effect, and has been utilized in 
orchitis, epididymitis, torticollis, neuralgic headache, the chest-pains of 
tuberculous subjects, tooth-ache, sciatica, rheumatism, and other painful 
affections. Only pure guaiacol should be used for this purpose, as an inferior 
quality produces a very grave cutaneous irritation. By some clinicians it is 
mixed with glycerin before application, in the proportion of 1 part to 8 of the 
latter, or even in equal quantity, and it is claimed that thereby no inconven- 
ience is experienced. In laryngeal tuberculosis the application of a 20 per 
cent, solution at first, gradually increased to full strength, has given very 
great satisfaction. According to Hare it is the best local application in acute 
follicular tonsillitis. 

Benzosol contains Guaiacol in the proportion of 54 per cent. In the intes- 
tinal canal the latter is probably set free by the action of the alkaline secretions, 
as benzosol is excreted by the urine in the form of guaiacol and benzoic acid 
combinations. Compared with guaiacol, this agent has the advantage of be- 
ing almost tasteless; hence it can be given in large doses without the digestive 
disturbance and disagreeable eructations produced by the parent substance 
when administered in liquids, and without the local irritant effect caused by the 
latter in capsules. In doses of 4 grains, gradually increased to 12 grains, thrice 
daily, it is said to have given as good results as creosote in the treatment of pul- 
monary tuberculosis. 



248 CROCUS CUBEBA. 

CROCUS, Saffron (Unofficial), — The stigmas of Crocus sativus, a plant of the nat. ord. 
Iridea?, cultivated in Europe, containing a volatile oil and coloring matter. So-called American 
Saffron is not Crocus but the flowers of Carthamus tinctorius. True Saffron is expensive, as it 
requires about 60,000 flowers to furnish one pound of the stigmas. Dose, gr. v-xx, in infusion. 

Saffron Tea, much used in domestic practice, is an infusion of Carthamus tinctorius, the 
Safflower. 

Crocus is a stimulant aromatic, having some antispasmodic and anodyne qualities. The 
hot infusion produces diaphoresis, probably by virtue of the hot water alone. It is said to 
have caused death with narcotic symptoms. On the continent of Europe it is employed as a 
stimulant and emmenagogue, but in this country its only use is as a coloring agent. The mis- 
called Saffron Tea noted above is used in domestic practice for measles and other exanthemata. 

CUBEBA, Cubeb, — is the dried unripe but fully-grown fruit of Piper Cubeba, 
a plant of the nat. ord. Piperaceae, culitivated in Java. It contains a Volatile 
Oil, which is official, an acrid resin composed in part of Cubebic Acid, also a 
fatty oil, gum, .and Cubebin, which is an insoluble, neutral, odorless and taste- 
less body. The volatile oil may be separated into Cubebene a, camphor, and 
Cubeben a liquid portion. The active principles are the volatile oil and cubebic 
acid, both of which are contained in the oleoresin. Cubeb should be kept whole 
and not pulverized until wanted for use. Dose of the powdered drug, gr. x- 
5j [av. gr. xv.] 

Preparations. 

Oleoresina Cubebae, Oleoresin of Cubeb, — extracted by alcohol. Dose, tijv-xx [av. 
n£viij.] 

Trochisci Cubeb ae, Troches of Cubeb, — each contains of the Oleoresin 2, Oil of Sassafras 
1, Extract of Glycyrrhiza 25, Acaciai2, and Syrup of Tolu q. s. to form 100 troches. Dose, 
j-iij. 

Oleum Cubeb as, Oil of Cubeb, — is the volatile oil, a colorless or pale greenish-yellow liquid, 
warm, aromatic taste, odor of cubeb and neutral reaction. Is soluble in an equal volume of 
alcohol. Dose, ttjjv-xx [a v. TTjjviij.] 

Cubeb belongs to the pepper family, and like black pepper is an aromatic 
stomachic and a stimulant diuretic in small or medium doses, but large doses 
derange digestion and may act as a gastro-intestinal irritant. Its constituents 
are eliminated by the bronchial mucous membrane, the skin and the kidneys, 
stimulating the genito-urinary passages, increasing the bronchial mucus, 
sweat and urine, and frequently causing an urticarial or vesicular eruption. 
It stimulates the venereal appetite, and promotes the menstrual discharge. 

Cubeb is particularly useful in affections of the bladder and urethra. It 
is used in the chronic stage of gonorrhea, in chronic cystitis, prostatorrhea and 
chronic bronchitis with excellent results. The powder is a good application 
in hay-fever, chronic nasal catarrh and follicular pharyngitis, blown on to the 
mucous membrane by an insufflator. It may also be smoked in cigarettes 
with temporary relief in cases of acute nasal catarrh with " stuffed" nasal pas- 
sages. In some subjects the continued use of cubeb produces nausea, 
hemorrhoids, hematuria, and severe headache. The troches are a useful prep- 
aration in chronic irritability of the fauces, pharynx and air-passages, and are 
much employed by singers and public speakers for their tonic effect on these 
parts and for the relief or prevention of hoarseness. 



CUNDURANGO CUPRUM. 249 

CUNDURANGO, Condurango, (Unofficial), — is the bark of Gonobulus Condor ango, nat. 
dod. Asclepiadeae, a native of Columbia and Ecuador. A fluidextract is on the market, the 
dose of which is n£xx-3j, or more. 

Cundurango is an astringent bitter, also a stomachic tonic and sedative. In South 
America it is employed as an alterative remedy in syphilis, and at one time it was supposed 
to be curative in gastric ulcer, in which its only value is as a sedative to the gastric mucous 
membrane, relieving the vomiting, pain and. bleeding. Its active principles are two glu- 
cosides, which in dogs cause ataxia and incoordination, increased motor activity, and 
finally convulsions, death occurring after 12 to 72 hours. 

CUPRUM, Copper, Cu, — is widely distributed in nature, and exists in 
minute quantity in many articles of food, also in the human body, especially 
in the blood, the liver, and the brain. Though its salts are actively poisonous, 
the metal itself is inert, but is oxidized and dissolved by fruit acids and salt 
water, hence the danger of using copper vessels for some cooking purposes. 
The Sulphate is the only official salt. 

Salts and Preparations of Copper. 

Cupri Sulphas, Copper Sulphate, CuS0 4 + 5H 2 0,— blue, translucent crystals, efflorescent, 
of nauseous, metallic taste and acid reaction, very soluble in water, soluble in 500 of alcohol. 
Its solution is blue by transmitted light, green by reflected light. Dose, as an emetic, gr. ij-v 
[av. gr. iv.] every 10 or 15 minutes, — as an astringent, gr. \-\ [av. gr. i.] 

Alkaline Cupric Tartrate Volumetric Solution, Fehling's Solution, — the official reagent 
for glucose, is prepared as follows: (1) Dissolve 34.64 grammes of pure Cupric Sulphate in 
water, to measure exactly 500 mils. (2) Dissolve 173 grammes of Potassium and Sodium 
Tartrate and 50 grammes of Sodium Hydroxide in water to measure exactly 500 mils. 
Keep the two solutions in small, rubber-stoppered bottles, separate; and for use mix ex- 
actly equal volumes of the two at the time required. One cubic centimeter of the mixed 
solution reduces 0.005 gramme (gr. ^3) of anhydrous glucose. 

Cuprum Ammoniatum, Ammoniated Copper (Unofficial), — is made by triturating 3 parts 
of Ammonium Carbonate with 4 of Cupric Sulphate until effervescence has ceased, then drying. 
A deep azure-blue powder of ammoniacal odor, a styptic, metallic taste, and alkaline reaction, 
soluble in water. Dose, gr. ^-j. 

Cupri Arsenis, Copper Arsenite, — is described under Arsentjm, page 153. 

Incompatibles. 
Incompatible with Copper Sulphate are: Alkalies, Ammonium Acetate, Arsenic Trioxide, 
Arsenites, Calcium Chloride, Carbonates, Ferric Acetate, Glucose in alkaline solution, Iodides, 
Lead Acetate, Lime-water, Mercuric Chloride, Potassium Tartrate, Phosphates, Silver Nitrate, 
Sodium Borate, Vegetable astringent infusions and tinctures; with Ammoniated Copper axe' 
Acids, Alkalies, Lime-water. 

Physiological Action. 

The salts of Copper in toxic doses are gastro-intestinal irritants, producing 
a metallic taste, nausea with greenish-colored ejecta, purging of blood and 
mucus, constricted fauces, depressed heart action, hurried respiration and 
fever. Or, as with Arsenic, gastro-enteritis may not occur, but instead pro- 
found nervous symptoms, as headache, defective coordination, coma and 
convulsions. After death fatty degeneration of the liver and parenchymat- 
ous changes in the kidney are found. The symptoms of chronic poisoning 
are bronchial irritation and catarrh, gastro-intestinal catarrh, colic with 
diarrhea [Lead produces colic with constipation], dysentery, nausea, ema- 
ciation, anemia, salivation, and a green line (sulphide) along the margin of 
the gums in those who do not clean their teeth. The nervous symptoms 



250 CUPRUM. 

above mentioned are also usually well marked. It is interesting to note, 
however, that chronic copper poisoning is rare and as Edsall points out, no 
evidence of this condition has been found among the employees of the great 
copper companies in Michigan, or among the people who live in the regions 
about the mines and who drink water that often contains copper. Brass- 
founding is known to cause various forms of disease, as gout, chronic nephri- 
tis, progressive paresis of the legs, tremor, muscular wasting, and locomotor 
ataxia. A group of symptoms known as "brass-founders' ague," has also 
been noticed. The fit of ague is ushered in by languor and depression, then 
follow prostration with pallor, cold sweats, and chills, which may even 
amount to rigors, with chattering of the teeth, precordial anxiety, headache, 
nausea, and muscular pains. The onset of vomiting arrests the symptoms 
and usually is followed by sleep, from which the patient awakens almost well. 
It is not clear whether these symptoms are due to copper or to zinc, both of 
which enter into the composition of brass, and some investigators contend 
that they are not to be credited to copper, but to its impurities, lead and 
arsenic. Brass workers are a shockingly short-lived lot and suffer from gas- 
trointestinal diseases, anemia and chronic lung diseases (Edsall). 

Copper Sulphate is a simple, irritant emetic, producing prompt and con- 
tinued vomiting with but little nausea or depression. When emesis fails 
to occur the drug passes into the intestine causing diarrhea, but almost never 
symptoms of poisoning because of its elimination in this manner and its very 
slow absorption. In small doses it is a general tonic not unlike Arsenic and is 
astringent to the gastro-intestinal tract. Externally applied in solution it is a 
useful stimulant and astringent to diseased mucous surfaces, and is mildly 
caustic if used in substance. The Acetate is possessed of the same general 
action as the sulphate. Its local action is stimulant and escharotic. The 
impure acetate (verdigris) is a violently irritant poison. Ammoniated Copper 
has no special action other than that of the sulphate. 

Copper sulphate has been used to color preserved vegetables, a practice 
which should be prohibited in the absence of proof that even such small 
amounts are harmless. 

Therapeutics. 

The Sulphate is a prompt and efficient emetic which ought not, however, be 
used in the presence of more efficient and less dangerous remedies. It has 
long been recommended in Phosphorus poisoning as a chemical antidote and 
to produce emesis. Thornton, however, has shown that its use for this pur- 
pose is not without danger and although it is theoretically of value, practi- 
cally it is better to use potassium permanganate instead. Fifteen or twenty 
grains may be dissolved in § iv of water, and a teaspoonf ul or more, according 
to age, given every ten minutes until vomiting is produced. In acute diar- 
rhea and chronic dysentery it is a good astringent in doses of gr. J with opium, 



CURARE. 251 

and in gastro-intestinal catarrh it is equally efficient. Locally, it is used 
with benefit in throat affections, gonorrhea, granular lids and corneal ulcers, 
indolent granulations and chronic inflammation of mucous membranes. In 
most of these affections weak solutions (gr. § to J to the § ) are best, but in 
granular conjunctivitis the smooth crystal may be rubbed quickly over the 
surface once daily. A very efficient method of relieving the painful small 
aphthous ulcers about the mouth is to touch them lightly wtih a smooth 
crystal. 

Copper Sulphate is advocated for the purification of drinking water. It 
has been shown that certain organisms which pollute public water supplies are 
effectually destroyed by one part of this salt in ten million parts of water, and 
that one part in fifty millions of water destroys most algae in a few hours; also 
that in the proportion of 1 to 100,000 it is fatal to cholera and typhoid germs 
in 4 or 5 hours. As J of a grain can be ingested daily without the slightest harm, 
this treatment of drinking water is not injurious, for it would require the daily 
ingestion of two gallons of water so treated to obtain this quantity of the salt 
(Moore). Dr. Doty finds that a mixture of copper sulphate and calcium oxide 
(unslaked lime) in ten parts of water gives a precipitate which is one of the most 
efficient deodorants and disinfectants. 

CURARE, Woorara (Unofficial), — is a vegetable extract obtained from 
various members of the Strychnos family, also from Paullinia curare and other 
plants. It is used in S. America as an arrow-poison under the names Caroval 
and Vao. Its activity depends upon two groups of alkaloids, the curines 
possessing little or no curare action and the curarines which produce the 
typical effects. 

The dose of Curare is gr. 3*5— £ hypodermically, — of Curarine, gr. -g-g- o "~ io 7 hypodermically, 
or S 1 "- rro~To by the stomach, but as the samples vary greatly in activity they should be tried 
on some inferior animal before being administered to man. 

Incompatibles are: all Caustic Alkalies, as they destroy the alkaloid. Physiologically 
incompatible are: Strychnine, Atropine. 

Physiological Action and Therapeutics. 

Curare is a paralyzer of the voluntary muscles, affecting them through the 
end-organs of the motor nerves. It does not at first act upon the brain or spinal 
cord, but if life be prolonged by artificial respiration the cord, sensory nerves 
and even the muscular tissue become affected. The heart, at first quickened, 
becomes depressed, the blood-pressure is lowered, the eyelids droop, the eye- 
balls protrude, vision is disordered, intestinal peristalsis and sensibility to stimuli 
are greatly increased, and an artificial glycosuria (curare-diabetes) is set up. 
The limbs are paralyzed first, death occurring by paralysis of respiration. The 
absorption of the drug by the stomach is very slow, as its active principle passes 
with difficulty through animal membranes, and its elimination, which takes 
place by the kidneys, being more rapid and complete than that of any other 



252 CUSSO DAMIANA. 

agent, no marked effect may be produced when it is administered internally. 
When hypodermically injected its action is very prompt. The urine of a curar- 
ized animal will poison another, and that of the second animal will paralyze 
a third. Compared with other motor depressants Curarine and Coniine par- 
alyze the end-organs of the motor nerves, Gelsemine paralyzing the motor 
centres. 

Curare is chiefly used for experimental purposes on the lower animals. It 
has an historical interest from its having been the means by which Bernard 
demonstrated the existence of contractility as an essential endowment of mus- 
cular tissue. It has been used with some success in spasmodic nervous affec- 
tions, particularly in tetanus, both idiopathic and traumatic, in hydrophobia, 
chorea and epilepsy. It does not promise well as a therapeutic agent, but un- 
doubted cases of hydrophobia are reported by high authority as having been 
cured by this drug. 

CUSSO, Kousso (Unofficial), — is the dried female inflorescence of Hagenia abyssinica, an 
Abyssinian tree of the nat. ord. Rosacese. It contains tannic acid, a volatile oil, and a crystal- 
line principle named Koussin. Dose, 3ij~5j [av. §ss.] 

Cusso has little or no effect except the nausea, vomiting, colic and slight diarrhea pro- 
duced by large doses. Its chief action is anthelmintic against both varieties of tapeworm, but 
it rarely expels the head of the parasite, and is very nauseous to the taste and difficult of reten- 
tion by the stomach in the large doses necessary to efficiency. From 3ij to §j of the flowers 
infused in §iv of boiling water is the usual dose, which should be taken on an empty stomach 
and followed by a castor-oil or saline purge after 3 or 4 hours. An emulsion of a 6 per cent, 
infusion with castor-oil, yolk of egg, a few drops of ether and oil of anise with 10 to 20 drops of 
the Oleoresin of Aspidium, is more agreeable and efficient than the infusion alone. 

CYDONIUM, Quince Seed (Unofficial), — is the seed of Cydonia vulgaris, a tree of the 
nat. ord. Rosaceae, native in Crete and Austria, and cultivated elsewhere. The seeds placed in 
water swell up, forming a mucilaginous mass. The mucilage is the only constituent of impor- 
tance and is contained in the epithelial cells. It is named Cydonin, and is considered to be a 
compound of gum and cellulose. 

Mucilago Cydonii, Mucilage of Cydonium (Unofficial), — is prepared by macerating 2 
parts of Cydonium in 100 of Distilled Water. Dose, indefinite. 

Cydonium is of value for its mucilage, which is used as a bland, demulcent application in 
conjunctivitis, abrasions of the skin, and fissures of the mucous membranes, and as a vehicle 
for injections in gonorrhea. Internally it may be used as a soothing remedy for the throat, 
stomach, or intestines. The preparation known as Bandoline, used as a hair-dressing, is iden- 
tical with mucilage of cydonium. 

CYPRIPEDIUM (Unofficial), — is the dried rhizome and roots of Cypripedium pubes- 
cens, the Ladies' slipper, or of C. parvifiorum, the moccasin-plant, or American valerian 
(nat. ord. Orchidaceae). It contains a volatile acid, resins, and tannin. 

Fluidextractum Cypripedii, Fluidextract of Cypripedium (Unofficial), — Dose, njx-xxx 
[av. ttjjxv.1 

Cypripedium is said to possess the same general properties as Valerian, whence one of 
its common names, American valerian. It is a popular remedy in some parts of the United 
States for nervous hyperesthesia, headaches and sleeplessness. 

DAMIANA (Unofficial), — the leaf of Turner a aphrodisiaca, a plant of the nat. ord. Turner- 
aceae, growing in Mexico and Lower California. Several varieties of so-called Damiana are 
in the market, but the true leaf is of a light-green color, small, lanceolate, and dentate along 
the margin. It contains a volatile oil and a resin. Dose, oj daily. 

Damiana is said to be a powerful aphrodisiac in cases of sexual atony, but the published 
reports of its use vary greatly as to its efficacy. It is probably a stimulant diuretic, a bitter 
tonic, and a purgative in sufficient doses. Besides its use as an aphrodisiac Damiana has 



DIGITALIS. 253 

been administered with benefit in some forms of cerebral exhaustion and general atony of the 
nervous system, also in sick headache and in some few cases of paralysis. It forms the chief 
stock in trade of the numerous charlatans who fill the daily papers with advertisements of 
" manhood- restorers." 

DIGITALIS, Digitalis, —is the carefully dried leaves of Digitalis purpurea, 
the purple foxglove, a plant of the nat. ord. Scrophulariaceae, which grows 
wild in Europe, and is cultivated in this country, often in private gardens for 
its beautiful spike of purple flowers, and largely by the Shakers for the drug 
market. Dose, gr. ss-ij [av. gr. j.] 

In order to standardize and insure the activity of Digitalis and its preparations the 
U. S. P. IX provides for a biological assay which is also applicable to the other members of 
the so-called "Digitalis Group," namely, strophanthus and squill. The method of assay 
is known as the "one -hour frog" and consists essentially in ascertaining the dose required to 
bring the heart of a standard-sized frog to a systolic standstill in one hour's time. The 
method is described in detail in the Pharmacopoeia, from which the following table has been 
taken: 

Mil for each gramme of body- 
weight of frog 
Digitalis : 

Leaves (in the form of tincture) o . 0006 

Fluidextract o . 0006 

Tincture o . 006 

Strophanthus : 

Seed (in the form of tincture) o . 000006 

Tincture o . 00006 

Squill: 

Dried Squill (in the form of tincture) o . 0006 

Fluidextract o . 0006 

Tincture o . 006 

Constituents of Digitalis. 

The supposed active principle of Digitalis was first designated by the term 
Digitalinum (Digitalin), under which name a substance was official in the 
U. S. Phar. and a process was given therein for its extraction, until the revision 
of 1880, when it was omitted. It was an amorphous product, of complex com- 
position, and did not represent Digitalis. In 187 1 Nativelle received the Orfila 
prize from the French Academy for the discovery of a crystalline principle in 
Digitalis, which he named Digitaline. This was supposed to be the active 
principle of the plant, until Roucher (1872) and Schmiedeberg (1875) found 
it to be a complex body consisting of a mixture of Digitalin and Digitoxin. 

Schmiedeberg's latest analysis is now accepted as the most accurate determination yet 
obtained of this vexed question. He enumerates five principles as contained in Digitalis, 
namely — 

Digitalin, C 35 H 36 14 , a granular glucoside, soluble in alcohol, almost insoluble in water, 
sparingly soluble in ether or chloroform; possesses in a high degree the medicinal action of 
digitalis; the active ingredient of Homolle's French Digitalin and the German Digitalin, 
both of which, together with most of the brands of "Digitalin" on the market, are mixtures 
of glucosides and not pure Digitalin. 

Digitoxin, C34H 54 0n, a crystalline principle, perhaps a glucoside; soluble in alcohol, 
slowly in chloroform, sparingly in ether, quite insoluble in water; the most toxic of all the 
constituents, cumulative and most nearly representing digitalis in its action; the principal 
constituent of Nativelle's prize Digitaline. It is the chief active principle of Digitalis. 



254 DIGITALIS. 

Digitalein, an amorphous glucoside, soluble in both water and alcohol, insoluble in ether 
or in chloroform. Its action on the heart is non-cumulative and it causes no irritation when 
subcutaneously injected. 

Digitonin, C54H92O28, a Saponin, soluble in water, insoluble in cold alcohol, in ether or 
in chloroform. It is somewhat antagonistic in action to the preceding principles, and 
possesses the property of bringing into solution these otherwise insoluble substances as, 
for example, in the infusion. 

Digitin, a crystalline body, insoluble in ether or chloroform, scarcely soluble in water, 
more readily in alcohol. It is physiologically inert. 

The first three are cardiac stimulants and are highly poisonous. Digitonin is a direct 
depressant of the heart and antagonizes the stimulant action of the others. Ail are non- 
nitrogenous and are glucosides. 

Official Preparations. 
Fluidextractum Digitalis, Fluidextract of Digitalis, — Dose, ttjjss— iij [av. ttjjj.] 

Tinctura Digitalis, Tincture of Digitalis, — 10 per cent., in diluted Alcohol. Dose, 
irgv-xx [av. TT^viij.] 

Infusum Digitalis, Infusion of Digitalis, — Digitalis i|, Cinnamon Water 15, Boiling 
Water 50, Water to 100. Dose, 3j _ iij [av. 5j-] Notice that the dose is in drachms, 
not in ounces. The British infusion has less than £ the strength of the above and is given in 
doses of 5ij-iv. In France a cold infusion is preferred, 5 grains of the powdered drug being 
macerated in 4 ounces of cold water for 8 to 12 hours and then filtered; dose §ss every two 
hours. 

Unofficial Preparations. 

Digipuratum, Extractum Digitalis Depuratum, — is free from the inactive constituents and 
gastric irritants and from all Digitonin. It is physiologically standardized. Dose, a tablet 
(equals i£ grains of potent leaf) 3 to 4 times daily. 

Digipoten, — a mixture of digitalis glucosides in soluble form diluted with milk sugar to 
give the preparation an activity approximately equal to digitalis. It is physiologically 
standardized. Dose, same as digitalis. 

Digitol, — a trade name for a fat-free tincture of digitalis. It is physiologically stand- 
ardized and used in same dose as the official tincture. The advantage of freedom from 
fat is not generally considered of importance (N.N.R.). 

Homolle's or Quivenne's Digitalin {French Amorphous Digitalin), — is much used in 
France in form of granules. Consists chiefly of Digitalin with a little Digitoxin, and pos- 
sesses the action of the leaves. An amorphous, yellowish- white powder or small scales, 
intensely bitter, inodorous, but irritant to the nostrils. Dose, gr. -o\o~ih, equal to about 
gr. jss of the powdered leaves. 

Nativelle's Digitaline {French Crystalline Digitalin), — consists largely of Digitoxin, 
and is cumulative in action. Light, white, crystalline tufts of needles, of very bitter taste; 
soluble in alcohol, insoluble in water. Dose, gr. Tinr'eV m pill. 

Digitalinum Verum, — is the distinguishing name given by Kiliani to Schmiedeberg's 
Digitalin, which he believes to be the best form in which to prescribe Digitalis. Its composi- 
tion is definite, it is obtainable commercially in a sufficiently pure condition, it possesses the 
medicinal action of Digitalis on the heart, and is soluble in 100 parts of 50 per cent, alcohol, 
and in 1000 of water. Dose, gr. jfa every 2 or 3 hours. 

Digitalinum Germanicum, German Digitalin (Merck), — is a mixture of the Digitalin 
verum, with Digitalein, Digitoxin, and certain inert principles. It occurs as a white powder, 
soluble in water and in alcohol. Dose, gr. eV^o* thrice daily. Recent investigations 
would seem to indicate that this preparation can be given in larger doses without ill effects, 
e.g., gr. T V-| thrice daily. 

Digitoxhmm, Digitoxin, — is crystalline, soluble in alcohol, insoluble in water, and is the 
chief active principle of Digitalis and most nearly represents its action. Dose, gr. -ofo— roo 
as beginning dose; gr. yfjy as continuing dose. The dose must be reduced or stopped as 
soon as toxic effects are noticed. 



DIGITALIS. 255 

Allied Plants (Digitalis Allies). 

Adonis Vernalis (Unofficial), — is a plant of the nat. ord. Ranunculaceae 
(which includes Aconite, Pulsatilla, Podophyllum, etc.). It contains a gluco- 
side named Adonidin, which acts almost exactly like Digitalin, but is much more 
powerful, and without any cumulative property. The Infusion (5ss-ij of the 
root to § vj of water) may be given in doses of § ss every 2-4 hours, or Adonidin 
itself, in doses of gr. J, four to six times daily. 

Erythrophlceum, Casca Bark, Sassy Bark, Ordeal Bark (Unofficial), — is the 
bark of Erythrophlceum Guinense, an African tree of the nat. ord. Leguminosae; 
used by the negroes as an ordeal in witchcraft trials. When used in quantity, 
it causes severe cephalalgia, nausea and vomiting, narcosis and death. It is 
used in Africa as a remedy for intermittents, dysentery and colic; — and in Eng- 
land it is believed to resemble Digitalis in its action on both the circulation and 
the renal secretion. It contains a poisonous glucoside, Erythrophlasin, which 
seems to combine the properties of both Digitalin and Picrotoxin. Dose of the 
tincture (1 in 10) Tfl,v-x; of the watery extract, -gr. ss-J. 

Apocynum, Convallaria, Hellebore, Scilla, and Strophanthus (including 
Oubain), are each described in its proper alphabetical order. 

Incompatibles. 
Incompatible with Digitalis are: Acids, Alkalies, Alkaloidal precipitants (see page 6), 
Cinchona infusion, Ferrous Sulphate, Lead Acetate, Tannic Acid, Vegetable astringents, 
Syrupy and Aqueous solutions. Physiologically incompatible are: Aconite, Chloral Hydrate, 
Cocaine, Glonoin, Muscarine, Saponin, Scoparin, Strychnine. 

Physiological Action. 

Locally, digitalis is irritant to mucous membranes, and when injected sub- 
cutaneously causes pain. Digitoxin is the most irritating and digitalein is 
the least irritating of the digitalis principles. When administered by mouth 
it may produce after several days nausea and vomiting, which is more the 
result of action on the vomiting centre than to irritation of the stomach. 
The principal action of digitalis is upon the cardiovascular system; acting 
upon the vagus nerves, sinus node, cardiac muscle, auriculoventricular band 
and coronary and systemic vessels. It exerts an inhibiting influence upon 
the sinus node through the vagus, as a result of which there is a slowing of the 
rate of the heart from a retardation of impulses arising in the node. The 
vagus effect is due to the stimulation of the vagus centres and perhaps, to a 
slight extent, the vagus nerve endings. In toxic doses there occurs an alter- 
ation in the cardiac rhythm due to an interference with the regular projection 
of impulses from the sinus. This is known as sinus or phasic arrhythmia. 
Digitalis acts directly upon the cardiac muscle increasing its tonicity and 
contractility, especially in conditions where tonicity and contractility are 
subnormal. In toxic doses it may increase the irritability or excitability of 
the heart to the point of producing premature contractions and paroxysms of 



256 DIGITALIS. 

tachycardia. Digitalis reduces the conductivity of the auriculoventricular 
bundle, so that impulses are less readily transmitted from the auricle to the 
ventricle. This is a result of vagus stimulation and may be prevented by 
atropine. The interference with conduction varies from slight prolongation 
of the auriculoventricular intervals to the complete interference known as 
heart-block. The slowing of the heart which is seen under digitalis is due, 
therefore, partly to the effect upon the sinus node and partly to the inter- 
ference with the conduction of impulses through the auriculoventricular 
bundle. In toxic doses in animals constriction of the coronary arteries occurs, 
but this action is negligible on human beings when the drug is given in ther- 
apeutic doses. The coronary circulation is improved indirectly as a result of 
the increased aortic pressure and the prolongation of diastole. As a result of 
the improvement in coronary circulation the nutrition of the heart muscle is 
improved and its recuperation facilitated. Hare and Coplin showed that 
digitalis administered to growing animals produces an increase in the weight 
of the heart in contrast to controls. The effects of digitalis upon the sys- 
temic arteries differ in laboratory experiments and at the bedside. In 
animals it causes a distinct rise in the blood pressure due to vasoconstriction 
resulting from stimulation of the vasomotor system centrally and peripher- 
ally. In most instances these effects have resulted from what in man would 
be considered as toxic doses. In therapeutic doses in man distinct vasocon- 
striction does not occur and the improvement in peripheral circulation is not 
dependent upon any rise in the arterial pressure. Digitalis exerts but little 
influence upon the kidneys in health. It acts as a diuretic in conditions 
associated with impairment of the circulation when the diuresis which results 
occurs from improvement in the general circulation and in the local kidney 
circulation, and not to any direct action upon the kidney cells. The respira- 
tory centre is mildly stimulated as a result of the improvement of the cerebral 
circulation. Toxic doses depress the respiratory centre. The vomiting 
centre is stimulated and the vomiting which results when full doses of digi- 
talis are administered is dependent upon this factor more than upon the local 
influence upon the gastric mucosa. Digitalis is absorbed slowly from the 
intestines and twelve to thirty-six hours or more may elapse before the sys- 
temic influence is noted. It is more slowly excreted, so that there is a ten- 
dency to accumulation in the system with poisoning if administration is con- 
tinued for any length of time. It is important to recognize the evidences of 
cumulative poisoning and if the drug is promptly stopped no harm results. 
Bastedo enumerates the conditions calling for stoppage of the drug as fol- 
lows: (1) Nausea becomes marked. (2) The radial pulse goes below 60. 
The pulse may become progressively slower for a few days after the drug 
is stopped, hence the necessity for ceasing its administration before the 
slowing has become extreme. (3) A rapid ventricle with rate unaffected by 
digitalis for several days suddenly becomes slower (heart-block). (4) A 



DIGITALIS. 



257 



regular ventricular rhythm changes to irregular, as from premature beats or 
the development of auricular fibrillation; or becomes intermittent, as from 
partial heart-block. (5) Paroxysmal tachycardia occurs. (6) The abso- 
lutely irregular rhythm of auricular fibrillation becomes slow and regular 
(complete heart-block), or shows coupled rhythm or phasic arrhythmia. 

Therapeutics. 

Digitalis is limited in its use to disorders of the circulation resulting from 
failing compensation of the heart in valvular lesions. It cannot be too 
strongly insisted upon that the mere presence of a valvular lesion does not 
indicate the use of digitalis, but the presence of failing compensation does. 
It acts by increasing the tonicity and contractility of the cardiac muscle, 
thus lessening the dilatation and increasing the force of contraction and by 
stimulating the vagus system slowing the rate. The improvement in the 
symptoms referable to the various organs is due to the improvement in the 
general and local circulation and not due to any direct action of digitalis 
upon the cells of the individual organ. The clinical usefulness of digitalis 
depends, therefore, upon its ability to influence the heart in conditions of fail- 
ing circulation. As previously stated, the determining factor in the use of 
digitalis is not the condition of the valve, but rather the disordered mechan- 
ism which results therefrom. The proper understanding of these disorders 
of the mechanisms of the heart beat is absolutely necessary if one is to use 
digitalis with maximum therapeutic efficiency. The reader is referred to the 
exceedingly valuable little book by Thomas Lewis dealing with the subject 
entitled " Clinical Disorders of the Heart Beat." In the absolute irregularity 
of auricular fibrillation, which constitutes 60 per cent, of the cases of cardiac 
failure in hospital practice, according to Lewis, digitalis finds its ideal indi- 
cation and gives at times almost miraculous results. The beneficial influ- 
ence in this condition is due to impairment of conduction of the auriculoven- 
tricular band from vagus stimulation, with the result that only a few of the 
myriads of impulses arising in the fibrillating auricle "get through" and the 
ventricle is caused to beat more slowly. In partial heart-block, sinus ar- 
rhythmia and premature contractions the use of digitalis is contraindicated. 
In complete heart-block, according to Bachman, it might be of some use because 
in this condition it can do no further harm with regard to the influence on the 
auric uloventricular bundle and may tend to quicken the beat and render it 
more effective. When used for auricular fibrillation the best results are 
obtained by starting with full doses until the effect of the drug is obtained and 
then continuing with small doses until evidences of cumulation occur. Al- 
though digitalis is especially effective in the absolute irregularity of auricular 
fibrillation, it is of distinctly less value and may be harmful, as stated above, 
in the other forms of arrhythmia. It may of itself produce various types of 
irregularity, the appearance of which call for stoppage of the drug. In acute 
17 



258 DIGITALIS. 

dilatation of the heart the use of strophanthus (the intravenous injection of 
strophanthin) is preferred to digitalis because of its rapid action. The results 
are often most striking. In acute myocarditis of toxic origin, and in fatty 
infiltration or degeneration, digitalis fails to be of value. In chronic myo- 
carditis, especially in those cases in which one has reason to suspect that coro- 
nary artery disease is present, digitalis fails to do good and may do harm. 
The older writers taught that aortic regurgitation contraindicated digitalis, 
but at present it is generally used if there is failing compensation. It is well 
to remember that in all instances where digitalis is given in full doses, and 
particularly in aortic regurgitations, that sudden rising in bed or to the 
upright position is dangerous a*nd fatal syncope has occurred. The patient 
should be warned against such action. Digitalis is frequently used in rapid 
heart action other than that due to auricular fibrillation, but its use is dis- 
appointing. In the rapid heart action of the acute infections and in the 
tachycardia of exophthalmic goitre, it frequently fails. 

A dministration. 

Of the four active principles contained in this plant, namely — Digitalin, 
Digitoxin, Digitalem and Digitonin, the first two are soluble in alcohol and 
practically insoluble in water, the third is soluble in both menstrua and the 
fourth is insoluble in alcohol but is freely soluble in water. Consequently all 
alcoholic preparations of Digitalis contain the first three principles and all 
aqueous ones contain the last two. In action the first three are very similar, 
producing the characteristic effects of the plant, while Digitonin is directly 
poisonous to the cardiac muscle, decreasing its contractile power. This prin- 
ciple produces dilatation of the arteries, generally antagonizes the action of 
the other constituents, and perhaps irritates the renal epithelium. Digitoxin 
most nearly represents Digitalis in action. When, therefore, the cardiac 
action of Digitalis is desired, the tincture should be employed, prohibiting the 
ingestion of any aqueous fluid within 20 minutes, either before or after swal- 
lowing it. 

Adonis, when fresh, has acrid, irritant and vesicant properties, which disappear when the 
plant is dried. It affects the heart in the same manner as Digitalis, but more promptly, slow- 
ing, regulating and strengthening the beats and raising the blood-pressure in the arteries. In 
consequence of the latter action it is a diuretic and removes edema and dropsy. It also slows 
and deepens the respiration, and relieves dyspnea. In toxic dose it paralyzes the terminals 
of the vagus, excites the accelerator apparatus of the heart, and finally causes paralysis of the 
cardiac motor nerves. It is rapidly eliminated and does not accumulate in the system. Adon- 
idin has similar action, which is almost exactly like that of digitalin, but stronger, and about 
ten times as powerful as that of digitoxin (Brunton). In large doses it causes either vomiting 
or diarrhea (Hu chard). 

In Russia this plant is a household remedy for cardiac and renal dropsy, and m Siberia it 
is used as an abortifacient. It is useful in cases of uncompensated heart disease^ in which, by 
reason of arrhythmia and feeble cardiac energy, grave circulatory disorders exist, # especially 
dyspnea and dropsy. It is recommended in functional irregularity of the heart and in palpita- 
tion without any cardiac lesion (Da Costa). It acts more promptly than digitalis and may be 
administered for months without cumulative effect (Durand), hence it is preferred to digitalis 
in those cases of mitral or aortic regurgitation in which the latter drug is not well tolerated. In 



DIOSCOREA — ELASTICA 259 

general it is less certainly beneficial in valvular disease than digitalis, and should be used only 
when the latter fails (Nothnagel). In connection with the bromides this drug has been 
successfully used in epilepsy. 

DIOSCOREA, Wild Yam, Colic-root (Unofficial) ,— is the rhizome of Dioscorea villosa, 
a creeping plant of the nat. ord. Dioscoraceas, indigenous to the eastern U. S. It contains 
an acid resin, and is reported to be expectorant and diaphoretic in action, as well as stimu- 
lating to the intestinal canal, and in large doses to cause general neuralgic pains with erotic 
excitement. It is used with success in bilious colic; and in the cramps of cholera morbus, 
spasmodic hiccough, dysmenorrhea and nocturnal emissions of sthenic type it is said to be 
very efficient. A powdered extract named Dioscorein is on the market, the dose of which is 
gr. j-iv. A fluidextract made according to the pharmacopceial rule may be administered 
in doses of ttjjxv-xxx. 

DITA BARK (Unofficial), — is the bark of Alstonia scholaris, a tree of the nat. ord. Apo- 
cynaceae, growing in the Philippine Islands. It contains two active alkaloids, Ditaine and 
Ditamine, the former of which has an action identical with that of Curare. The bark is con- 
sidered tonic and antiperiodic, and is used in the East as a remedy for intermittents. It may 
be given in doses of 3j-ij of the tincture, or gr. iij-vi of the powder, or TT£iij-vi of the fluid- 
extract. 

The Australian bitter bark, Alstonia constricta, yields an alkaloid Alstonine, which re- 
sembles quinine in many respects. A tincture of the bark has slight diuretic and diaphoretic 
action and has been used with benefit in influenza. 

DROSERA, Sundew (Unofficial), — a fluidextract of Drosera rotundifolia, the round- 
leaved Sundew, is said to have been successfully used in whooping-cough and other spasmodic 
coughs; especially when marked by violent paroxysms, the cough being loud and harsh, and 
followed by bleeding from the nose or mouth, and perhaps by vomiting of the contents of the 
stomach. Dose of the fluidextract, irjjv-xx. 

DULCAMARA, Bittersweet (Unofficial), — the young branches of Solarium Dulcamara, 
the woody night-shade, a shrub of the nat. ord. Solanaceae, growing in Europe and N. 
America. It contains the glucoside Dulcamarin, and the alkaloid Solanine. 

Dulcamara is but imperfectly understood. In overdoses it has produced nausea and 
vomiting, vertigo, convulsive muscular movements, pruritus, erythematous eruptions on 
the skin, and languid circulation with a dusky color of the face and hands. In children 
who have eaten the berries there have been observed signs of severe enteralgia, abdominal 
tenderness, nausea, thirst, heat in the throat and chest, great prostration, rapid pulse, 
quick and painful respiration. In very large doses it is a narcotic poison. 

Dulcamara was formerly used in a variety of affections, as herpetic diseases, chronic 
rheumatism, gout, and jaundice. It is now obsolete. 

ELASTICA, Rubber {Caoutchouc), — is the prepared milk-juice of several 
species of Hevea (nat. ord. Euphorbiaceae), known in commerce as Para Rub- 
ber. It is very elastic, insoluble in water, dilute acids, or dilute solutions of 
alkalies, soluble in chloroform, carbon disulphide, oil of turpentine, benzin and 
benzol. When pure, or nearly pure, it floats on water. 

Rubber is a hydrocarbon, and may be combined with sulphur by the aid 
of heat (vulcanized), which process, long continued, converts it into hard rub- 
ber. It is used in the fabrication of catheters, bougies, pessaries, court plaster, 
bandages, elastic stockings, tubing, etc. An analogous substance is — 

Gutta-percha (Unofficial), — the concrete exudation of Isonandra gutta, a large tree of the 
nat. ord. Sapotaceae, growing in the Malay peninsula and adjoining islands. It occurs in 
tough but somewhat flexible pieces, of grayish or yellowish color, plastic above 140 F., soft at 
212 F., insoluble in water or alcohol, soluble in chloroform, oil of turpentine, carbon disul- 
phide, benzin and benzol. It contains a hydrocarbon, Gutta, C 10 H lfi (80 per cent.), two resins 
named Fluavil and Albau, also a volatile oil, salts, fat and coloring matter. 



260 ELATE RINUM — ERG OTA. 

Liquor Gutta-perchae, Solution of Gutta-percha (Unofficial),— Gutta-percha 9, Carbonate 
of Lead 10, in Chloroform 91. Used as a protective application to eruptions and slight 
wounds, the evaporation of the menstruum leaving behind a thin adhesive and non-irritating 
pellicle. 

Emplastrum Elasticum, Rubber Plaster, Rubber Adhesive Plaster, — is an official prepara- 
tion consisting of a mixture of rubber, resins and waxes, with a filler of an absorbent powder, 
such as orris root or starch, mechanically mixed and spread upon cotton or other fabric. 

Gutta-percha has neither physiological action nor therapeutics, being used for its physical 
qualities alone. In surgical practice it has several applications, making a good material for 
splints, as it can be softened in hot water and adapted to any surface while pliable. From 
it are manufactured pessaries, specula, stethoscopes and other instruments. The solution may 
be used as a protective covering for excoriations and slight wounds, and to paint over the line 
of suture after post-mortem examinations. 

ELATERINUM, Elaterin, C 20 H 28 O 5 ,— is a neutral principle extracted 

from Elaterium, a substance deposited by the juice of the fruit of Ecballium 

Elaterium, the squirting cucumber, a European plant of the nat. ord. Cucur- 

bitaceae. Elaterin occurs in small, colorless scales or prisms, of bitter taste and 

neutral reaction, insoluble in water, soluble in 325 of alcohol and in solutions of 

the alkalies. Dose, gr. ^o~tV I av - § r - "sV-l 

Trituratio Elaterini, Trituration of Elaterin, — Elaterin 10, Sugar of Milk 90, thoroughly 
mixed by trituration. Dose, gr. \-] [av. gr. ss.] 

Elaterin is the most powerful of the hydragogue cathartics, causing pro- 
fuse, watery stools, and when given in large doses great prostration and gastro- 
intestinal irritation, nausea and vomiting. In the lower animals it does not 
produce purgation, but profoundly impresses the nervous system, causing ir- 
regular breathing, convulsions and death. Its chief use is to produce free watery 
discharges in ascites, anasarca, uremia and cerebral disorders, but while the 
most efficient agent we possess for this purpose it must be used with great cau- 
tion in the aged and feeble, as its action is very depressant. 

Aside from its action on the excretory functions of the bowels and kidneys, 
Elaterium excites absorption of fluid from the tissue spaces, and has removed 
edema when administered in non-purgative doses. 

ERGOTA, Ergot {Ergot of Rye), — is the sclerotium (compact mycelium 
or spawn, intermediate fibrous stage) of Claviceps purpurea (class Fungi), re- 
placing the grain of .Rye, Secale cereale (nat. ord. Gramineae) . It occurs in fusi- 
form, curved, grain-like bodies, of purplish-black color, peculiar, heavy odor, 
and oily, disagreeable taste. It should be only moderately dried, preserved 
in a close vessel, and have a few drops of chloroform dropped upon it from 
time to time, to prevent the development of insects. When more than one year 
old it is unfit for use. Dose, gr. x-5j [av. gr. xxx.] 

Composition of Ergot. 

Ergot contains a number of active principles of which four are important 
— two alkaloids, Ergotoxine and Ergotinine, and two closely allied principles 



ERGOTA. 26l 

(sometimes spoken of as putrefactive principles because of their presence in 
putrefying flesh), Tyr amine and Histamine. 

Ergotoxine, or Hydroergotinine, C35H41O6N5, is the active alkaloid of 
Ergot. Ergotoxine is amorphous, insoluble in water, readily soluble in alco- 
hol, rather unstable and readily converted by loss of water into Ergotinine. 

Ergotinine, C35H39O5N5, is an inactive, or at least very weak alkaloid of 
Ergot. Ergotinine is crystalline, insoluble in water, sparingly soluble in 
alcohol, and may be converted into the active Ergotoxine by hydration 
(Hydroergotinine). 

Tyr amine, or Para-hydroxyphenylethylamine, is the important putre- 
factive principle. It is closely allied chemically and in its physiological action 
to epinephrine. It is soluble in water and probably constitutes the chief 
active principle of the aqueous preparations of Ergot. It is largely respon- 
sible for the vascular effects of Ergot, and also causes active contraction of 
the pregnant uterus. The uterine action is considered unimportant by some 
investigators. 

Histamine, or Beta-iminazolylethylamine, is considered as relatively 
unimportant because of its small quantity. It is, however, a powerful 
uterine stimulant and lowers the blood pressure. Tyramine and Histamine 
can be prepared synthetically. 

The composition of Ergot and the nomenclature of its supposed constituents were 
subjects upon which a great diversity of opinion existed in the past. Barger and Dale 
tabulated the relationship between some of these preparations and the active principles 
now known to exist, as follows: 

Ecbolin and ergotin (Wenzell) : Mixtures of alkaloids, containing cholin (Meulenhoff). 

Sphacelinic acid (Kobert) : Inactive resin with adherent alkaloid. 

Cornutin (Kobert) : An alkaloidal resin, probably containing some ergotoxin, and also 
some other active substance which may be a decomposition product of ergotoxin. 

Cornutin (Keller) : Impure mixture of ergotinin with ergotoxin. 

Chrysotoxin (Jacobi) : Inactive yellow coloring-matter with a small proportion of ad- 
herent alkaloid. 

Secalintoxin (Jacobi) : Mixture of ergotoxin and ergotinin. 

Sphseclotoxin (jacobi) : Impure ergotoxin. 

Hydroergotinin (Kraft) : Recent synonym for ergotoxin. 

Preparations. 
Extractum Ergotae, Extract of Ergot, — Dose, gr. ij-x [av. gr. iv.] 
Fluidextractum Ergotae, Fluidextract of Ergot, — Dose, Tj#x-3j [av. tt#xxx.] 
Injectio Ergotae Hypodermica, Hypodermic Injection of Ergot (B. P.), — is a 33 percent. 

solution of the extract, in distilled water, with about 1 per cent, of Phenol. It should be 

recently prepared. Dose, hypodermically, ttjjv-x. 

Unofficial Preparations. 

Ergotin (Unofficial), — is the name of several watery extracts found on the market, and 
varying much in action from each other and from the parent drug. 

Ergotinine Citrate, — Dose, gr. 2 Jo~ro hypodermically. 

Extractum Ergotae Purificatum, Bonjean's Ergotin, Merck's Ergotin, — Dose, gr. iij-viij. 

Secacornin, — a standardized solution of the active principles of Ergot in water, glycer- 
ine and alcohol (7! per cent.); of which one mil corresponds to four grams Ergot. Dose, 
TT£viij-xv. 



262 ERGOTA. 

Cornutol, — a liquid extract of Ergot, biologically tested, containing the water soluble, 
alcohol insoluble, constituents of Ergot and about 10 per cent, alcohol. It can be given 
hypodermically or by mouth. Dose, TT£x-5j. 

Incompatibles. 

Incompatible with Ergot preparations are: Tannic Acid and other alkaloidal precipitants 
(see page 6), also Caustic Alkalies, Metallic Salts. Physiologically incompatible with its 
action on the circulation are: Aconite, Amyl Nitrite, Lobelia, Tobacco, Veratrum. 

Physiological Action. 

Ergot is a powerful stimulant to sympathetic nerve endings having motor 
functions, a vaso-constrictor, a cardiac sedative, a motor excitant, and a 
stimulant of involuntary muscular tissue. After a full dose there is at first a 
brief fall of the blood-pressure, due to the depressant action of the drug on the 
heart; but the vessels soon contract throughout the body, the blood-pressure 
is greatly raised, and the blood-supply being decreased an arterial ischemia 
results. This effect is believed to be due to stimulation of the vaso-constrictor 
nerve endings in the walls of the vessels. A very large dose depresses both 
the heart and the peripheral nerve endings, the primary fall of blood-pressure 
continues, and progressive paralysis of the cardiac and vaso-motor apparatus 
results. In the usual therapeutic dose a definite rise in blood-pressure is 
rarely obtained although Bastedo states that a hypodermatic or intravenous 
dose of tyramine is a practical means of raising the blood-pressure in an 
emergency. 

Ergot causes powerful contractions of the parturient uterus by stimulating 
the peripheral nerve endings — the sympathetic myoneural junctions — in the 
uterus. This action is not so constant on the impregnated but not parturient 
womb, and though it often produces abortion it frequently fails to initiate 
uterine contraction in pregnant women. It arrests post-partum hemorrhage 
by laterally closing the blood outlets in spite of the increased pressure in the 
vessels. It increases intestinal peristalsis, blanches the intestinal vessels, 
and lessens the secretion of the urine, saliva, sweat, and milk. 

The toxic phenomena produced by Ergot are divided into two classes, 
according as the drug is taken in large quantity for a short time, or in small 
doses for a considerable period. In a large dose it acts as a gastro-intestinal 
irritant, causing nausea and vomiting, gastralgia, colic, thirst, and purging. 
It slows the heart, raises the arterial tension greatly, dilates the pupils and 
produces pallor, vertigo and frontal headache. It stimulates the contraction 
of unstriped muscular fibre, especially affecting the sphincters and causing 
contraction of the sphincter of the bladder, making micturition difficult if 
not impossible. It produces cerebral and spinal anemia, a great fall of the 
body-temperature, coldness of the surface, tetanic spasms, and violent con- 
vulsions. A very large dose is necessary to cause these results, and as much 
as giij of the fluidextract has been given daily for a week or more, without 
producing any marked effect. 



ERGOTA. 263 

Chronic Ergotism occurs in two forms, the convulsive and the gangren- 
ous, — either usually excluding the other. The convulsions are tetanoid spasms 
of the flexor muscles, the uterus, the intestinal fibres, and the muscles of respi- 
ration, ending in coma and death by asphyxia. The gangrenous form begins 
with coldness and numbness of the limbs, formication of the skin all over the 
body, loss of sensibility and abolishment of the special senses, bullae of blood and 
ichor, followed by dry or moist gangrene of the lower extremities, buttocks and 
other parts, epileptiform convulsions, coma and death. Autopsies show changes 
in the posterior columns of the cord, resulting probably from spinal anemia. 
Chronic Ergotism is rare in this country, although frequent in certain parts of 
Europe, where it is due to eating bread made from infected rye. 

Experiments with the various derivatives of Ergot show that no one con- 
stituent possesses the power of the drug itself. Its actions on the circulation 
and the uterus are ascribed largely to Ergotoxine and Tyramine, although 
some have thought that the latter does not materially affect the uterus. 
Histamine lowers blood-pressure and powerfully stimulates the uterus but 
it is present in such small amounts that the extent of its action is question- 
able. Tyramine, which is chemically related to epinephrine, acts similarly, 
although its action is weaker, slower and more prolonged than epinephrine. 

In order to ascertain the physiological activity of a given sample of the 
drug various biological assays have been suggested: (1) the effect on the 
cock's comb, (2) the action on the blood-pressure, and (3) the influence on the 
excised uterus of the cat. The first is based on the development of gangrene 
of the cock's comb if the sample is active and given continuously. It is 
generally recommended although the uterine method is considered by 
Meyer and Gottlieb as the most rational in view of the fact that Ergot is 
used therapeutically chiefly for its effect on the uterus. 

Therapeutics. 

The use of Ergot to promote uterine contraction in protracted labor due 
to inertia of the womb, is dangerous when there is much resistance in front of 
the child, the probable results being rupture of the uterus or severe laceration 
of the perineum, and stoppage of the placental respiration of the fetus. Ergot 
tends to produce tetanic contractions instead of the intermittent natural ones. 
Towards the end of the second stage, when the head is beginning to emerge at 
the vulva, is the proper time for its administration, if used at all, in order to 
prevent post-partum hemorrhage, promoting the expulsion of the placenta, 
and guarding against puerperal infection by closing the uterine lymph-spaces 
and thus opposing a barrier to the entrance of infectious material. Some 
authorities teach that Ergot should not be given until the uterus is emptied 
and then hypodermically for quick action. It is used in many uterine affec- 
tions, as chronic metritis, subinvolution, congestive dysmenorrhea, hemor- 
rhages, fibroids, and polypi, to produce firm contraction and promote the 



264 ERIGERON — EUCALYPTUS. 

absorption of inflammatory products. It is efficient in many cases of amen- 
orrhea in plethoric subjects, and in the atonic type of spermatorrhea. 

Ergot was formerly extensively employed in all forms of hemorrhage in 
which no direct styptic application could be made, and even when such was 
considered possible it was a useful hemostatic adjuvant. Thus we find refer- 
ence to its use in hemoptysis, hematuria, hematemesis, hemorrhoids, epis- 
taxis, etc. In the light of our present knowledge it is difficult to see how it 
can possibly do good in these cases, particularly in pulmonary hemorrhage 
(in which it was most highly recommended) where a vasomotor system is not 
known to exist. There is the possible danger of increasing the local bleeding 
by raising the systemic pressure. It is particularly efficient in uterine hemor- 
rhages because of its action on the uterine muscle and not to any action on the 
uterine vessels. It is an excellent remedy in acute and chronic dysentery, 
chronic diarrhea, headache and migraine of congestive form, lax sphincters 
of the rectum and bladder, and incontinence of urine from paralysis of the 
sphincter vesicae. 

ERIGERON, Fleabane (Unofficial), — is the flowering plant Erigeron canadense, a plant 
of the nat. ord. Composite, growing in N. America. It contains a Volatile Oil, tannic acid 
and a bitter extractive. 

Oleum Erigerontis, Oil of Fleabane (Unofficial), — a pale yellow liquid, becoming darker 
by age and exposure to air, of peculiar and persistent odor, pungent taste and neutral re- 
action, readily soluble in alcohol. Dose, tj£x-3ss [av. njxv.] 

Oil of Erigeron has the same action as Oil of Turpentine but is less irritant and less 
efficient. It has considerable reputation as a hemostatic, especially in menorrhagia and intes- 
tinal hemorrhage of passive form, as in typhoid fever. It is used with benefit in diarrhea and 
dysentery, and in hemoptysis without fever or other evidence of irritation it is a valuable 
remedy. 

ERIODICTYON, the dried leaves of Eriodictyon calif ornicum, the Yerba 
Santa, a California shrub of the nat. ord. Hydrophyllaceae. They contain 
an acrid resin and an aromatic Volatile Oil. Dose, gr. v-xxx [av. gr. xv.] 

Fluidextractum Eriodictyi, Fluidextract of Eriodictyon, — Dose, tirv-xxx [av. ttj?xv.] 

Eriodictyon possesses the property of abolishing the sense of taste for 
bitter substances and for this' purpose is sometimes used to cover the taste 
of Quinine. The fluidextract in water as a mouth wash is a better way of 
using the drug for this purpose than the former one of combining it with 
Quinine in a mixture. By the latter method its action on the taste buds is 
too transient to be effective and the lessened bitterness is probably due to 
the conversion of the quinine salt into the almost tasteless tannate. Erio- 
dictyon has fallen out of use as an internal medicament except as an adjuvant. 

EUCALYPTUS, Eucalyptus,— the dried leaves, collected from the older 
parts of the tree, of Eucalyptus Globulus or blue gum-tree, nat. ord. Myrtaceae, 
a native of Australia, now grown in California and Italy. They contain tannic 
acid, a resin, a fatty acid and a Volatile Oil. The latter consists of three different 



EUONYMUS. 265 

oils which distil over at various temperatures, the first product being the offi- 
cial substance Ettcalyptol, which by the action of phosphoric acid is converted 
into Eucalyptene, a substance allied to Cymene, and Eucalyptolen. Dose, gr. 
x~3j jav. gr. xxx.] 

Preparations. 
Fluidextractum Eucalypti, Fluidextract of Eucalyptus, — is three-fourths alcohol. Dose, 

TTJ7X-5J [aV. TT£XXX.] 

Oleum Eucalypti, Oil of Eucalyptus, — the volatile oil, is distilled from the fresh leaves 
of Eucalyptus and should yield not less than 70 per cent, by volume of Eucalyptol. Is 
soluble, in all proportions, in alcohol, carbon disulphide, or glacial acetic acid. Dose, 
Trjjv— xx [av. n^viij], in emulsion or capsules. 

Eucalyptol, C 10 H 18 O, — is an organic oxide (cineol) obtained from the volatile oil; a 
colorless liquid, of aromatic, camphoraceous odor, and pungent, cooling taste; soluble in all 
proportions in alcohol, carbon disulphide and glacial acetic acid. Dose, iTjmj-x [av. ttj^v.] 

Incompatible with Eucalyptol is Potassium Permanganate. 

Physiological Action. 

The taste of Eucalyptus is warm, aromatic, bitter and camphoraceous. It 
increases the flow of saliva, the gastric juice and the intestinal secretions, and 
in small doses promotes appetite and digestion, increases the heart's action 
and lowers arterial tension. In large doses it produces eructations, indigestion, 
diarrhea, nausea and vomiting, lowered temperature, great muscular weakness, 
and if continued will irritate and congest the kidneys, and induce a feverish 
state with symptoms of cerebral congestion and great constitutional disturbance. 
In toxic doses it is a narcotic poison, and a fatal dose causes paralysis of respi- 
ration by direct action on the respiratory centre in the medulla. 

Eucalyptus is powerfully antiseptic and destructive to low forms of life, 
and by some authorities it is believed to possess anti-malarial properties. 

Eucalyptus is eliminated by the skin, the bronchial mucous membrane and 
the kidneys. It imparts its odor to the breath and the urine, and is more or 
less irritant at the points of its elimination. 

Therapeutics. 

Eucalyptus is an efficient stomachic in atonic dyspepsia and chronic gastric 
catarrh, and is used in intestinal catarrh, and in conditions of the intestinal 
canal which favor the development of worms. In chronic catarrhal conditions 
of the genito-urinary organs, the broncho-pulmonary mucous membrane and 
especially the bladder, it is very useful, acting as a stimulant to the mucous 
membranes. It is beneficial in chronic bronchitis and bronchorrhea, and in 
epidemic influenza (grippe) the oil has been used internally with good results. 
In hysteria, chorea and asthma it is beneficial, in the latter affection being 
advantageously smoked in cigarettes with stramonium or belladonna leaves. 
It is occasionally used in malaria as a substitute for quinine when an idiosyn- 
crasy exists for that drug. As an antiseptic it is highly valuable in dilute 
solution for application to ulcers and as a substitute for phenol on gauze in 



2 66 EUONYMUS — FEL BOVIS. 

the antiseptic treatment of wounds. It is used in dilute solution locally, as 
a stimulating disinfectant in stomatitis, and in the subacute stages of rhinitis, 
pharyngitis and tonsillitis. An aqueous preparation is highly recommended 
as a vehicle for alkaloids in solution for hypodermic use, to prevent the, devel- 
opment of the penicillium which rapidly destroys the alkaloid. 

EUONYMUS, Euonymus (Unofficial), — is the dried bark of the root of Euonymus 
atropiirpurcus, Wahoo, nat. ord. Celastraceae, native in the United States. It contains a 
bitter principle Euonymin, also Asparagin, Euonic Acid, resins and a fixed oil. Dose, gr. 
v-xv [av. gr. vijss.] 

Extractum Euonymi, Extract of Euonymus (Unofficial), — Dose, gr. j-v [av. gr. ij.] 

Fluidextractum Euonymi, Fluidextract of Euonymus (Unofficial), — Dose, njjv-xv [av. 
TTJiviij.] 

Euonymus is classed with Rhubarb, Jalap, Aloes, etc., as a tonic-astringent and resin- 
bearing purgative. It is said to be diuretic and a cholagogue. Its cathartic action is 
similar to that of Rhubarb, but milder. It has been employed with benefit in some cases 
of dropsy, also in habitual constipation and torpid liver. In overdoses it will set up con- 
siderable gastro-intestinal irritation. 

EUPATORIUM, Eupatorium {Thorough-wort, Boneset) (Unofficial), — the dried leaves 
and flowering tops of Eupatorium perfoliatum, an American plant of the nat. ord. Com- 
positae. It contains a neutral, bitter principle, named Eupatorium, tannic acid, a volatile 
oil, etc. Dose, gr. x-5j [av. gr. xxx.] 

Eupatorium is a bitter tonic and diaphoretic, also in full doses emetic and aperient. 
A warm infusion (Boneset tea) is a popular diaphoretic in remittent fevers, also at the onset 
of an acute cold. As a bitter tonic it may be used with advantage in dyspepsia and general 
debility. Its common name is derived from its supposed power to relieve the bone pains 
of dengue, the "break-bone fever." 

FEL BOVIS, Ox-gall, the fresh bile of Bos Taurus, the ox,— is a dark- 
green, viscid liquid, of peculiar odor, bitter taste, and neutral or faintly 
alkaline reaction. It contains Sodium Glycocholate, Sodium Taurocholate, 
Cholesterin and coloring matter. 

Extractum Fellis Bovis, Extract of Ox-gall,' — of which i part of the extract represents 
8 parts of ox-gall. Dose, gr. j-iij (av. gr. jss.) 

Physiological Action and Therapeutics. 

Ox-gall, or Ox-bile, was introduced into medicine as a remedy for those 
conditions supposed to be due to a deficiency in the normal secretion of bile, 
and acting in the intestine as a substitute for the deficient secretion and after 
absorption as a hepatic stimulant increasing its production. A word at this 
juncture ought to be said with regard to our modern conception of the group 
of drugs said to possess a cholagogue effect, that is, increase the production 
of bile. The criterion of such an influence was the appearance of increased 
amounts of bile in the feces. We now know that oftentimes this resulted 
from increased peristalsis and interference with the decomposition of the 
bile by bacteria and not to increased secretion. There are very few drugs 
which exert an appreciable effect on the flow of bile; notable among these, 
however, are bile, the bile salts and salicylic acid, but even these exert only 



FERRUM. 267 

a feeble influence. The term cholagogue is becoming restricted in its appli- 
cation and true cholagogue effects are uncommon. 

Fel bovis and bile salts are indicated in fat indigestion, when fat appears 
in undue amounts in the feces, and in association with laxative substances of 
the anthracene group (phenolphthalein, aloes, cascara, etc.) to enhance their 
action in the treatment of constipation in hepatic torpor. The drug should 
be given about two hours after eating when the food has passed from the 
stomach and intestinal activity is beginning. It is contraindicated in ob- 
structive jaundice. 

FERRUM, Iron, Fe. — is metallic Iron in the form of fine, bright, and 
non-elastic wire. 

Ferrum Reducttun, Reduced Iron, — is metallic Iron in fine powder, ob- 
tained by reducing ferric oxide by hydrogen at a dull red heat. It is a fine, 
gray-black, lustreless powder, odorless, tasteless, and insoluble in water or 
alcohol, but soluble in dilute sulphuric acid with evolution of nearly odorless 
hydrogen gas. Dose, gr. ss-ij [av. gr. j], after meals. 

Salts of Iron and their Preparations. 

Ferri Carbonas Saccharatus, Saccharated Ferrous Carbonate, — has at least 15 per 
cent, of ferrous carbonate. A greenish-brown powder, of sweetish taste at first, changing to 
ferruginous. Partially soluble in water, but soluble in dilute hydrochloric acid with evolution 
of C0 2 . Action, — slightly stimulant to the digestive tract. Dose, gr. ij-x [av. gr. iv]. 

Massa Ferri Carbonatis, Mass of Ferrous Carbonate, (Vallet's Mass) — Ferrous Sulphate 
100, Sodium Carbonate 46, Honey 38, Sugar 25, Syrup and Distilled Water, each, to make 
100 parts. Has not less than 35 per cent, of Ferrous Carbonate. An astringent, non- 
irritant, ferruginous tonic. Dose, gr. j-v [av. gr. iv] after food. 

Pilulae Ferri Carbonatis, Pills of Ferrous Carbonate, (Ferruginous Pills, Chalybeate 
Pills, Blaud's Pills) — made by mixing Ferrous Sulphate, about 2b grains for each pill, with 
Potassium Carbonate, Sugar, Tragacanth, Althaea, Glycerin and Water. Dose, j-iij [av. ij.] 

Mistura Ferri Composita, Compound Iron Mixture (Griffith's Mixture), (Unofficial), — 
has of Ferrous Sulphate 6, Myrrh 18, Sugar 18, Potassium Carbonate 8, Spirit of Lavender 
60, Rose-water to 1000. Is really a solution of the Carbonate formed by reaction between 
the two principal constituents. An excellent chalybeate. Dose, 5ij _ vj [av. gr. iv.] 

Ferri Chloridum, Ferric Chloride, (Per chloride of Iron) FeCl 3 + i2H 2 0, — orange-yellow 
deliquescent pieces, of styptic taste and acid reaction, freely soluble in water, alcohol or ether. 
Action, — strongly astringent, hemostatic. Dose, gr. ss-jss [av. gr. j.] 

Liquor Ferri Chloridi, Solution of Ferric Chloride, — an aqueous solution of the preceding, 
corresponding to 10 to n per cent, of Iron. Action is strongly astringent and styptic. 
Dose, TiEJ-iij [av. TTjrjss.], well diluted. Creuse's Tasteless Solution, is an agreeable prepara- 
tion; it has Liquoris Ferri Chloridi §j, Acidi Citrici gr. 544, Sodii Carb. gr. 1000 or q. s., 
Aquae Destil. § j, Alcoholis, q. s. Dissolve the citric acid in water, heat to the boiling point, 
gradually adding the sodium carbonate until the acid is neutralized. Mix with the iron 
solution and add alcohol up to a total of §iv. Dose, ttjjxx-xxx, diluted. 

Tinctura Ferri Chloridi, Tincture of Ferric Chloride, — a hydro-alcoholic solution of 
Ferric Chloride, containing about 13 per cent, of the anhydrous salt, corresponding to 
not less than 4.48 per cent, of metallic iron. Has of the preceding solution 35 in Alcohol 
to make 100. A bright, brownish liquid of ethereal odor, styptic taste and acid reaction. 
Is used in Liquor Ferri et Ammonii Acetatis. One of the best preparations of Iron. Ac- 
tion, — ferruginous tonic. Dose, ttjjv-xv [av. TTlviij.] in water, syrup, or glycerin. 

Ferri Citras, Ferric Citrate (Unofficial), — garnet-red, transparent scales, slowly soluble 
in water, not in alcohol. Action, — mildly stimulant. Dose, gr. ij— vj [av. gr. iv.] 



268 FERRTJM. 

Pilulag Ferri Iodidi, Pills of Ferrous Iodide, — made with Reduced Iron, Iodine, Licorice, 
Sugar, Acacia and Water, covered with a coating of Balsam of Tolu in Ether. "Blancard's 
Pills" differ from these only in being covered with a coating of reduced iron to protect the 
interior from oxidation, but it also protects them from the solvent action of the gastric juice. 
Dose, i or 2 pills [av. ij], thrice daily. 

Syrupus Ferri Iodidi, Syrup of Ferrous Iodide, — is a syrupy liquid containing about 5 
per cent, of ferrous iodide. Action, — ferruginous tonic. Dose, ttjv-xxx [av. ttj)xv.] 

Ferri Hydroxidum, Ferric Hydroxide (Hydrated Ferric Oxide) Fe (OH) 3 (Unofficial), — is a 
brown-red magma, wholly soluble in HC1 without effervescence. Should be freshly pre- 
pared by mixing together Solution of Ferric Sulphate 100, Ammonia Water 138, and Water 
to 300 grammes. It is the chemical antidote for Arsenic. Dose, 3j in water, frequently 
repeated. 

Ferri Hydroxidum cum Magnesii Oxido, Ferric Hydroxide with Magnesium Oxide 
{Ferric Hydrate with Magnesia), — is a more convenient and more efficient antidote for 
Arsenic than the preceding, as the excess of the alkaline precipitant is non-irritant, and is 
itself an Arsenic antidote. The two following solutions should be kept ready: (1) Solution of 
Ferric Sulphate 40 mils, in Water 125 mils. (2) Magnesium Oxide, 10 grammes rubbed up 
with Water 750 mils, in a bottle of 1000 mils, capacity. When wanted, shake the latter to a 
homogeneous magma, add it to the former gradually, and shake them together to a uniform, 
smooth mixture. Should be given in large doses (§iv) and frequently repeated. 

Ferri Phosphas, Ferric Phosphate, — bright-green, transparent scales, of acidulous, saline 
taste, soluble in water, not in alcohol. Used as an adjuvant to laxative pills to prevent 
the after reactionary constipation. Dose, gr. j-vj [av. gr. iv.] 

Ferri Sulphas, Ferrous Sulphate, {Copperas), FeS0 4 + 7H 2 0, — large, pale, bluish-green 
prisms, efflorescent, of saline, styptic taste, and acid reaction, soluble in water, insoluble in 
alcohol. Is chiefly used to make the Dried Sulphate and other preparations. Dose, gr. 
j-iii [av. gr. jss.] 

Ferri Sulphas Exsiccatus, Exsiccated Ferrous Sulphate, — a grayish-white powder, 
slowly soluble in water, consisting of not less than 80 per cent, of the anhydrous salt. The 
most astringent and irritating ferrous salt, but an excellent one in small doses. Dose, 
gr. ss-iij [av. gr. j| in pills. 

Ferri Sulphas Granulatus, Granulated Ferrous Sulphate, — is the same salt as the Sulphate, 
precipitated by alcohol from solution in dilute sulphuric acid. Dose, gr. ss-v [av. gr. jss] 

Liquor Ferri Subsulphatis, Solution of Ferric Subsulphate {MonseVs Solution), — is an 
aqueous solution of chiefly Basic Ferric Sulphate; a dark, reddish-brown almost syrupy 
liquid, of very astringent but not caustic taste, and acid reaction, mixing with water and alcohol 
in all proportions without decomposition. Is but slightly irritating and powerfully astringent, 
chiefly used locally as an astringent and hemostatic, but may be given internally in doses of 
TTjrj-v [av. TTjnij] well diluted. The salt obtained by its evaporation, Ferri Oxyper sulphas, 
{MonseVs Salt), is used in astringent ointments. 

Liquor Ferri Tersulphatis, Solution of Ferric Sulphate, — is an aqueous solution of Nor- 
mal Ferric Sulphate, Fe 2 (S0 4 )3- Has the properties described for the preceding. Used 
to make other preparations of Iron. 

Compound Iron Salts and their Preparations. 

Liquor Ferri et Ammonii Acetatis, Solution of Iron and Ammonium Acetate, {Basham's 
Mixture) — prepared with Tincture of Ferric Chloride 4, Diluted Acetic Acid 6, Solution of 
Ammonium Acetate 50, Aromatic Elixir 12, Glycerin 12, Water to 100. An excellent and 
very pleasant preparation, having some diuretic and diaphoretic powers. Dose, oij-vj 
[av. 3iv], well diluted. 

Ferri et Ammonii Citras, Iron and Ammonium Citrate, — transparent, garnet-red scales, 
deliquescent, readily soluble in water, insoluble in alcohol. Dose, gr. ij-vj [av. gr. iv.] 

Ferri et Quininae Citras, Iron and Quinine Citrate, — thin, transparent scales, of greenish, 
golden-yellow color, rapidly soluble in cold water, partly soluble in alcohol. Dose, gr. 
iij-v [av. gr. iv.] 

Unofficial Preparations of Iron. 

Ferratin, Acid Albuminate of Iron, — is a proprietary preparation, claimed to be iron in 
the ferric state in organic combination. It is artificially prepared from albumin is insoluble 
in water and dilute acids, but is soluble in water having a slight alkaline reaction. It 



FERRUM. 269 

causes no digestive disturbance, and has given good results in anemia, chlorosis, and allied 
affections. Dose, gr. jss-viij. 

Hemogallol, — is Hemoglobin deoxidized by pyrogallol. It occurs as a reddish-brown 
powder, insoluble in water and in alcohol. It is claimed to be the nearest to blood iron of any 
of the organic iron preparations, and to be readily assimilated without disagreeable effects of 
any kind. Dose, gr. iv-viij, thrice daily, ^ hour before meals. 

Hemaboloids, — a liquid containing iron combined with proteins in which it is claimed 
that 75 per cent, of the iron is in stable organic combination with vegetable nucleoproteins. 
It is said to act as a promptly absorbable and non-irritant form of food-iron. Dose, 5j~iv 
after each meal. 

Ovoferrin, — a solution containing 5 per cent, of an artificial product in which iron is 
present in organic form. Dose, 3ij - iv. 

Proferrin, — a compound of iron and milk casein containing iron equivalent to about 
10 per cent, elementary iron and phosphorus equivalent to about 0.5 per cent, elementary 
phosphorus. Dose, gr. ij-v. 

Triferrin, — a compound of caseinparanucleinic acid with iron and phosphorus. Dose, 
gr. v. 

Hemol, — an organic iron compound produced from blood by reduction and said to 
contain about 3 per cent, of iron in organic combination. Dose, gr. ij-viij. 

Syrupus Ferri et Mangani lodidi, Syrup of Iron and Manganese Iodide, — is a pale, 
straw-colored liquid, containing a little sulphate of potassium, and in each fluid 5 has 50 grains 
of the mixed iodides in the proportion of Iron Iodide 3 parts to 1 of Manganese Iodide. Dose, 

TT£X-XXX. 

Ferro-mangan, Liquor Mangano-Ferri Peptonatus, — is described under Manganum. 

Incompatibles. 

Incompatible with Metallic Iron are: Hydrogen Dioxide, Oxidizers, Potassium Chlorate, 
Potassium Permanganate; Salts of Antimony, Copper, Bismuth, Lead, Mercury, and Silver. 
With Ferrous Salts are: Alkalies, Carbonates, Chromates, Chlorates in acid solution, Ferri- 
cyanides, Gold salts, Hydrogen Dioxide, Mercuric salts, Phosphates, Permanganates, Sul- 
phides, Tannic Acid, Silver Salts. With Ferric Salts are: Acacia, Albumin, Alkalies, Apo- 
morphine, Aloin, Benzoates, Carbonates, Creosote, Balsam of Peru, Benzoin in alcoholic 
solution, Diuretin, Gallic Acid, Gelatin, Guaiac, Guaiacol, Hydriodic Acid, Hypophosphites, 
Hyposulphites, Iodides, Morphine; Oils of Bay, Cloves, Cinnamon, Pimento, Thyme, and 
Wintergreen; Pyrogallol, Resorcin, Salol, Salicylates, Sulphides, Sulphites, Tannic Acid, 
Vegetable infusions and decoctions. 

Incompatible with the Tincture of Ferric Chloride are: Acacia, Albumin, Alkalies, Car- 
bonates, Gelatin, Lime-water, Magnesium Carbonate, Piperazin, Vegetable decoctions, in- 
fusions, and tinctures. With Ferrous Sulphate are: Alkalies, Carbonates; Chlorides of Am- 
monium, Barium, and Calcium; Gold and Silver salts, Lead Acetate, Lime-water, Piperazin, 
Potassium Iodide, Potassium Nitrate, Rochelle salt, Sodium Borate, Tannic Acid, Vegetable 
astringent infusions. 

Notes on the Preparations. 

The blandest iron preparations are those which are insoluble or but spar- 
ingly soluble in water; as reduced iron, ferrous carbonate and ferric hydroxide. 
Of the aqueously soluble compounds, those which are salts of the vegetable 
acids are more or less bland, especially the citrate, the tartrate and the phos- 
phate, which are purely bland. The iron salts of the strong mineral acids 
are irritant and astringent or styptic in varying degree ; the iodide is irritant 
but not very astringent, ferrous sulphate is powerfully astringent but not 
styptic; and ferric chloride and ferric sulphate are powerfully astringent and 
styptic. In overdoses the astringent salts are irritant poisons and may pro- 
duce fatal results if in sufficient volume and concentration of solution. The 



270 FERRUM. 

per-salts (ferric) are the most actively irritant. The ferrous salts are the 
most readily absorbed and tolerated, are less irritant and astringent than 
the ferric salts, and are the most suitable ones for prolonged administration. 

The Carbonates possess the hematinic action of iron with but slight 
astringency, and are therefore employed to restore the quality of the blood 
in cases of anemia, chlorosis and amenorrhea with tendency to dyspepsia and 
constipation. Ferrum Reductum is one of the least irritating and best 
preparations for internal use. The Hydroxide is used only as an antidote in 
arsenical poisoning. 

The Vegetable Acid Salts are the least irritant to the stomach, but are also 
the least efficient as chalybeates. They may be administered in white wines, 
or with alkalies and vegetable acids in effervescent mixtures. The Mineral 
Acid Salts are characterized by their astringent and corrugating action on the 
tissues, and are used locally as hemostatics, the solution of the subsulphate 
being preferred for topical use as it is powerfully styptic but not corrosive. 
The tincture of the chloride is the most diuretic preparation for internal use. 
•Compounds containing iron in combination with other active agents, as the 
preparations of the iodide and that with quinine, are generally used for a 
twofold purpose, namely to relieve anemia and to act upon the specific ail- 
ment upon which the anemia depends. The organic preparations are con- 
sidered by many practitioners to be the most readily assimilated of all the 
iron preparations, but as a matter of fact there exists no proof of any essential 
difference in absorption between the organic and inorganic forms. Ferratin 
and other organic iron preparations are claimed to be devoid of irritant qual- 
ities, and to be fully efficient chalybeates. 

Physiological Action. 

Metallic Iron is not inert, for in the stomach it acquires molecular activity 
through its oxidation. It is a normal constituent of the blood (1 part to 230 
of red corpuscles), and is also found in the bile, lymph, chyle, gastric juice, in 
the pigment of the eye, in the milk and in the urine. Occurring in the blood, 
the tissues generally and many of the healthy secretions, also in most of the 
foods upon which the body is nourished, it may be considered a food rather 
than a medicine, though it has an important medicinal value. Administered 
internally in small doses it improves the quality of the blood, increasing the 
number and hemoglobin richness of the red corpuscles. 

In large doses or in small ones long continued it is directly unfavorable to 
digestion, nausea and vomiting being caused by the soluble preparations. Its 
per-salts are actively irritant, and some, as the iodide, chloride, and sulphate, 
are active poisons, highly astringent to the tissues and very injurious to 
the teeth. Locally the iron salts of the mineral acids are more or less con- 
stringent and irritant to the mucous membranes and the tissues, acting as as- 



FERRXJM. 271 

tringents and hemostatics by virtue of their power to coagulate albumin. The 
tincture of the chloride is considered diuretic. 

Absorbable iron preparations administered to a healthy person, or for a long 
time in disease, exert but little influence, and give rise to few and slight clinical 
symptoms. A sense of tension and fulness of the head, dull pains, discomfort, 
also a hard and quickened pulse, constitute usually the only obvious derange- 
ment. When given, however, to a person suffering from anemia or chlorosis the 
morbid symptoms expressive of deficient hemoglobin subside and the patient 
soon improves in health and strength. The action of iron is to cause an increase 
of the hemoglobin of the red blood corpuscles either by its direct conversion into 
an ingredient of hemoglobin, or by stimulating the functional activity of the 
hematopoietic organs, or perhaps by both means combined. This power of 
enriching the red blood corpuscles with hemoglobin is essentially the whole con- 
stitutional action of iron. About 40 to 50 grains are estimated to be present in 
the tissues of a healthy adult, but only about -^ to -J- of a grain is daily sup- 
plied by the ordinary dietary. This amount of intake is sufficient to preserve 
the iron equilibrium, about the same quantity being excreted daily, chiefly in 
the feces and to a slight extent in the urine. The following table, adapted 
by Hatcher and Wilbert from those of Bunge and Stockman, shows approxi- 
mately the iron content of certain foods. 

Iron Content of Foods Ready to Serve. 

Mg. 

1 teacupf ul of boiled oatmeal o . 2 to 0.5 

Two apples or oranges o . 1 to 0.5 

500 gm. (about 1 pouDd) of grapes o . 4 to 1 . o 

Yolk of two eggs 2 . o to 5.0 

500 c.c. (about 1 pint) of milk 1 . o to 1.5 

500 gm. of white bread 2 . 5 to 5.0 

500 gm. of whole wheat bread S-oto 15.0 

1 teacupf ul of mashed potato o. 3 to 1.5 

1 teacupf ul of boiled cabbage o . 5 to 3.0. 

1 teacupful of boiled carrots, peas or beans o. 5 to 2.0 

1 teacupful of boiled spinach 3-oto 15.0 

500 gm. "blut-wurst" 50.0 to 125.0 

100 gm. yellow ox-marrow (dried) 4.0 

100 gm. red calf-marrow (dried) 8.7 

100 gm. roast beef 4.0 to 12.0 

In the stomach all iron preparations are changed to the chloride by the 
HC1 of the gastric juice, and in the duodenum to the carbonate or an alkaline 
albuminate. The absorption of Iron takes place mainly in the duodenum. 
The greater portion, however, is carried on through the intestinal canal, 
where it is converted into a sulphide, which blackens the feces. After pass- 
ing into the portal blood and the lymph channels, the small quantity of ab- 
sorbed iron is deposited in the spleen, where it may undergo some changes, 
is again taken up by the blood and deposited in the liver and perhaps in the 
bone marrow. In the liver the originally inorganic iron is converted into 
higher forms and eventually into hemoglobin. When there is no deficiency 



272 FERRUM. 

of iron in the system the liver slowly yields its store to the blood again, to be 
carried to the cecum and large intestine, by the epithelium of which it is 
finally excreted. 

The doctrine of Kletzinsky, Bunge and others, concerning the non-absorp- 
tion of iron, though often shown to be erroneous, is occasionally resuscitated 
by writers and teachers of medicine. Briefly stated, this doctrine is as follows: 
That the iron existing in food-stuffs as a constituent of nucleo-albumin is the 
only source of iron supply to the system for the formation of hemoglobin. That 
no iron compound administered by the stomach is absorbed, but after conver- 
sion to a chloride by the gastric juice the only function of iron so administered 
is to chemically satisfy the hydrogen sulphide and other sulphur compounds 
in the intestinal canal, thereby protecting the ingested food-iron from attack 
by these sulphur compounds and permitting it to enter the system. Against 
this theory have been urged the facts that no metal replaces iron in the treat- 
ment of chlorosis, though others would similarly satisfy the sulphur compounds; 
that iron is curative in chlorosis when injected hypodermically, and that the 
sulphide administered so as to reach the intestines unchanged acts as well as 
other iron preparations. Furthermore, it has been shown that ordinary prepa- 
rations of iron given internally are absorbed; that anemia is not necessarily 
accompanied by intestinal putrefaction; and that hydrogen sulphide is not 
present in the duodenum where the absorption of iron occurs. 

Therapeutics. 

The chief indication for the internal administration of Iron is anemia, when 
plethora, hemorrhage or fever exist it is contraindicated. It should always 
be given after meals, and occasionally suspended for a time, to avoid deranging 
the stomach. It is generally considered useless to prescribe iron in any form 
until after constipation has been relieved and a regular action of the bowels 
established. When the appetite and digestion are improved by Iron it will 
do the greatest amount of good, many authorities holding that the principal 
benefit derived from its use, even in anemia, is due to its stimulating action upon 
digestion and the primary assimilation. In chlorosis, chorea and neuralgias 
of anemic girls at the age of puberty, amenorrhea and other menstrual dis- 
orders of the same class of subjects, and in acute rheumatism of pale, cachec- 
tic persons, the chalybeates are generally very efficient remedies, especially 
the tincture ot the chloride. The same preparation is employed empirically 
in erysipelas and diphtheria with good results, and in albuminuria with 
chronic disease of the kidneys it is a useful chalybeate diuretic. In the syphi- 
litic cachexia, chancroid, and sloughing phagedena, the iodide gives good results, 
particularly when the subject is one of debilitated constitution. In the noc- 
turnal incontinence of children the syrup of the iodide is one of the most effi- 
cient remedies. In the phlyctenular inflammations of the cornea and con- 



FICUS — FORMALDEHYDE. 273 

junctiva as seen in pallid and ill-nourished children, a favorite remedy in- 
ternally is a combination of Arsenic, in the form of Fowler's Solution, and 
the Syrup of the Iodide of Iron. The subsulphate is a powerful styptic, a 
weak solution (3j ad §viij), used in the form of spray, is one of the most 
serviceable astringents in obstinate epistaxis, and in hematemesis the same 
solution may be swallowed in small quantities at\short intervals. The prin- 
cipal objection to its use is the formation of a hard, dirty clot. In chronic 
diarrhea and dysentery the solution of the sulphate is an efficient astringent. 
Ferrous sulphate (Copperas) is much employed as a cheap disinfectant for 
sewage, its action being to precipitate the proteins, which carry down the 
bacteria mechanically. It is also an excellent deodorant for urinals. The 
hydroxide is the most effective antidote in arsenical poisoning, as it forms with 
arsenic trioxide an almost insoluble compound. The solutions used in its prep- 
arations should be kept on hand and mixed only when wanted for use. 

FICUS, Fig, — is the partly dried fruit of Ficus Carica, the fig-tree, nat. ord. Moracese, a 
native of the shores of the Levant, but cultivated in Southern Europe and in other warm 
countries. Figs contain about 62 per cent, of grape sugar, also gum, fat, etc., and are a con- 
stituent of the official Confectio Sennae. 

Figs are demulcent, laxative and nutritious. They are used in their fresh state as an ali- 
ment, but if eaten in quantity may produce flatulence, enteralgia and diarrhea. .They are 
chiefly used as an article of diet in habitual constipation, but may be employed as an ingre- 
dient of demulcent decoctions, and locally as a poultice to gum-boils. 

FCENICULUM, Fennel, — is the dried fruit of Fceniculum vulgare a European cultivated 
plant of the nat. ord. Umbelliferae. It contains a volatile oil, which is a constituent of Pulvis 
Glycyrrhizae Compositus, and Spiritus Juniperi Compositus. Dose, gr. v-xx [av. gr. xv.] 

Oleum Foeniculi, Oil of Fennel, — the volatile oil, a light yellow-colored liquid, having the 
odor of fennel, a warm taste and neutral reaction, soluble in alcohol. Dose, fijij-v [av. njjiij. 

Aqua Foeniculi, Fennel Water, — contains 2 parts of the oil in 1000 of distilled water. 
Dose, 3j-oj [av. 3iv.] 

Fennel is an aromatic stomachic and a mild stimulant. It is chiefly used as an agreeable 
carminative in flatulence and colic, and as a corrigent to Senna, Rhubarb, and other disagree- 
able medicines. An infusion is often used as an enema to expel flatus in infants. 

FORMALDEHYDE, Formic Aldehyde, Formyl, CH 2 0,— is a gaseous 
aldehyde obtained by the oxidation of methyl alcohol. It has a low specific 
gravity, mixes readily with air, and is soluble in water and in alcohol. It does 
not affect the color or structure of clothing or other fabrics in common use. 
The official preparation is — ■ 

Liquor Formaldehydi, Solution of Formaldehyde, — commecially known as Formalin, 
Formol, Methanal, M ethyl-aldehyde, Oxymethylene, etc., is an aqueous solution, containing not 
less than 37 per cent., by weight, of absolute formaldehyde. It is miscible in all proportions 
with water and alcohol. One part by volume added to 40 of water makes a 1 per cent, solution 
of formaldehyde. To prevent polymerization it should be mixed with an equal quantity of a 
saturated solution of boric acid, or a 2 per cent, solution of borax, or with glycerin. 

Official Derivative. 

Hexamethylenamina, Hexamethylenamine, C 6 H, 2 N 4 , commonly known under various 
trade names, the most important being Aminoform, Formin and Urotropin, — is a condensa- 
tion product obtained by the action of ammonia upon formaldehyde. It occurs in color- 
less, odorless crystals, readily soluble in water, and in 12.5 of alcohol, decomposed by 
18 



274 FORMALDEHYDE. 

diluted sulphuric acid, liberating formaldehyde. Dose, gr. j-x [av. gr. iv], up to 5 j daily, 
in water or carbonated water. 

Unofficial Preparations. 

Glyco-Formalin, — has of Formaldehyde 30, Glycerin 10, Water 60, the glycerin preventing 
the polymerization of the gas and the formation of paraform. 

Paraform, Paraformaldehydum, (CH 2 0), — is trioxymethylene, a solid polymeric form 
of formaldehyde, which it gives off when slowly heated. It occurs as a white, crystalline 
powder, of stable constitution, insoluble in water. 

Unofficial Compounds. 

Numerous compounds of Formaldehyde with other substances are marketed under 
various trade names, the most important of which are as follows: — 

Amphotropin, — a molecular combination of camphoric acid and hexamethylenamine; 
a white crystalline powder soluble in water and alcohol. It is supposed to combine the 
actions of its two components and to prove useful as a urinary antiseptic without the sub- 
jective gastric disturbances of full doses of camphoric acid. Dose, gr. x-xxv daily. 

Empyroform, — a grayish-brown, odorless powder, insoluble in water, soluble in acetone 
and chloroform; a condensation of birch tar and formaldehyde. It is used locally in skin 
diseases as an antipruritic and sedative in 5 to 10 per cent, ointment. 

Formicin, — a compound of formaldehyde and acetamide which in solutions of 1 to 5 per 
cent, liberate formaldehyde gradually at body temperature, exerting a local antiseptic 
effect without irritation. It is used in tuberculous joints, chronic abscesses, chronic 
cystitis, etc. It is a yellowish, thick, liquid with bitter taste and formaldehyde-like odor. 

Glutol, — is prepared by the action of formaldehyde on gelatin, and is used as an antiseptic 
surgical dressing. 

Helmitol, — the methylene-citrate of hexamethylenamine (urotropin), occurs as a white, 
crystalline powder, readily decomposed by alkalies, soluble in water up to 10 per cent., and gives 
off formaldehyde more readily than urotropin. It is used as a urinary disinfectant in doses of 
gr. x-xv, up to 5j or 3ij daily. 

Ichthoform, — a combination of formaldehyde and ichthyol, is described under the title 
Sulphur. 

Tannoform, — a condensation product of formaldehyde and tannic acid, is described on 
page 64. 

Veroform, — a neutral liquid consisting of formaldehyde gas dissolved in a solution of 
soap. It is used for cleansing and disinfection. 

Incompatibles. 

Incompatible with Formaldehyde are: Albumin, Alkalies, Ammonia, Bisulphites, Gelatin, 
Iron preparations, Phenylhydrazine ; Salts of Copper, Gold, and Silver, Tannic Acid. 

Physiological Action and Therapeutics. 

Formaldehyde is powerfully antiseptic and disinfectant, ranking next be- 
low Mercuric Chloride as a germicide, and above it in being but slightly toxic to 
the higher animals. A solution of 1 in 1000 kills most bacteria if the contact 
is prolonged , and a 1 per cent, solution destroys all pathogenic spores within 
an hour. It is probably the most reliable disinfectant for general use, when 
employed in connection with warm, moist air. It is used for the disinfection 
of instruments, furniture, clothing and rooms; the gas being disengaged by 
heating the solution or paraform, or by the addition of potassium perman- 
ganate to the solution. To thoroughly disinfect a room, it should be made as 
air-tight as possible, the gas then introduced through the key-hole of the door, 
and the room kept closed for twenty-four hours. The amount of the solution 



FORMALDEHYDE. 275 

required is about five ounces for each iooo cubic feet of space. Another 
method which is widely practiced is tc place some formaldehyde solution in 
a large pail in the center of the room and add potassium permanganate in 
the proportion of 6 oz. per pint for every thousand cubic feet. Clothing and 
bed-linen should be unfolded and hung loosely on a line in the room, so that 
the gas may have free access to the fabrics. It does not kill bedbugs, roaches, 
fleas or mosquitoes. Although formaldehyde has very generally supplanted 
Sulphurous acid as a disinfectant, the latter still remains as the most effective 
means of killing the yellow fever carrier — Stegomyia fasciata. It is generally 
believed that a "free airing" of the rooms for twenty-four hours after dis- 
infection, with careful scrubbing of the floors and woodwork is a most valuable 
adjunct to disinfection. 

Formaldehyde is intensely irritant to mucous membranes, a minute quan- 
tity in the atmosphere causing violent irritation of the conjunctivas and the 
lining of the respiratory tract, with stinging and prickling in the nose and throat, 
tears'; salivation, and catarrh. In concentrated solution it coagulates albumin 
and gelatin, and applied to the skin it produces a leathery condition which 
may pass into a localized necrosis without suppuration, leaving the surface 
with the appearance of a recently healed wound. It is much too irritant to 
be generally available as a surgical antiseptic, the application of a i per cent. 
solution to an ulcerated surface causing intense and prolonged pain. It is 
used however by surgeons in tuberculous joints and abscesses, infected wounds, 
suppurating buboes, and infectious inflammations of mucous membranes. 
Solutions of i per cent, strength are sufficiently strong for most local purposes, 
and when sprayed above the patient's head by a steam-atomizer for 20 minutes 
thrice daily have proved highly efficient in whooping-cough and chronic bron- 
chitis. Weaker solutions (J per cent.) are used as gargles and mouthwashes 
and for the irrigation of cavities, and stronger ones (2 \ per cent.) for psoriasis, 
lupus and other skin diseases. , 

McGuigan has recently investigated the migration, fate and changes of 
formaldehyde when introduced into the organism. In an experimental study 
on animals he came to the conclusion that there is nothing to indicate that 
the drug has a field of usefulness other than for local use. His other conclu- 
sions are as follows: — 

"Formaldehyde is rapidly absorbed from all parts of the gastro-intestinal 
tract and lungs, and may be excreted again by them. It is rapidly oxidized 
in the body to formic acid and carbonates. There is also a small amount of 
a dialyzable compound formed in the blood, which is most probably hexa- 
methylenamin, since the latter is found in the urine (bromin test). 

" Small amounts of formaldehyde may pass through the body without 
causing apparent inflammation, while larger amounts always cause some. 

"Recovery from severe inflammatory reactions may be rapid and appar- 
ently complete. 



276 FRANGULA — GALBANUM 

"Formaldehyde depresses the heart by direct action. Its action on 
respiration is transient and apparently the result of irritation, though the 
quick oxidation would account for some of the increase. 

''Formaldehyde causes a stimulation of the intestinal movements which 
in large doses is extreme. 

"Morphin and ammonia are antidotes." 

Formaldehyde solutions are used in the preparation for preservation of 
pathological material and cadavers. To overcome the irritating vapor per- 
meating the air in rooms where these .solutions are handled, the use of am- 
monia water in a dish or sprayed in the air will be found helpful. 

The chief therapeutic value of Hexamethylenamine (Urotropin) in the 
organism depends upon the liberation of formaldehyde which occurs only in 
the presence of an acid medium. Therefore while the drug may be found 
in the cerebrospinal fluid, bile, blood, milk, and other fluids after its absorp- 
tion, as reported by numerous observers, it is of no value except in the urine 
and then only if the urine is acid. To insure a maximum effect the acidity 
of the urine may be increased by the administration of acid (mono) sodium 
phosphate which, however, like other acid salts and acids, ought not to be 
given in combination with hexamethylenamine because of the tendency to 
decompose it before it reaches the urine. When used as an urinary antiseptic 
it is particularly efficient in pyelitis, cystitis and to diminish the number of 
Dacillii n the urine of typhoid fever patients. It is frequently used as prophy- 
lactic in operations upon the bladder and in prostatectomy. It is of no value 
in gout for which it was formerly recommended and cannot prevent the de- 
velopment of nephritis of scarlet fever, in which its use is not without danger. 
Ordinary medicinal doses cause no general effects as a rule, but in susceptible 
persons it may cause gastric and renal irritation, with hematuria, hemo- 
globinuria, and albuminuria, also diarrhea, abdominal pain, a measly rash, 
headache, tinnitus aurium, and strangury. 

FRANGULA, Frangula, {Buck-thorn), — is the bark, collected at least one year before 
being used, of Rhamnus Frangula, the alder buckthorn, a European shrub of the nat. ord. 
Rhamnaceae. It contains several principles, of which the only important one is Frangulin, 
or Rhamnoxanthin, a lemon-)^ellow, odorless and tasteless glucoside, insoluble in water and 
but sparingly so in alcohol or ether, and thought to be identical with Cathartin, the active 
principle of Senna. Another species of the genus Rhamnus is Rhamnus . Purshiana or 
Cascara Sagrada. Dose, gr. x-xxx [av. gr. xv.] 

Fluidextractum Frangulas, Fluidextract of Frangula. — Dose, ttjjx-xxx [av. ttj7xv.] 
Frangula-bark when fresh is a violent irritant to the gastro-intestinal tract, producing 
vomiting, purging, and much pain. The old dried bark is a safe purgative without irritant 
qualities, and is much used in the constipation of pregnancy, and other conditions requiring 
purgation. The fluidextract is the best form for administration. 

GALBANUM (Unofficial), — is a gum-resin obtained from Ferula galbaniflua, an Asiatic 
plant of the nat. ord. Umbelliferae, and probably from other allied plants. It occurs in minute 
tears, agglutinated into a hard mass, of balsamic odor and acrid, bitter taste. It contains a 
Volatile Oil isomeric with Turpentine, a Gum, and a mixture of Resins which yield by dry 
distillation a blue oil and Umbelliferon, a tasteless substance in satiny crystals. Dose, gr. 
x-xx, in pill or emulsion. 






GELSEMIUM. 277 

Galbanum is stimulant, expectorant and antispasmodic, acting much like Ammonia and 
Asafetida, and usually given with either of these substances. It was formerly used in 
chronic bronchitis and catarrh of mucous membranes generally, in amenorrhea and chronic 
rheumatism. 

GELSEMIUM, Gelsemium (Yellow Jasmine), — is the dried rhizome and 
roots of Gelsemium sempervirens, sl climbing plant of the nat. ord. Loganiacese, 
with showy yellow flowers, which grows in the forests of the southern states, 
forming festoons from one tree to another. It contains two alkaloids, Gel- 
semine, which forms crystalline salts and is only slightly active and Gelsem- 
inine, which is amorphous and highly toxic. Dose, gr. J-ij [av. gr. ss.] 

Preparations. 

Extractum Gelsemii, Extract of Gelsemium, — Dose, gr. |-| [av. gr. £.] 
Fluidextractum Gelsemii, Fluidextract of Gelsemium, — Dose, ttj^ss— ij [av. ttjjss.] 
Tinctura Gelsemii, Tincture of Gelsemium, — strength 10 per cent. Dose, tirv-xv [av. 
jjS.iv.] 

Gelsemina, Gelsemine (Unofficial), — as it occurs in commerce is a mixture of the alka- 
loids in varying proportions, and owes its activity to its contained Gelseminine, of which none 
could be found in some samples. Dose, gr. -£q—£q. 

Incompatibles. 

Incompatible with Gelsemium preparations are: Caustic Alkalies, Tannic Acid and other 
alkaloidal precipitants (see page 6). 

Physiological Action. 

Gelsemium is a motor and respiratory depressant, acting on the anterior 
cornua of the spinal cord and the respiratory centres. Later in its action it 
depresses sensation. Its symptoms resemble those of Conium very closely, 
differing therefrom chiefly by indicating a more depressant effect on the general 
nervous system. In moderate doses it causes languor, slowing of the cardiac 
rate, enfeebled muscular action, impaired sensibility, drooped eyelids and 
slightly dilated pupils, with some diaphoresis. In toxic dose, as a teaspoonful 
of the fluidextract, it produces vertigo, diplopia, drooped eyelids and dilated 
pupils (paralysis of 3d nerve), labored respiration, slow and feeble heart, dropped 
jaw, staggering gait, extreme muscular weakness and almost complete anesthesia, 
profuse diaphoresis, loss of articulation, and death by asphyxia from paralysis 
of the centres of respiration, consciousness being preserved until C0 2 narcosis 
sets in. Convulsions, with backward movements, occur in many animals but 
not in man. Motion is affected before sensibility in warm-blooded animals, 
sensibility before motion in frogs. It does not irritate the stomach or affect 
the blood-pressure, though it slows the heart and lowers the body temperature. 
The effects of a moderate dose pass off in about three hours. Gelseminine is 
the active principle, being highly toxic and resembling Conii'ne in most of its 
effects. It is decidedly mydriatic when locally applied to the eye, acting prob- 
ably by paralyzing the oculo-motor nerve terminations. 



278 gentiana. 

Therapeutics. 

Gelsemium is indicated in conditions of exalted nerve function, and con- 
tra-indicated whenever there is a weak heart. It is best used in cerebro- 
spinal meningitis, mania with great motor excitement and persistent insom- 
nia, delirium tremens, many forms of sleeplessness, coughs of convulsive and 
spasmodic character, neuralgia of the fifth nerve, after-pains, ovarian neural- 
gia, dysmenorrhea, irritable bladder of women, and incontinence of urine 
from spasm of the vesical muscular fibres. In most of these affections the 
remedy must be pushed to the inducing of some physiological symptoms, 
but its action should not be carried beyond the production of drooped eye- 
lids, diplopia and muscular debility. It has been used with varying success 
in intercostal neuralgia, myalgia, sciatica, spasmodic asthma, sick headache, 
eczema, pruritus and tetanus. 

There is much evidence for the claim of singular efficiency in antagonizing 
the mental condition occasionally manifested by an unusual degree of dread, 
in regard to some approaching ordeal, or ordinary trial of life; as, for example, 
that of a woman concerning her impending confinement, or of a student in 
reference to his examinations. In very many such cases, the use of gelse- 
mium in combination with cannabis has seemed to remove the state of abnor- 
mal fear entirely. Before the introduction of the coal tar analgesics this 
same combination was our best remedy in the treatment of migraine. Gel- 
seminine is sometimes used as a mydriatic and paralyzer of accommodation, 
its effects passing off more rapidly than those of atropine. 

GENTIANA, Gentian, — is the dried rhizome and roots of Gentiana lutea, 
the yellow gentian, one of a numerous family of plants, nat. ord. Gentianacese 
growing in the mountainous districts of Europe. An American species, G. 
Catesbcei, blue gentian, is considered nearly equal in value to the official species. 
It contains an active, bitter principle, Gentianin, C20H30O12, which is crystal- 
line and soluble in water; also an inert, amorphous body, Gentianic or Gentesic 
Acid; gum, considerable sugar, and a trace of volatile oil, but no tannin. 
Dose, gr. x-xxx [av. gr. xv.] 

Preparations. 

Extractum Gentianae, Extract of Gentian, — aqueous. Dose, gr. j-v [av. gr. iv.] 
Fluidextractum Gentianae, Fluidextract of Gentian. Dose, ttjx-xxx [av. ttjxv.] 
Tinctura Gentianae Composita, Compound Tincture of Gentian, — Gentian 10, Bitter 
Orange Peel 4, Cardamom 1, Alcohol and Water to 100. Dose, 3 ss-i j [a v. 3j-] 

Unofficial Preparations. 

Infusum Gentianae Compositum, Compound Infusion of Gentian, — contains Gentian 
10, Bitter Orange Peel 2\, Coriander 2\, Alcohol 40, Water to 320. Dose, oj-ij. 

Mistura Gentianae Alkalina, Alkaline Mixture of Gentian, — Acidum Hydrocyan. Dilut. 
TT^iij, Sodii Bicarb, gr. xv, Infusum Gentianae Co. to §j. One dose. 



; GERANIUM GLYCERINUM. 279 

Mistura Gentianae et Sennae, Mixture of Gentian and Senna, — Infusum Sennae 3iij, 
Tr. Cardamomi Co. 5], Infusum Gentianae Co. 5vj. One dose. 

Incompatibles. 

Incompatible with Gentian preparations are: Lead salts, Silver Nitrate. Iron salts are 
not chemically incompatible, for Gentian contains no tannic acid; but as they darken gentian 
preparations they are considered esthetically incompatible. 

Gentian is a simple bitter without astringency or aroma, its action corre- 
sponding to that of Calumba. The Bitters stimulate the taste buds and in- 
crease the appetite bur do not, according to the observations of Carlson and 
his co-workers, increase the hunger contractions of the stomach. Clinical 
experience, however, demonstrates the value of bitters in increasing the ap- 
petite and Pawlow has proved experimentally the close relationship between 
appetite and digestion in the instance of the dog in which gastric juice is 
secreted when allowed to smell meat and the lack of digestion when food is 
introduced into the stomach through a fistula. Gentian is highly esteemed 
in the loss of appetite during convalescence from acute diseases and from 
malarial fever. In the anorexia of alcoholics, and of overworked and nervous 
patients it gives most gratifying results. The compound tincture is an ex- 
cellent vehicle for cod-liver oil, and the compound infusion is a good vehicle 
for the administration of mineral acids and neutral salts. 

GERANIUM, Geranium (Cranesbill), — is the rhizome of the indigenous perennial 
Geranium maculatum, nat. ord. Geraniacese. Its active constituents are tannic and gallic 
acids 

Geranium is an efficient astringent, and its action corresponds with that of Tannic Acid. 
Having no unpleasant taste, it is a useful agent for infants and others having delicate stomachs, 
and is a very popular domestic remedy in many parts of the country. It is especially used in 
diarrheas, dysentery and cholera infantum. It was formerly official in the form of the 
Fluidextract in the dose of ttrx-xxx. 

GLYCERINUM, Glycerin, Glycerol, Propenyl Alcohol, — is a liquid obtained 
by the hydrolysis of vegetable or animal fats or fixed oils, containing not less 
than 95 per cent, of the trihydric alcohol, C 3 H 5 (OH) 3 , an alcohol existing in 
fats and fixed oils in combination with the fatty acids. 

Glycerin is a clear and colorless liquid, of syrupy consistence, hygroscopic, non-drying, 
odorless, of warm and very sweet taste, neutral reaction, soluble in water and in alcohol, 
insoluble in ether, chloroform and fixed oils. It dissolves Tannin, Gallic Acid, Salicylic Acid, 
Bromine, Iodine, and Phenol, and with the aid of heat metallic salts, oxides and alkaloids. 
With strong Nitric Acid it forms Nitroglycerin, and it reduces Potassium Permanganate, 
Chromic Trioxide and Chlorinated Lime with great violence. An impurity frequently present 
in it is Acrolein, formed by the use of too high a degree of heat in its manufacture, and which 
is very acrid and poisonous. Glycerin is a constituent of the 5 Glycerites, Pilulae Phosphori, 
Mucilago Tragacanthae, Massa Hydrargyri, and several fluidextracts. Dose, 5 j-ij, [av. 3j.] 
diluted. The official preparations are: — 

Gelatinum Glycerinatium, Glycerinated Gelatin, — consisting of equal parts of Gelatin 
and Glycerin. 

Suppositoria Glycerini, Suppositories of Glycerin, — each suppository contains about f 
grain of Sodium Carbonate, 3 grains of Stearic Acid, and 46 grains of Glycerin. They are 
used per rectum in chronic constipation. 



280 GLYCYRRHIZA. 

Glycerites of Tannic Acid, Starch, Boroglycerin, Hydrastis, and Phenol, are described 
under the titles of their principal ingredients. 

Unofficial Preparations. 

Unna's Paste, — is a mixture of equal parts of Glycerine and Mucilage of Acacia, with 
which are incorporated various substances, such as zinc oxide, mercuric oxide, etc. 

Unna's Paint, — has of Glycerine 10, Gelatin 4, Zinc Oxide 4, and Water 10, incorporated 
together to form a mixture which when cold resembles white rubber. 

Cataplasma Kaolini, Cataplasm of Kaolin, — contains of Glycerin 37 \ parts by weight. 
Boric Acid 4^, Thymol ^, Methyl Salicylate J, Oil of Peppermint ^, Kaolin 57!, intimately 
incorporated by the aid of heat to a homogeneous mass. Used as a poultice. This preparation 
is similar to that sold as Antiphlogistine. 

Incompatibles. 

Incompatible with Glycerin are Acids (hot), Chromic Trioxide, Chlorinated Lime, Lead 
Oxide, Potassium Permanganate, Silver Nitrate. 

Physiological Action and Therapeutics. 

Glycerin abstracts water from tissues with which it comes in contact, and 
unless pure is often very irritating to the skin. On the stomach it has no 
particular action, but in large quantities (5j-"j) it is laxative. The urine 
of persons using glycerin contains a body which acts like sugar in the copper 
tests, but is not sugar. It has been tried as a remedy in diabetes, but with 
unsatisfactory results so far as reported, except as a sweetening substitute 
for sugar in the dietary of those afflicted with that disease. In chronic con- 
stipation excellent results are obtained from rectal enemata of Glycerin, or 
from the official suppositories thereof. As a vehicle it is used for many drugs, 
and is a good ingredient of solutions for hypodermic use, promoting the solu- 
bility of many alkaloids and acting as an antiseptic. It has distinct but 
feeble power as a germicide and antiseptic, and is employed to preserve and 
aid the action of the digestive ferments, Pepsin and Pancreatin, also to pre- 
vent the decomposition of vaccine lymph. Locally it is valuable in many 
cutaneous affections as an emollient and softening agent. In acute coryza 
it gives relief if applied by a brush or as a spray to the nasal mucous mem- 
brane. It is used on cotton to the cervix uteri as a depleting agent, and 
mixed with an infusion of flaxseed as an enema to relieve tenesmus in acute 
dysentery. With tincture of Benzoin it is an excellent application to chapped 
hands or lips and fissured nipples. For the dry glazed tongue and sordes of 
profound toxic states the use of equal parts of glycerin, water and lemon 
juice is most satisfactory. In the external auditory canal it is usefully em- 
ployed to soften cerumen, diminish the secretion of pus, deplete the tissues, 
and keep the surface moist. 

Unna's Paint and its imitations are very efficient applications for inflam- 
matory conditions of the skin, chronic ulcers, and eczema with induration. 

GLYCYRRHIZA, Glycyrrhiza, Licorice Root, — is the dried rhizome and 
root of Glycyrrhiza glabra typica, and of Glycyrrhiza glabra glandulifera, nat. 



GOSSYPIUM PURLFICATUM. 28 1 

ord. Leguminosse, native in southern Europe and Asia, but largely cultivated 
in many other parts. It contains a yellow, amorphous glucoside, Glycyr- 
rhizin, C24H36O9, also Glycyrrhizic Acid, Asparagin, sugar, resin, gum, etc. 
Glycyrrhizin when boiled with dilute acids yields glucose and a very bitter 
substance named Glycyrrhetin. Dose, gr. x-g j [av. gr. xxx.] 

Preparations. 

Extractum Glycyrrhizae, Extract of Glycyrrhiza, — is the commercial extract of the 
root, occurring in glossy-black rolls, of sweet, peculiar taste. Not less than 60 per cent, of it 
should be soluble in cold water. Dose, gr. x-xxx [av. gr. xv.] 

Extractum Glycyrrhizae Purum, Pure Extract of Glycyrrhiza, — made with Aqua 
Ammoniae, Aqua Chloroformi, and Water, by percolation and evaporation. Dose, indefi- 
nite [av. gr. xv.] 

Fluidextractum Glycyrrhizae, Fluidextract of Glycyrrhiza, — made with Aqua Chloro- 
formi, Aqua Ammoniae and diluted alcohol. Dose, TTJ7X-5J [av. ttrxxx.] 

Mistura Glycyrrhizae Composita, Compound Mixture of Glycyrrhiza (Brown Mixture), — 
has of the Pure Extract 3 parts, Syrup 5, Acacia 3, Tr. Opii Camph. 12, Antimonii et 
potassii tartras T \, Spt. ^Etheris Nitrosi 3, and Water to 100. Dose, 5j-§ j [av. Sijss.] 

Pulvis Glycyrrhizae Compositus, Compound Licorice Powder, — Senna 18, Glycyrrhiza 
2$h, Oil of Fennel 0.4, Washed Sulphur 8, Sugar 50 parts. Dose, 3ss-ij [av. 5j] 

Elixir Glycyrrhizae, Adjuvant Elixir, — has of the Fluidextract of Glycyrrhiza 12.5, Aro- 
matic Elixir 87.5, mixed and filtered. 

Glycyrrhizinum Ammonia turn, Ammoniated Glycyrrhizin,—- -is very sweet to the taste,, 
readily soluble in water and in alcohol. Dose, gr. j-vj [av. gr. iv.]. Incompatible with it. 
are: Mineral Acids, Alkalies, Metallic salts. 

Physiological Action and Therapeutics. 

Licorice is demulcent and mildly laxative. It has an agreeable taste, and' 
increases the flow of saliva and mucus when slowly chewed or sucked, the 
increased secretions acting as emollients to the throat. It is used in many 
pharmaceutical preparations, covering the taste of senna, senega, hyoscyamus, 
turpentine, ammonium chloride, the bitter sulphates, and to some degree the 
bitterness of quinine. The powdered extract or root is used as an excipient 
in pills and troches. The compound mixture is an efficient expectorant, much 
employed in acute bronchitis and catarrhal laryngitis, but owing its power over 
cough mainly to the opium contained in it. The compound powder is a gentle 
laxative, of which senna is the most active ingredient. 

GOSSYPIUM PURIFICATUM, Purified Cotton,— is the hairs of the seed 
of Gossypium herbaceum, or of other cultivated species of Gossypium, nat. ord. 
Malvaceae, freed from adhering impurities and deprived of fatty matter. It 
is insoluble in ordinary solvents, but soluble in an ammonia solution of 
cupric oxide. Cotton-fibre is familiar in appearance to every one, but when 
examined microscopically it shows as flattened, hollow and twisted bands, 
spirally striate, and slightly thickened at the edges. It is a modification of 
Cellulose, C 12 H 10 O 10 , and corresponds therewith in all its ordinary chemical 
properties. 



2 82 GOSSYPIUM PURLF1CATUM. 

Preparations of the Cotton Plant. 

Oleum Gossypii Seminis, Cotton-seed Oil, — the fixed oil expressed from the seeds and 
purified. Is yellow, odorless, of bland taste and neutral reaction, soluble in ether, but slightly 
soluble in alcohol. Is introduced into the Pharmacopoeia for the reason that it constitutes 
most of the "Olive Oil" sold in foreign-shaped bottles and under foreign -appearing labels. 
It is used in the Official Liniment Camphor. Dose, 3j-oj [av. 5iv.] 

Pyroxylinum, Pyroxylin {Soluble Gun-cotton, Colloxylin), — is official for the purpose of 
making Collodium. It is prepared by macerating Cotton in a mixture of Sulphuric and 
Nitric Acids, washing, draining and drying. 

Collodium, Collodium, — made by dissolving Pyroxylin 4, in Ether 75 and Alcohol 25. 

Collodium Flexile, Flexible Collodion, — Collodion 95, Camphor 2, Castor Oil 3, mixed 
thoroughly. 

Collodium Stypticum, Styptic Collodion (Unofficial), — Ether 25, Alcohol 5, Tannic 
Acid 20, Collodion to 100. 

Collodium Cantharidatum, Cantharidal Collodion {Blistering Collodion), — Cantharides 
60, Flexible Collodion 85, Glacial Acetic Acid 5, Acetone q.' s. to 100. 

Physiological Action and Therapeutics. 

Cotton-root is believed to be an efficient emmenagogue and oxytocic by some 
southern practitioners, also somewhat of a galactagogue, but experiments on 
pregnant animals have not confirmed this view of its action. The Oil of the 
seed is very bland and may be applied to all the purposes for which olive oil 
is used. Cotton itself, when freed from oily matter, is remarkably absorbent 
of water, and is a good agent for excluding air from injured surfaces. Pyrox- 
ylin is highly inflammable, and explosive at 300 F. Collodion is inflam- 
mable, and dries rapidly on exposure to the atmosphere by evaporation of its 
ether, leaving a transparent film of Pyroxylin on the surface to which it has 
been applied; which film, if the flexible collodion be used, does not contract 
on drying or readily crack, making it an excellent protective application. Styp- 
tic Collodion is a solution of tannin, and an excellent hemostatic. Cantharidal 
Collodion is a convenient blistering agent, suitable for cases where the patient 
is inclined to remove a blister if applied in the ordinary way. 

Purified Cotton is a valuable agent in surgical practice, being employed 
as an application in burns and scalds, erysipelas, and articular rheumatism, to 
exclude the atmosphere, allay pain, and when covered with oiled silk or rubber 
cloth to keep up local perspiration. It may be phenolated, borated or salicy- 
lated, by soaking in the respective solutions, and is then used as an antiseptic 
dressing for wounds, and ulcers. It is employed by the pharmacist in funnels 
to filter oils, and for the preparation of the official waters. 

Collodion is used as a protective covering for superficial burns, ulcers and 
wounds, slight cuts, cracked nipples, anal fissures, and erysipelas. For these 
affections the flexible collodion should be used, but where it is desirable to 
produce pressure on the part the ordinary form is best, as it contracts with 
considerable force in drying. Styptic Collodion has many uses as a hemo- 
static and protective which will suggest themselves, and the cantharidal 
form is a convenient epispastic for uneven surfaces, the therapeutics of which 
are detailed under Cantharis. 



GRANATUM — GRINDELIA. 283 

GRANATUM, Pomegranate, — is the bark of the stem and root of Punica 
Granatum, sl small tree of the nat. ord. Punicaceae, cultivated in subtropical 
countries. It contains tannic and punico-tannic acids, mannite and an active 
mixture of alkaloids named Pelletierine, which is soluble in water, alcohol, 
ether, chloroform, etc., and has strong basic properties. Dose, gr. x-xxx 
[av. gr. xxx.] 

Preparations. 

Fluidextractum Granati, Fluidextract oj Pomegranate. — Dose, Ti£x-5 j [av. tt^xxx.] 
Decoctum Granati, Decoction of Pomegranate (Unofficial) — 3xvij of bark from the 
fresh root in oxvij of boiling water, boiled down to §xij and strained. Dose, 5iv-vj every 
hour, preceded and followed in a few hours by a brisk cathartic. 

Pelletierinae Tannas, Pelletierine Tannate, — is a mixture of the tannates of four alkaloids 
(punicine, iso-punicine, methyl-punicine, and pseudo-punicine), obtained from Punica Gra- 
natum. Dose, gr. iij-viij [av. gr. iv.], in powder, taken fasting and followed after 2 hours 
by a full dose of Epsom Salts or Castor Oil. 

Physiological Action and Therapeutics. 

Granatum and its alkaloids are teniafuge, and very efficiently so, rarely 
failing to bring away the whole worm. The decoction was formerly em- 
ployed, but because of the disagreeable taste and nausea it has been sup- 
planted by Pelletierine which in the form of a proprietary, Tanret's Pelle- 
tierine, can be secured in bottles containing one adult dose (5 grains) at three 
dollars each. The decoction in full doses causes nausea and vomiting, flat- 
ulence, purging, and sometimes cramps in the legs, giddiness, dimness of 
vision, general numbness of the limbs and increase of the quantity of urine. 

GRINDELIA, — is the dried leaves and flowering tops of Grindelia cam- 
porum, Grindelia squarrosa, or Grindelia cuneifolia, herbaceous perennial plants 
of the nat. ord. Compositae indigenous to the Pacific slope of the United States 
and Mexico, where they are common along the coast and in the mountains, 
having yellow flowers, a balsamic odor and a pungent, aromatic and bitter 
taste. They contain a resin, which is probably the active constituent, a 
volatile oil, also Robustic Acid and an alkaloid named Grindeline. Dose, gr. 
xx-xxx [av. gr. xxx.] There is but one official preparation, — 

Fluidextractum Grindeliae, Fluidextract of Grindelia, — is three-fourths alcohol and 
contains much resin. Dose, ttj?x-3J or more [av. Trj?xxx], every 3 or 4 hours, in sweetened 
water or milk, the mixture being well stirred to prevent the resin adhering to the glass. 

Physiological Action and Therapeutics. 

Grindelia has an acrid, bitter taste, and excites the secretion of saliva when 
chewed. Its principal action is that of an antispasmodic, but it is also a motor- 
depressant and somewhat expectorant. Given in large doses to small ani- 
mals it induces paralysis, beginning in the hind extremities and affecting 
the sensory nerve-trunks first, then the sensory side of the spinal cord, after- 
wards involving the motor nerve-trunks, and finally the spinal motor tract. 



284 GXJAIACUM. 

It stimulates the cardiac inhibitory apparatus and the vaso-motor centre, slow- 
ing the heart and respiration, and raising the blood-pressure. In sufficient 
quantity it causes dilatation of the pupils, reduced cutaneous sensibility and 
sluggish reflexes, even narcotism in small animals. Its elimination occurs by 
the bronchial mucous membrane and the kidneys, both of which it stimulates, 
and in large doses it has produced renal irritation. 

Grindelia is chiefly employed as a palliative in spasmodic asthma and the 
dyspnea accompanying bronchitis. In several cases of recurring asthma in 
elderly persons 3 SS of the fluidextract has afforded almost instantaneous relief t 
but has not prevented the return of the paroxysms. It is an efficient remedy 
in chronic bronchitis, especially that of the aged, also in whooping-cough and 
other spasmodic coughs, in hay fever and in the dyspnea of various pulmonary 
and cardiac affections, and has been employed with benefit in chronic cystitis. 
Locally, it is used with advantage as a lotion for the dressing of burns and blis- 
ters, in vaginitis and uterine catarrh, and to allay the pain of herpes zoster. In 
the proportion of 1 part of the fluidextract to 9 of water, as a sedative lotion,, 
it is a very efficient application for the cutaneous irritation due to poison-oak 
or ivy, also in skin diseases attended with itching and burning sensations. 

GXJAIACUM, Guaiac, — is the resin of the wood of Guaiacum officinale,. 
Lignum vitae, or of G. sanctum, trees of the nat. ord. Zygophyllaceas. It con- 
sists of three resins, Guaiaconic Acid, C 19 H 20 O 5 , 70 per cent., Guaiacic Acid, 
C 6 H 8 3 , resembling Benzoic Acid, and Guaiaretic Acid, C 20 H 26 O 3 ; also an 
indifferent resin. The wood also contains a yellow coloring matter, gum, etc., 
and yields, by destructive distillation, Guaiacol (see page 244). Dose of Guaiac,. 
gr. x-xxx [av. gr. xv] in wafer. The official preparations are — 

Tinctura Guaiaci, Tincture of Guaiac. — 20 per cent. Dose, 3ss-jss [av. 3j], in mucilage 
or syrups, as the resin is precipitated by water. 

Tinctura Guaiaci Ammoniata, Ammoniated Tincture of Guaiac, — has of Guaiac 20, 
Aromatic Spirit of Ammonia to 100. Dose, TT£x-5j [av. tt#xxx.] 

Incompatible with Guaiac are: Acacia, Acids (mineral), Chlorine-water, Chromic Tri- 
oxide, Ferric Chloride, Gold Chloride, Metallic salts, Potassium Permanganate, Spirit of 
Nitrous Ether. 

Physiological Action and Therapeutics. 

Guaiac is diaphoretic, expectorant and alterative; also laxative and pur- 
gative, according to the dose administered. Its taste is acrid and very disagree- 
able. Internally it is a local stimulant, producing salivation, an acrid sensa- 
tion in the throat, warmth in the epigastrium, increase of the gastric and in- 
testinal secretions and reflex stimulation of the heart. Its continued use 
causes gastric catarrh, and in large doses it is a gastro-intestinal irritant, 
causing vomiting, purging and severe congestive headache. It increases the 
bronchial secretion and is mildly diaphoretic. Sometimes it fails to act on 
the skin and is then markedly diuretic. 

Guaiac was first used as an antisyphilitic, employed in docoction and in 



GURJUN BALSAM HAMAMELIS. 285 

large quantity, with a spare diet and external warmth. It acquired a great 
reputation in that disease during the 16th century, but it is now abandoned 
for more certain remedies. It is an efficient remedy in tonsillitis, given in 
5 ss doses of the tincture in emulsion with mucilage or yolk of egg, to abate 
the inflammation and abort the disease. It has considerable reputation in 
neuralgic dysmenorrhea, amenorrhea, chronic rheumatism, gout, lumbago and 
sciatica. The ammoniated tincture in water makes a cleanly and not very 
disagreeable gargle. The reputation of Guaiac in many chronic and obscure 
complaints is due, partly to its purgative property and partly to its nastiness, 
a quality which is highly appreciated by many patients. 

GURJUN BALSAM, Balsamum Dipterocarpi, Wood Oil (Unofficial), — is an oleoresin 
obtained from incisions in various trees of the genus Dipterocarpus, growing in India. It is 
thick, opaque and grayish-brown by reflected light, soluble in chloroform and partly so in 
alcohol, ether and volatile oils, odor balsamic, taste bitter. It contains from 40 to 70 per 
cent, of a Volatile Oil, a Resin and Gurjunic Acid. Dose, TT£x-5ij, in emulsion, or in capsules. 

The properties of this balsam are similar to those of Copaiba, but it is less disagreeable 
and less apt to upset the stomach, also less actively diuretic. It has been used in leprosy, 
given internally in full doses and used locally at the same time. Mixed with 4 parts of 
Lime-water it is well applied in chronic eczema, lupus and psoriasis. 

HJEMATOXYLON, Log-wood (Unofficial), — is the heart- wood of Hcematoxylon cam- 
pechianum, a tree of the nat. ord. Leguminosae, native of tropical America, but naturalized 
in the West Indies. It occurs in chips or powder of a dark brown-red color, often with a 
greenish lustre, and colors the saliva a dark pink when chewed. It contains Tannic Acid, 
and a sweet, crystalline coloring principle named Hematoxylin, which is Colorless when 
pure, but turns red on exposure to light. 

Extractum Haematoxyli, Extract of Hematoxylin (Unofficial), — Dose, gr. v-xx [av. gr. 
xv.] 

Incompatible with liquid preparations of Hcsmatoxylon are Acids, Ammonia, Alum, Cin- 
chona infusion, Copper Sulphate, Ferrous Sulphate, Lead Acetate, Opium, Tartar Emetic. 

Logwood is mildly astringent, its properties depending on the Tannin contained in it. 
As it is devoid of irritating qualities it is well adapted to the diarrheas and hemorrhages of 
young children. It does not produce constipation or disorder of the bowels, but colors the urine 
and stools blood-red, and has caused phlebtis. 

HAMAMELIS, Witch-hazel, — is Hamamelis virginiana, a shrub of the 
nat. ord. Hamamelidaceae, growing in the United States. The leaves contain 
about 8 per cent, of Tannic Acid, a bitter principle and probably some vola- 
tile matters, but the chemistry of the plant has not been fully studied. It is 
official. 

Preparations. 

Aqua Hamamelidis, Hamamelis Water, — is a saturated aqueous preparation obtained 
by distilling with steam or water the bark and twigs or entire shrub. Dose, 5 j-iij [av. 3ij-] 

Hamamelin (Unofficial), — is an uncertain extract of very indefinite composition. Dose, 
gr. HJ- 

Distilled Extracts, so-called but really Waters distilled from the bark, are sold by 
various manufacturers and are said by the vendors to contain the volatile principles of the 
plant. Pond's Extract is such a preparation, said to be made by distilling the bark with a 
very dilute alcohol, and is a proprietary medicine of uncertain composition. 

No trustworthy experimentation has yet been made with this drug. It is 
tonic, astringent, styptic and sedative, owing most of its properties to its tannin. 



2 86 HEDEOMA HELLEBORUS. 

In full doses it may produce severe throbbing pain in the head. It is used 
both internally and locally with great benefit in hemorrhoids, particularly 
those of the bleeding variety, varicose veins and ulcers, venous congestions 
and threatening local inflammations. It is recommended in hemorrhages 
from the nose, stomach, rectum and kidneys, in threatened abortion, and 
externally for sprains and bruises, foul ulcers, the pruritus of eczema, also in 
leucorrhea and gonorrhea. An ointment of Witch-hazel is found in the 
shops, and suppositories may be prepared extemporaneously by evaporating 
the fluidextract and incorporating the residue with cacao-butter. 

HEDEOMA, Hedeoma (Unofficial), — the dried leaves and flowering tops of Hedeoma 
pulcgioidcs, Pennyroyal, nat. ord. Labiatae, a common plant in the United States. Dose, 
5j-iij [av. 5ij-l 

Oleum Hedeomae, Oil of Pennyroyal (Unofficial), — is the volatile oil, readily soluble in 
alcohol. Dose, ttjjj'-v [av. rrj^iij.] 

Spiritus Hedeomae, Spirit of Pennyroyal (Unofficial), — contains i part of the oil in 9 of 
alcohol. Used externally or as a spray. 

Hedeoma is a stimulant aromatic, also somewhat carminative and emmenagogue. Its 
odor is extremely repulsive to insects, especially fleas and mosquitoes. In warm infusion 
it is a popular remedy for amenorrhea and flatulent colic. It may be used as a corrective 
with other medicines, and the spirit is well employed on the hands and face to keep away 
mosquitoes. The writer has known death by narcosis to result from an overdose of the oU 
taken to produce abortion. 

HELLEBORUS, Hellebore (Unofficial),— the rhizome and rootlets of Hel- 
leborous niger, black hellebore, and Helleborus viridis, green hellebore, plants of 
the nat. ord. Ranunculaceae, natives of Europe. A third variety, Helleborus 
occidentalism growing in Greece, is probably the true hellebore of the ancients. 
Its' most important constituents are two glucosides, Helleborin and Helleborein, 
both crystalline and poisonous. 

Unofficial Preparations. 

Extractum Hellebori Nigri, Extract of Black Hellebore. Dose, gr. j-x cautiously. 
Fluidextractum Hellebori Nigri, Fluidextr. of Black H. Dose, n^ij-xv. 
Helleborin, C 36 H 42 6 , — insoluble in water, soluble in alcohol, and in chloroform. 
Helleborein, C 26 H 44 15 , — crystalline, very soluble in water, slightly so in alcohol, 

insoluble in ether. Dose, gr. ^— /„. 

Physiological Action and Therapeutics. 

Black Hellebore is a drastic, hydragogue cathartic, and an emmenagogue. 
In overdoses it is a violent gastro-intestinal irritant, producing vomiting, hyper- 
catharsis, vertigo, cramps and convulsions, which may result fatally. Locally 
applied, the fresh root is violently irritant to the skin, producing inflammation 
and vesication. 

Helleborin is an active poison, acting on the tongue like Aconite, and on 
the nervous system as a narcotic, producing in animals paresis of motion and 
sensation, cerebral and spinal congestion, dilated pupils and death. It is less 
irritant than Helleborein to the mucous membranes. 



HOANG-NAN HUMULUS. 287 

Hellebore'in is less actively toxic to animals, but is very irritant, producing 
conjunctivitis, sneezing, salivation, nausea, vomiting and purging. It affects 
the heart like Digitalis, small doses frequently repeated slowing its action, but 
large ones quicken it and then suddenly paralyze it through the pneumogastric 
nerve. Respiration is at first accelerated, then slowed and rendered laborious. 
Diuresis is a constant result, the kidneys and uterus are congested, gradual 
paralysis and convulsions follow, and death occurs by paralysis of the heart. 

Black Hellebore is an old remedy, having been highly esteemed by the early 
physicians in insanity, dropsies, worms, cutaneous affections and amenorrhea. 
Hellebore'in has come into notice as a substitute for Digitalis in cardiac affec- 
tions, being of less bulk and more definite composition. Its action on the 
heart is attained by doses much smaller than those necessary to produce its 
irritant effects on the gastro-intestinal canal. Its solubility in water and 
the freedom with which it can be used hypodermically are important quali- 
ties to recommend it. 

HOANG-NAN, Hwang-Nao (Unofficial), — is the bark of Strychnos Gautheriana, Tropical 
Bind-weed, a creeping vine of the nat. ord. Loganiaceae, found in the mountains of Tonquin. 
It contains the alkaloids Strychnine and Brucine, thus resembling in compostion its congeners 
Nux Vomica and Ignatia, but differing from them, as they do from each other in the propor- 
tional quantities in which the alkaloids are contained, — Brucine predominating in this plant, 
as Strychnine does in the other two. 

Like the other members of the Strychnos family, Hoang-Nan is an active tetanizer, its 
action generally corresponding to that of Nux Vomica. It was first brought into notice by 
the missionary fathers stationed in the French colonies in Asia, they having found its employ- 
ment general among the natives for leprosy and hydrophobia. Along the coast of Tonquin 
and Cochin-China, also in Pondicherry, Trinidad, and Venezuela, it has an established repu- 
tation in the two terrible diseases mentioned, also as a remedy for the bites of venomous 
serpents and other reptiles, scrofulous and syphilitic ulcers, and indolent sores. It has been 
used successfully for malarial fevers, in lieu of quinine, and is highly spoken of by Father 
Brosse, as a stimulant to the intellect, without producing any subsequent depression. 

The dose of the powdered drug is about gr. iij-v; of the aceto-alcoholic Extract, gr. f-J; 
and of the concentrated tincture, ttjh-v. 

HUMULUS, Hops, — the dried strobiles (fruit-cones) of Humulus Lupulus , 
a cultivated creeping plant of the nat. ord. Moraceae. Its constituents are a 
liquid volatile alkaloid named Lupuline, a volatile oil, which consists in part 
of Valerol and Trimethylamine, the crystalline, bitter principle Lupulinic Acid, 
also wax, resin, and tannin. Except the last named, the constituents are most 
abundant in the glandular powder of the strobiles, which is named Lupulin. 
Dose, gr. x-xlv [av. gr. xxx.] 

Unofficial Preparations. 

Fluidextractum Humuli, Fluidextract of Hops, — Dose, ttjjv-xv [av. TTgyiij.] 

Infusum Humuli, Infusion of Hops, — oss to the pint. Dose, Sj-iv. 

Lupulinum, Lupulin, — is the glandular powder separated from the strobiles, of bright, 
brownish-yellow color, aromatic and bitter taste. The Volatile Oil exists in the Lupulin 
grains, and contains Valerol, which is changed by long exposure, giving a disagreeable odor to 
old hops. Dose, gr. v-xv [av. gr. vijss.] * 

Mineral acids and metallic salts are chemically incompatible with preparations of Hops. 

Humulus is a bitter tonic, and a feeble hypnotic and antispasmodic. 
After slight cerebral excitement it produces calm and a soporific disposition, 



2 88 HYDRANGEA HYDRARGYRUM. 

especially if the solution administered be strongly alcoholic. The stomachic 
and tonic effects are due to the bitter principle, Lupulinic Acid, and are found 
in bitter ale. The primary stimulant and secondary sedative effects are due 
to the volatile oil and are also possessed by ales and beer. 

Hops are used as a tonic and calmative in delirium tremens, in which a 
combination of the tincture with tincture of capsicum is very efficient and is 
an excellent substitute for alcohol. In dyspepsia of atonic form Humulus is 
an excellent stomachic tonic, and in nervous irritability the fluidextract may 
be used as a calmative and hypnotic, or the hop-pillow, which certainly exer- 
cises considerable imaginary influence. A poultice of hops is a favorite 
domestic application in inflammations and pain. Lupulin has been used 
with benefit in irritable bladder and alcoholism, and as an anaphrodisiac in 
the treatment of chordee, gonorrhea, spermatorrhea and other affections of 
the geni to-urinary organs. 

HYDRANGEA (Unofficial), — is the root of Hydrangea arborescens, a plant of the nat- 
ord. Saxifragaceae, growing in the southeastern states. It is a white, tough root, containing 
gum, albumin, starch, resin, and a ferrous salt, with other salts. 

Hydrangea has been long used by the Cherokee Indians in calculous affections, pro- 
moting the removal of gravel from the bladder, and relieving pain during the passage of 
renal concretions through the ureters. Large doses produce vertigo, oppression of the chest, 
and considerable cerebral disturbance. It is obsolete as far as modern scientific thera- 
peutics is concerned. 

HYDRARGYRUM, Mercury (Quicksilver), Hg,— is a shining, silver- 
white metal, fluid and slowly volatile at ordinary temperatures, solidifies at 
— 40 C, boils at 3 5 8° C, volatilizes at a temperature below that of visible 
redness, is odorless and tasteless, soluble in nitric acid, insoluble in ordinary 
solvents. It is obtained from its native sulphide (cinnabar), but occurs also 
in globules disseminated through the ore.] 

Preparations of Mercury. 

Hydrargyrum cum Creta, Mercury with Chalk {Gray Powder), — has of Mercury 38, 
Honey 10, Prepared Chalk 57, Water q. s., shaken, triturated together, dried to 100, and then 
reduced to a uniform gray powder. Dose, gr. ss-x [av. gr. iv.] 

Massa Hydrargyri, Mass of Mercury (Blue Mass, Blue Pill), — has of Mercury 33, 
Licorice 10, Oleate of Mercury 1, Althaea 15, Glycerin 9, Honey of Rose 32. Each grain 
contains gr. -| of Mercury. Dose, gr. ss-x [av. gr. iv.] 

Unguentum Hydrargyri, Mercurial Ointment, — Mercury 50, Lard 25, Suet 23, Oleate 
of Mercury 2, triturated together, until globules of Mercury cease to be visible under a lens 
having a magnifying power of ten diameters. 

Unguentum Hydrargyri Dilutum, Diluted Mercurial Ointment {Blue Ointment), — has of 
the preceding 60 with Petrolatum 40, thoroughly mixed. 

Chlorides and their Preparations. 

Hydrargyri Chloridum Corrosivum, Corrosive Mercuric Chloride (Bichloride of Mercury, 
Corrosive Sublimate), HgCl 2 , — heavy, colorless crystals, of acrid, metallic taste, and acid 
reaction; soluble in 13.5 of water and in 3.8 of alcohol, in 2 of boiling water, 1.6 of boiling 
alcohol, 22 of ether and in about 12 of glycerin. Dose, gr. sV'rV t av - § r - "2VO 

Toxitabellse Hydrargyri Chloridi Corrosivi, Poison Tablets of Corrosive Mercuric Chlo- 
ride (Corrosive Sublimate Tablets), — blue colored tablets of an angular shape; each hav- 



HYDRARGYRUM. 289 

ing the skull and cross bones and the word POISON distinctly stamped upon it. Each 
tablet weighs about 1 Gm. and contains from 0.45 to 0.55 Gm. (approx. 6.9 to 8.5 gr.). 

Hydrargyri Chloridum Mite, Mild M er cur ous Chloride {Subchloride of Mercury, Calomel), 
HgCl, — a heavy, white, impalpable powder, odorless and tasteless; insoluble in water, alcohol 
or ether. Is an ingredient of Pil. Catharticae Co. Dose, gr. 2V~"g r - v - The dose depends 
on the effect desired; [av. laxative, gr. ijss; alterative, gr. j.] 

Hydrargyrum Ammoniatum, Ammoniated Mercury {White Precipitate, Mercuric Am- 
monium Chloride), HgNH 2 Cl, — is a white, insoluble powder, odorless and of earthy, metal- 
lic taste. Only used externally. 

Unguentum Hydrargyri Ammoniati, Ointment of Ammoniated Mercury {White Pre- 
cipitate Ointment), — Ammoniated Mercury 10, White Petrolatum 50, Hydrous Wool Fat 40. 

Oxides and their Preparations. 

Hydrargyri Oxidum Flavum, Yellow Mercuric Oxide, HgO, — an orange-yellow, heavy, 
impalpable powder, odorless and tasteless, insoluble in water or alcohol, but wholly soluble 
in nitric or hydrochloric acid. Used to prepare: — 

Unguentum Hydrargyri Oxidi Flavi, Ointment of Yellow Mercuric Oxide, — strength 
1 in 10. 

Oleatum Hydrargyri, Oleate of Mercury, — has of the Yellow Oxide 25, Alcohol 20, 
Oleic Acid to 100. 

Hydrargyri Oxidum Rubrum, Red Mercuric Oxide {Red Precipitate), HgO,— a heavy, 
orange-red, crystalline powder, having the same properties as the yellow oxide, from which 
it differs only in being crystalline, and in a less minute state of subdivision. Dose, gr. -io"^. 

Lotio Hydrargyri Flava, Yellow Wash (Unofficial), — prepared by adding Corrosive 
Sublimate gr. xviij to Lime-water §x, producing the yellow oxide; a favor? t p application for 
syphilitic sores. 

Lotio Hydrargyri Nigra, Black Wash (Unofficial), — prepared by adding Calomel gr. xxx 
to Lime-water §x, producing the black oxide. 

Iodides and their Preparations. 

Hydrargyri Iodidum Rubrum, Red Mercuric Iodide {Biniodide of Mercury), Hgl 2 , — a 
scarlet-red, amorphous powder, almost insoluble in water, soluble in 115 of alcohol, in solu- 
tion of potassium iodide or of mercuric chloride. Prepared by double decomposition be- 
tween Potassium Iodide 5, and Mercuric Chloride 4 parts. Dose, gr. sV-xV [av. gr. 2V] 

Liquor Arseni et Hydrargyri Iodidi, Solution of Arsenous and Mercuric Iodide {Dono- 
van's Solution), — see page 153. 

Hydrargyri Iodidum Flavum, Yellow Mercurous Iodide {Protiodide of Mercury), Hgl, — 
a bright yellow or greenish-yellow powder, insoluble in alcohol or ether and almost -so in 
water. Dose, gr. T V~J [av. gr. f.] 

Acid Combinations and their Preparations. 

Hydrargyri Benzoas, Mercuric Benzoate (Unofficial), — a white, crystalline, tasteless 
powder, slightly soluble in water, but readily soluble in a solution of common salt. Its 
action and uses are the same as mercuric chloride. Dose, hypodermically, gr. |-|, once 
daily. 

Unguentum Hydrargyri Nitratis, Ointment of Mercuric Nitrate {Citrine Ointment), — 
Mercury 7 dissolved in Nitric Acid 17^, adding Lard 76. 

Hydrargyri Salicylas, Mercuric Salicylate, — a white, tasteless powder, nearly insoluble 
in water or alcohol, but readily soluble in a solution of sodium chloride or any of the halo- 
gen salts. Dose, gr. ifo-gr. J (U. S. P. Dose, gr. yV). 

Unofficial Preparations. 

Mercurol, — is a compound of metallic mercury and yeast nuclein, containing 20 per 
cent, of mercury; a brown powder, soluble in water, insoluble in alcohol. It is used in a 1 per 
cent, solution as an injection in gonorrhea and cystitis and as an antisyphilitic remedy. 
Dose, gr. ss-ij. 

_ Sublamin, — is a combination of Mercuric Sulphate 1, and Ethylene-diamine 2, con- 
taining 44 per cent, of mercury, freely soluble in water, sparingly soluble in alcohol. Used 
in 1 to 1,000 solution for disinfecting hands and 1 to 5,000 for irrigation. 

19 



29O HYDRARGYRUM. 

Hydrargyri Succinimidum, Mercury Succinimide, — a white, crystalline powder, soluble 
in 25 of hot and 75 of cold water. Dose, gr. £-| by injection, which is comparatively pain- 
less. Recommended in syphilis and pulmonary tuberculosis. 

Triturations. 

These may be prepared according to the general formula under the title Triturationes 
in the Pharmacopoeia, 10 parts of the substance to 90 of Sugar of Milk. Mercury itself or 
any of its salts may be so treated with excellent results, the particles being much finer and 
therefore more easily absorbed than if rubbed up with another agent. In this form a larger 
proportion of the drug is utilized for specific purposes, while but a small amount remains 
to give rise to local irritation (Piffard). All trouble concerning incompatibility may be 
avoided by using triturations. 

Incompatibles. 

Incompatible with Mercuric Chloride {corrosive sublimate) are: Albumin, Alkalies, Alka- 
loids, Ammonia, Antimonous and Arsenous salts, Bromides, Borax, Carbonates, Copper and 
Ferrous salts, Formic Acid, Glucosides, Honey, Hypophosphites, Hypophosphorous Acid, 
Iodides; Infusions of Cinchona, Calumba, Oak-bark, Senna; Lead salts, Lime-water, Milk, 
Phosphates, Piperazin, Silver Nitrate, Soap, Sulphates of Potassium or Sodium, Sulphides, 
Compound Syrup of Sarsaparilla, Tannic Acid, Tartar Emetic, Vegetable astringents, Zinc 
salts. 

With Mercurous Chloride (calomel) are: Acacia, Acids mineral, Alkalies, Ammonia, 
Antimony Sulphide, Arsenites in alkaline mixtures, Bromides, Carbonates, Chlorides, Citric 
Acid, Cocaine, Copper salts, Cyanides, Hydrocyanic Acid, Hydrogen Peroxide, Hypophos- 
phorous Acid, Iodides, Iodine, Iodoform, Lead salts, Lime-water, Mercuric Oxides, Pilo- 
carpine, Sodium Bicarbonate; Sugar, both cane and milk; Silver salts, Soaps, Sulphides, 
Tragacanth. 

With Ammoniated Mercury are: Acids, Alkalies, Bromine, Chlorine, Iodine, Lime-water. 
With Mercuric Iodide, as with Mercuric Chloride. With Mercurous Iodide, as with Mercurous 
Chloride. "With Mercuric Oxide are Acids (mineral), Chloral Hydrate, Mercuric Chloride. 

Physiological Action. 

Mercury is tonic, purgative, alterative, antiphlogistic and sorbefacient, and 
indirectly cholagogue. Some of its salts are corrosive poisons, others are local 
caustics, all produce by long-continued administration the peculiar cachexia 
termed Hydrargyrism. The metal itself is inert, but by combination with the 
acids and fluids of the body it becomes active, and is readily absorbed in any 
form, passing into the blood from the skin, mucous membranes, lungs and 
stomach, in each case probably as an albuminate. Entering the stomach in 
any form it is first converted into a double chloride of sodium and mercury; 
it next unites with the albuminous juices to form a complex molecule of mer- 
cury, sodium, chlorine and albumin, which being soluble in an excess of so- 
dium chloride or albumin, exists in solution and is easily absorbed, then being 
decomposed in the blood and changed to the albuminate. Entering the in- 
testines a purgative action is soon set up, of more or less severity according 
to the preparation used, a small portion only is absorbed, the rest being con- 
verted into a sulphide and excreted with the feces, unless combined with Opium, 
which delays its progress through the intestines and permits of its freer absorp- 
tion. On the blood its effects in small doses are tonic, but. in quantity it indi- 
rectly produces impoverishment thereof, diminishes the red corpuscles, and 
consequently disorders nutrition and deranges digestion. From the blood it 
enters the tissues, where it remains for an indefinite period, exerting a peculiar 



HYDRARGYRUM. 29! 

influence, termed "alterative," on all processes characterized by growth of 
young cells, but not producing any definite anatomical changes either in the 
viscera or the nervous tissue, though in the latter a low form of inflammation 
arises, resulting in loss of coordination-power. It stimulates most of the 
glands to the production of pathological secretions, especially the salivary 
glands and the pancreas, and is excreted with comparative slowness by 
all the excretory organs, being found in the saliva, sweat, milk, urine and 
bile. A single dose is entirely eliminated in 24 hours, but if repeated 
in less time it accumulates in the body, only gr. T x ¥ being eliminated daily by 
the kidneys, so that when its full desired effect is produced, the dosage should 
be decreased, and only enough should be given to maintain its action. It 
tends to accumulate in the liver, while stimulating its cells, and is not a direct 
cholagogue, though stimulating the flow of bile already secreted by reflex action 
on the bile-ducts due to its purgation of the duodenum. Its excretion is has- 
tened and completed by the use of Potassium Iodide. 

In small doses administered for a short time the mercurial preparations 
are blood-tonics, improving the general condition, increasing the number of 
red corpuscles and the body-weight. They soon begin to promote waste by 
stimulating the lymphatic system, and if the small doses are long continued 
or the quantity is increased, symptoms of mercurial poisoning begin to mani- 
fest themselves. 

The first symptoms of Hydrargyrism are fetid breath, swollen and spongy 
gums having a tendency to bleed upon slightest touch, stomatitis, sore and 
loosened teeth, inflamed and tender salivary glands pouring out a peculiar, 
thin saliva of foul odor in large quantity, and a metallic taste in the mouth. 
Anorexia, diarrhea and fever follow, also ulceration and in some cases even 
gangrene of the lips and tongue. If the use of the drug be continued nutri- 
tion will be greatly impaired through the extreme promotion of retrograde 
metamorphosis, and various nervous disturbances will follow, the effects 
being emaciation, pallor, edema, ulcerated skin, erythematous, vesicular or 
pustular eruptions, headache, insomnia, neuralgia, tremor through paresis of 
the muscles of the head and extremities, epilepsy, coma and convulsions. In 
pregnant women abortion will occur by reason of the impoverishment of the 
blood. 

The drug is a specific antagonist to the syphilitic virus and the old clinical 
observation that patients with syphilis can tolerate larger doses of mercury 
than normal individuals- suggests that both poisons destroy each other in 
the organism. Mercury is certainly capable of bringing about a radical cure 
of syphilis, if introduced into the system in considerable quantity and its use 
protracted over a very long time, the action of the drug in all cases being 
kept short of ptyalism or any pronounced physiological effects. 

The observations on the antiphlogistic and sorbef acient actions of Mercury 
are clinical rather than physiological, but it is generally agreed that exhibited 



292 HYDRARGYRUM. 

in inflammation mercurials antagonize in some unknown way the inflam- 
matory process, and that in chronic diseases attended by the formation of 
semi-organized deposits, a mild mercurial course will aid the removal of the 
new-formed material. 

Salivation is most readily produced by blue mass, next by calomel, and 
less easily by gray powder. Individuals differ greatly in their susceptibility 
to the action of mercury, some persons having been affected after a single moder- 
ate dose. Children are not easily salivated. Inhalation of mercurial vapors 
is most apt to affect the nervous system; the internal administration and that 
by inunction are more likely to produce salivation. A not uncommon result 
of full doses of blue pill is an acute coryza of very severe character, which the 
writer has frequently observed to follow on neglect of the old-fashioned pre- 
caution to "work off" the mercurial by a saline cathartic. The symptoms 
produced are those of a severe attack of influenza, — epistaxis, conjunctivitis 
and obstinate muco-purulent discharge from the nasal passages being espe- 
cially marked. Similar effects have been observed during physiological ex- 
periments with mercury on animals by Overbeck and Bennett. 

All mercurials are antiseptic, germicidal, and antiparasitic, the Bichloride 
and Biniodide being the most powerful in these respects. Micrococci and bacilli 
in active growth without spores are killed by solutions of the Bichloride of 1 
in 20,000, while solutions of 1 in 1,000 will rapidly destroy the spores of bacillus 
anthracis and bacillus subtilis. The chemical instability of this salt prevents 
its general use as a disinfectant, it being rapidly decomposed by ammonia and 
other substances usually present in excreta. The oleate, oxide, ammoniate, 
nitrate, and bichloride, are the preparations generally used to destroy the animal 
and vegetable parasites which infest the skin. The toxic action of mercury 
on protoplasm is due to its great affinity for nitrogenous molecules. The in- 
soluble preparations are less powerful as germicides than the soluble ones, 
owing to the difficulty of bringing them into intimate contact with the microbes; 
but the Subchloride (calomel) has considerable effect as an intestinal antiseptic. 

Notes on the Action of the Preparations. 

Metallic Mercury is not used internally except in the finely divided form 
obtained in blue pill and gray powder, which are capable of producing the 
effects previously described. Mercurial Ointment is the preparation generally 
used for inunction, a piece the size of a small nut being daily rubbed into the 
soft skin at the flexures of joints. The Oleate painted over the surface is a 
more cleanly method of making the same application. Both these prepara- 
tions are efficient parasiticides. 

The Bichloride (corrosive sublimate) is the most actively toxic of the mer- 
curial salts. It is probably the most active germicide and parasiticide, a solu- 
tion of 1 part in 2,000 being efficiently antiseptic for use as injections or dress- 






HYDRARGYRUM. 293 

ings, and a solution of i in 250 being the usual strength for use against epizoa 
and in parasitic skin affections. It is a very active gastro-intestinal irritant, in 
toxic dose producing nausea, retching and vomiting, a metallic taste, constric- 
tion of the fauces, burning pain in the stomach, suppression of urine, bloody 
diarrhea, collapse and death often preceded by convulsions. It affects specific- 
ally the lower bowel [Calomel preferring the upper intestine], and produces 
inflammation and ulceration of the rectum. It is, however, one of the most 
manageable and efficient of the mercurials when used in proper doses. 

The mild mercurous chloride (calomel) is very insoluble and unirritating, 
tasteless, laxative in grain doses, decomposed by the alkaline contents of the 
intestines, oxide of mercury being formed, and stimulates peristalsis directly 
by its local action and indirectly by stimulation of the intestinal glands and 
liver. Large doses of Calomel are rarely required as only a small quantity 
can be converted into the active gray oxide by the alkaline intestinal juices; 
the addition of sodium bicarbonate to Calomel powders and triturates facili- 
tates the reduction of the drug. Externally applied it is sedative to the 
mucous membranes and the skin. It is an efficient diuretic, in small doses 
frequently repeated. Ammoniated Mercury is an ammonio-chloride, and a 
useful stimulant and parasiticide when used locally in the form of ointment. 

The Iodides are actively poisonous, the red being much the most irritant, 
producing symptoms and results similar to those of the bichloride. The 
Oxides are irritant, the red being the most so, and are rarely used internally. 
The acid Nitrate is a good escharotic, the pain caused by it being transient 
though severe, and its caustic action being comparatively superficial. The 
Ointment of the Nitrate (citrine ointment) is more irritant than that of 
ammoniated mercury, and generally needs dilution. All these preparations 
may produce the constitutional effects of mercury, and the subjects of their 
administration should be carefully watched for the first symptoms of 
mercurialization . 

Therapeutics. 

Mercury is undoubtedly a specific in syphilis destroying the Spirochete 
pallida. As an accurate diagnosis of syphilis is essential before administering 
mercury, it was formerly believed that it should be withheld until the con- 
firming secondary symptoms appeared, but with the present available meth- 
ods for demonstrating the Spirochete pallida in the initial lesion and the 
reliability of the Wassermann test, such delay is no longer warranted, in fact 
is considered dangerous. The efficiency of Mercury as an antisyphilitic 
remedy depends to a great extent upon the early diagnosis and active treat- 
ment. The longer the infection is allowed to exist without treatment, the 
more difficult to destroy the parasite. The same may be said with regard 
to insufficient and improper treatment which failing to overcome the infec- 
tion renders the spirochete more resistant to subsequent mercurial influence. 



294 HYDRARGYRUM. 

Mercury may be administered by mouth, inunction, inhalation, and injection. 
Unless otherwise contraindicated oral administration is preferable and for 
this purpose gray powder, blue mass, the bichloride or the protiodide are 
usually selected. The protiodide is perhaps the best preparation for internal 
use. It should be carefully watched, and its administration stopped just 
short of ptyalism, but renewed again, and continued in this manner for sev- 
eral months. Fumigation by Calomel volatilized by heat, or the inunction 
or hypodermic methods may be used when the stomach will not bear the 
mercurial. 

Tonsilli is, parotitis and other acute glandular inflammations of the throat 
and neck may often be rapidly cured by calomel gr. -^ or gray powder gr. % 
every two hours. In irritable stomach with obstinate vomiting the same small 
doses of calomel every half hour are very efficient. The dysentery of adults 
with slimy and bloody stools is best treated by small doses (gr. T fo) of the 
bichloride, and in the diarrhea and dysentery (ileo-colitis) of infants gray powder 
gr. ^ or calomel gr. ■£$ will be found effective. In gastric ulcer and in the 
first stage of hepatic cirrhosis, the bichloride in doses of gr. -gV to ¥ \ thrice 
daily is a good remedy. Asiatic cholera is frequently treated by small, re- 
peated doses of calomel with opium from the start. Inflammations of 
sthenic character in the stage of exudation, especially when affecting serous 
membranes, are considered by many authorities to be best met by the free 
use of mercurials, but this treatment is fast going out of favor, excepting in 
cases of iritis, which affection is very often of syphilitic causation. 

In the general condition known as "biliousness," manifested by whitish 
or clay-colored stools, constipation, nausea, anorexia, coated tongue, and slight 
jaundice, mercurial purgatives have long been a routine remedy, but mild 
saline purgatives are by many authorities considered equally efficient. As an 
antiseptic to the gastro-enteric tract in many forms of stomach and intestinal 
disorders (dyspepsia septica) the administration of minute doses of the yellow 
oxide will be found remarkably efficient. It is best used in trituration with 
sugar of milk, i to 1,000, and in doses of gr. -eV'To • By the use 9* these small 
doses failing digestion and nutrition may often be improved. 

Locally, an ointment of calomel 5j to § j of lard is an excellent antipruritic, 
and ointments of the chlorides and iodides are much used in skin diseases, par- 
ticularly psoriasis, herpes, acne and pityriasis. In parasitic affections a lotion 
of the bichloride, gr. ij to § j of distilled water, or a 5 per cent, oleate with J 
part of ether, is very efficient. The oleate is a serviceable application to syphilitic 
indurations, but is not deemed advisable when ulceration exists. In conjunc- 
tivitis calomel may be used as a sedative application, or still better an ointment 
of the yellow oxide, gr. ij-x to 5j of vaselin, triturated to the utmost fineness 
before mixing. Goitre and enlarged spleen are often speedily reduced by rub- 
bing into the skin covering them the ointment of the red iodide somewhat di- 
i luted and applied before a hot fire or in the direct sunlight. The acid nitrate 



HYDRASTIS. 295 

solution is one of the best caustics for destroying chancroid and syphilitic warts 
and vegetations. The black and yellow washes are used as applications to 
syphilitic erosions and ulcerated indurations. 

As an antiseptic injection or application to dressings a solution of the bi- 
chloride, gr. vijss in a quart of water, with gr. xl of citric or tartaric acid to 
prevent albuminate formation, is probably the most efficient, as it is the most 
generally used. This proportion makes a solution of i in 2,000, but weaker 
solutions, 1 in 5,000, are sufficiently antiseptic for many purposes. They should 
not be employed for the disinfection of surgical instruments, which are injured 
by this salt. 

Mercurol does not coagulate albumin, and is used as an alterative, astrin- 
gent, and antiseptic application in many morbid conditions. As a gonococcide 
its use in 1/2 to 2 per cent, solutions is considered by many specialists to be a 
decided advance on the treatment of gonorrhea by astringent injections and 
balsamic remedies. In chronic cystitis a 1 per cent, solution as a wash for 
the bladder has given great satisfaction, and it is said to be the least irritant 
of effective antiseptics for the local treatment of the nose and ear. A 2 to 5 
per cent, ointment is used with benefit as a dressing for ulcers, and the pow- 
der itself may be dusted on wounds. Internally in doses of gr. j-jss twice daily 
it has given satisfaction in syphilis. 

The Hypodermic Injection of mercurials has many advantages in syphilis, being rapid 
and powerful in action, free from gastro-intestinal irritation, and cleanly, though somewhat 
painful. Many preparations have been thus used, but none has any distinct advantage over 
the Bichloride, which is less dangerous than many others, especially those containing calomel. 
Hebra's formula is a 1 per cent, solution in a 6 per cent, solution of sodium chloride, giving 
of the salt gr. £ to & once daily, gr. ^ to \ daily or every other day (Wood), injected deeply 
into the gluteal muscles or those of the back, the part being massaged to prevent local irrita- 
tion. The Sal Alembroth Solution is prepared by dissolving the bichloride gr. xvj, ammo- 
nium chloride gr. viij, in distilled water §j; the dose of which is itjjx, containing gr. J of mer- 
curic ammonium chloride. Gray Oil, (Oleum Cinereum), is prepared by emulsifying 5ij of 
lanolin with chloroform, adding 3iv of metallic mercury, triturating, and adding £th part of 
olive oil; the dose being Tj#j-ij every 2 or 3 days; or mercury 3j, lanolin 5ij, oil carbolized 
2 per cent. 5 j, made into a cream, of which nj?x may be injected once a week. Other Prepa- 
rations adapted to this method are: The Benzoate, in 1 per cent, aqueous solution, with £ per 
cent, of sodium chloride (Gaucher) ; the Salicylate, gr. \-% in 20 minims of sterilized liquid 
petrolatum; the Succinimide in 2 per cent, aqueous solution, dose gr. \-}\. The latter is 
comparatively painless, and does not form abscesses. 

HYDRASTIS, Hydrastis, — is the dried rhizome and roots of Hydrastis 
canadensis, Golden Seal, a small plant of the nat. ord. Ranunculaceae, grow- 
ing in most parts of the United States. It contains three alkaloids, Hydrastine 
C 21 H 21 N0 6 , white and crystalline, soluble in alcohol and in ether, insoluble in 
water; Berberine C 20 N 17 NO 4 , yellow and crystalline, soluble in hot water 
and in alcohol, insoluble in ether; and Xanthopuccine or Canadine, C 20 H 21 NO 4 , 
white needles, present in very small quantity. From Hydrastine, oxidation 
liberates the artificial alkaloid Eydrastinine, C11H11NO2, the hydrochloride 
of which is official. Dose of Hydrastis, gr. x-xlv [av. gr. xxx.] 



296 HYDRASTIS. 

Preparations. 

Extractum Hydrastis, Extract of Hydrastis,— contains from 9 to 11 per cent, of ether 
soluble alkaloids of hydrastis; one part of the extract representing four parts of hydrastis. 
Dose. gr. v-x [aw gr. viij.J 

Fluidextractum Hydrastis, Fluidextract of Hydrastis,— -Dose, ttjjx-xIv [av. tt^xxx.] 

Tinctura Hydrastis, Tincture of Hydrastis, — 20 per cent, strength. Dose, 3ss-jss 
[av. 5j.] 

Glyceritum Hydrastis, Glycerite of Hydrastis, — Dose, ttjjx-xIv [av. tt^xxx]. 

Hydrastina, Hydrastine, — the alkaloid (see above). Dose, gr. \-\ [av. gr. £.] 

Hydrastinse Hydrochloridum, Hydrastine Hydrochloride, — the hydrochloride of the 
preceding alkaloid. A white, odorless and hygroscopic powder, very soluble in water and 
alcohol. Dose, gr. \-\ [av. gr. f.] 

Hydrastininae Hydrochloridum, Hydrastinine Hydrochloride, — the hydrochloride of 
an artificial alkaloid derived from Hydrastine. Dose, gr. £-j [av. gr. ss.] in capsule 3 or 4 
times a day, or hypodermically in 10 per cent, solution. 

Incompatibles. 

Incompatible with preparations of Hydrastis are Alkalies, Hydrochloric Acid, Tannic 
Acid, and other alkaloidal precipitants (see page 512). 

Physiological Action. 

Hydrastis is a simple bitter and a stomachic tonic. It promotes appetite 
and digestion and increases the secretions of the gastro-intestinal tract, but 
if long used it will derange digestion and produce constipation. It is con- 
sidered alterative to the mucous membranes, slightly diuretic, antiseptic, and 
antiperiodic, in the latter respect ranking next to cinchona. Hydrastine 
stimulates the medullary centres and the intestinal, cardiac, and uterine 
muscles, raises arterial tension, slows and strengthens the heart beat, quickens 
respiration, promotes intestinal peristalsis and uterine contraction. In toxic 
dose it stimulates the spinal cord, causing tetanic convulsions, depresses the 
motor nerves and the muscles, and finally paralyzes the medullary and spinal 
centres and the heart, death occurring by respiratory paralysis. It is a 
poison to the muscular system, both striated and non-striated, throughout 
the body. Hydrastinine is a powerful depressant to the entire motor tract, 
from the cerebral cortex to the muscular tissue. It has a stimulant effect 
upon the circulation, causes the heart to act more slowly and more powerfully, 
and contracts the blood vessels, producing a marked and prolonged rise of 
arterial tension throughout the body. It is believed to have a powerful anti- 
spasmodic action, and to decrease the general excitability of the cerebral 
cortex. Berberine causes toxic symptoms in small animals, but seems to act 
only as a bitter tonic on man. Canadine in small dose produces drowsiness 
and languor, in large dose it depresses the central nervous system after a 
short period of excitement, and causes weakness and arrhythmia of the heart, 
and its injection is followed by violent intestinal peristalsis and diarrhea. 



. hydrocotyle hyoscyamus. 297 

Therapeutics. 

Hydrastis is used as a stomachic tonic, an alterative application to mucous 
surfaces, and an antiperiodic. It is an excellent remedy locally and internally 
in all forms of catarrh, especially that of the stomach, duodenum, gall-ducts, 
bladder, uterus and vagina. Internally it is efficient in many glandular swell- 
ings, in chronic constipation due to a sluggish state of the liver or deficiency 
of the other intestinal secretions, in chronic dyspepsia, and as a substitute for 
alcohol in dipsomaniacs when a catarrhal state of the stomach has been in- 
duced. In gonorrhea, gleet, and chronic nasal catarrh, it is employed locally 
with much benefit, also in syphilitic affections of the mouth, throat and nares. 
As an alterative and antiseptic application it is recommended for unhealthy 
ulcers and sores, cancerous ulcerations, mercurial and aphthous stomatitis, 
rectal fissure, fistula and prolapse, internal and external hemorrhoids, cracks, 
fissures and abrasions of the nipples, erosion and ulceration of the cervix uteri, 
and in conjunctivitis with muco-purulent discharge. In the second stage of 
gonorrhea, after the acute inflammation has subsided, injections of the com- 
mercial extract (hydrastin), or the fluidextract suspended in mucilage, are 
often very efficient in restoring the urethral mucous membrane to a healthy 
condition. Hydrastine and Hydrastin rank high in the treatment of intermit- 
tent fever and chronic malaria, though much inferior to quinine. 

Hydrastinine has long been known as a uterine vaso-constrictor, and as 
such has been successfully employed in metrorrhagia. It is considered prefer- 
able to hydrastine on account of its stimulant action on the cardiac muscle, and 
the persistent constriction which it produces in the walls of the vessels. The 
hydrochloride is employed in a dose of one grain hypodermically, using a ten per 
cent, solution; the injections being best made, for menstrual irregularities, 
during a few days previous to the expected term. It has been used with 
benefit in dysmenorrhea, metritis and endometritis. 

HYDROCOTYLE, Pennywort (Unofficial),— is the leaf of Hydrocotyle asiatica, a small 
plant of the nat. ord. Umbelliferae, a native of southern Africa and India. It contains a pecu- 
liar, oleaginous substance, Vellarine, which has a bitter, persistent taste, and is thought to 
be the active principle. It has long been used in its native countries as an alterative to purify 
the blood, and has been found of service in eczema, lupus, psoriasis, syphilitic and scrofulous 
sores, and in leprosy. An ounce of the dried plant or leaves is given daily in infusion. It 
causes great itching over the whole body, ovarian pain in females, and urinary irritation. In 
one case in which the drug was being given for lupus of the hand a severe orchitis was set up 
without any other apparent cause. It certainly exerts a markedly special influence on the 
geni to-urinary tract. 

HYOSCYAMUS, Hyoscyamus, — is the dried leaves and flowering tops, 
collected from plants of the second year's growth, of Hyoscyamus niger, Hen- 
bane, nat. ord. Solanacese, growing in Europe and the northern United States. 
It should contain not less than 0.065 P er cent, of mydriatic alkaloids, includ- 
ing Hyoscyamine C17H23NO3, isomeric with Atropine, Scopolamine, C17H21- 
NO4, closely allied to Atropine, and Atropine, C17H23NO3 (see under Bella- 



298 HYOSCYAMUS. 

donna), the latter in very small quantity. Dose of Hyoscyamus, gr. j-vj 
[av. gr. iv.] 

Allied Plants. 

Scopola (Unofficial), — is the dried rhizome of Scopola Camiolica, nat. ord. 
Solanaceae, yielding not less than 0.5 per cent, of its alkaloids. It contains 
the alkaloid Scopolamine, C17H21NO4. The plant is a common one in the 
mountains of Bavaria and Hungary. Dose, gr. ss-j [av. gr. f .] 

Stramonium, — is the dried leaf of Datura Stramonium, the Jamestown 
(Jimson) weed or Thornapple, nat. ord. solanaceae, yielding on assay not less 
than 0.25 per cent, of mydriatic alkaloids. The plant is an annual, of rank 
and vigorous growth, has a green stem with large, white flowers, and grows 
wild in Russia and the middle United States. It contains Hyoscy amine, also 
some Scopolamine and Atropine (see page 167), and a volatile oil containing 
Daturic Acid. Daturine is the name of the mixed alkaloids. Dose, gr. 
ss-iij [av. gr. j.] 

Datura Tatula (Unofficial), — is an indigenous plant of the nat. ord. Solanaceae, resembling 
Stramonium very closely, with which it generally agrees in its alkaloids, physiological action 
and therapeutics. It is distinguished by its purple stem, purple flowers and anthers, and the 
darker green of its leaves. It has been smoked in asthma, in a few cases giving continued 
relief when Stramonium had failed to render any service. 

Mandragora, — the plant Mandragora autumnalis, contains Mandragorine, which is 
probably a mixture of Atropine and Hyoscyamine. 

Belladonna and Duboisia are described on pages 166, 167. 

Official Preparations. 

Extractum Hyoscyami, Extract of Hyoscyamus, — obtained by evaporating the fluid- 
extract. Dose, gr. ss-jss [a v. gr. j.] 

Fluidextractum Hyoscyami, Fluidextract of Hyoscyamus, — Dose, njrj-v [a v. TTjuij.] 

Tinctura Hyoscyami, Tincture of Hyoscyamus, — 10 per cent, strength. Dose, ttrv-xxx 
[av. ttjjxxx.] 

Preparations of Hyoscyamus are very uncertain in strength and physiological activity. 

Scopolamine Hydrobromidum, Hyoscine Hydrobromide — colorless crystals, soluble in 
1.5 of water and in 20 of alcohol. Nearly all of this salt furnished by manufacturing chem- 
ists as Hyoscine Hydrobromide consists of Scopolamine Hydrobromide (Schmidt). Dose, 
Tcro~Tl5Tr f° r the sane; larger doses, up to gr. 3^, are used for the insane and morphine victims. 

Hyoscyaminae Hydrobromidum, Hyoscyamine Hydrobromide, — white, prismatic crys- 
tals; very soluble in water, soluble in 2.5 of alcohol. In aqueous solution it is strongly 
levorotary. Dose, gr. zlo'ilo t av - S r - irU-l 

Preparations of Stramonium. 

Extractum Stramonii, Extract of Stramonium. — Dose, gr. $-§ [av. gr. £.] 
Tinctura Stramonii, Tincture of Stramonium, — 10 per cent. Dose, nj^v-xv [av. njjviij.] 
Unguentum Stramonii, Stramonium Ointment, — has of the Extract 10, Diluted Alcohol 
5, Benzoinated Lard 65, Hydrous Wool Fat 20. 

Daturina, Daturine, (Unofficial), — is a mixture of the alkaloids. Dose, gr, g£r~ t&« 

Incompatibles. 

Incompatible with Hyoscyamus are: Acids, Caustic Alkalies, Alkaloidal precipitants 
(see page 6), Ferrous Sulphate, Lead Acetate, Silver Nitrate, Vegetable astringents. Liquor 






HYOSCYAMUS. 299 

Potassii Hydroxidi, though incompatible, is frequently prescribed with the tincture of hyos- 
cyamus, the combination seeming to have therapeutical value. Physiological incompatibles 
are the same as for Belladonna (see page 167). With Stramonium they are as for Belladonna 
(see page 167); with the addition of Mineral Acids and the salts of Iron, Lead, Mercury and 
Silver. 

Physiological Action. 

Hyoscyamus has similar action to that of Belladonna and Stramonium, 
except that it is the least powerful and irritant of the group, but the most 
calmative and hypnotic. The delirium produced by it is never furious and 
is without hyperemia, but is frequently accompanied by insomnia. It is 
more stimulant to the vaso-motor system and to the cardiac accelerator appa- 
ratus than Stramonium, but is less active on the pneumogastric. It has 
decided laxative and carminative effects on the intestines and a very marked 
sedative influence on the urinary passages. 

Hyoscyamine is considered identical with Atropine in its effects on the motor 
apparatus and the circulation, including the heart and the vaso-motor system, 
but having a less stimulant action on the central nervous system, producing 
symptoms of cerebral depression instead of garrulous delirium. It is less power- 
ful than atropine as a mydriatic, and in a few cases it has seemed to diminish 
the respiratory rate. It is believed to be a hypnotic, though some deny that 
it possesses any soporific influence. 

Considerable confusion has arisen with regard to the terms Hyoscine and 
Scopolamine. The present Pharmacopoeia contains reference to Scopo- 
lamine hydrobromidum which in the previous Pharmacopoeia was called 
Hyoscinae hydrobromidum. It is generally regarded that the substance first 
described as hyoscine was an impure form of the alkaloid which in pure form 
was first described as scopolamine. The latter term will be used in this 
work, although in the literature they are used interchangeably. 

Scopolamine is a cerebral and spinal sedative, and a powerful hypnotic, 
directly depressing the higher functions of the brain, and affecting the heart 
but feebly. It is probably the action of this agent which prevents Hyoscy- 
amus from causing the excitation and delirium of belladonna. After the hypo- 
dermic administration of a full dose (gr. -^g-), there is, in most subjects, a period 
of semi-maniacal delirium, with flushed face and dry mouth, lasting from one 
to two hours, and followed by the sedative action of the drug, during which 
the pulse-rate and frequency of respiration, at first quickened, are distinctly 
lowered. It especially affects the motor tract of the spinal cord and the cere- 
bral cortex, slightly depresses the heart, but paralyzes respiration. It is free 
from irritant qualities and may be used hypodermically. Its habitual use 
brings on muscular paralysis and delirium of violent character. It is frequently 
used as a hypnotic by alcoholics and nervous subjects, and will probably be 
responsible for many deaths. As a mydriatic its reputation is doubtful, some 
observers claiming greater power for it in this respect than that of Atropine, 
while others say that mydriasis may follow its use but is not always produced 



300 HYOSCYAMUS. 

by even large doses. Severe toxic symptoms have followed the application 
of 4 drops of a i per cent, solution (equal to gr. 2V) to the ocular conjunctivae. 
In large doses Scopolamine is a dangerous depressant of the respiration, but 
it may be used without unpleasant effects in medicinal doses. Whenever full 
doses are employed the respiration should be watched for several hours. 

Dr. Balagopal, of India, has reported a case in which a man suffering from intermittent 
attacks of maniacal delirium was accidentally given gr. £ of the hydrobromide of hyoscine 
hypodermically. Severe toxic symptoms supervened, which were however antagonized 
by Sulphuric Ether administered subcutaneously. The patient recovered, and thereafter 
remained' free from mental disorder. 

The action of Stramonium is similar to that of Belladonna in almost every 
particular, except that Stramonium is more powerful and chiefly influences the 
sympathetic nervous system, not affecting the motor or sensory nerves. It 
excites a greater degree of cardiac irregularity and a more furious delirium, 
and seems to have a special affinity for the generative apparatus, being decidedly 
aphrodisiac in full doses. It relaxes the muscular coat of the bronchial tubes 
more powerfully than belladonna. Poisoning by Daturine is not to be distin- 
guished from that by Atropine. 

Therapeutics. 

Hyoscyamus is a valuable though feeble narcotic, and is chiefly used as a 
hypnotic and an anodyne when opium is contraindicated, and for children. 
It is by far the best agent to use in acute mania with great motor excitement, 
obstinate insomnia and varied hallucinations. Chronic mania has been more 
benefited by it than by any other drug, and it is very efficient in insanity char- 
acterized by frequent delusions. In delirium tremens and the delirium of fevers 
it is an excellent hypnotic, and the monomania of hypochondriacs is alleviated 
by it. Whooping-cough, nervous coughs, and especially a dry, tickling 
night-cough, are greatly alleviated by full doses of Hyoscyamus. It is effi- 
cient in colic of various forms, to palliate the trembling of paralysis agitans 
and mercurial tremor, and to relieve the pains and disordered coordination 
of locomotor ataxia. In constipation it is a good remedy, the extract being 
much employed in combination with other purgatives to render them more 
efficient and less drastic, but the quantity generally used is too small to be of 
any particular benefit. The tincture is an efficient remedy in irritability of 
the bladder from any cause. 

Hyoscyamine may be used for the same purposes as Atropine, but being 
liable to considerable variation in purity and activity, it is not a popular agent 
with the profession. 

Scopolamine has been frequently used in neuralgia, whooping-cough, acute 
mania, insomnia from cerebral excitement, delirium tremens, asthma and en- 
teralgia, also in ophthalmic practice as a mydriatic. It is an excellent hypnotic 
and sedative, and has been used with satisfaction to control the motor restless- 



HYOSCYAMUS. 301 

ness of fevers. It efficiently but temporarily controls the tremor of paralysis 
agitans, and is highly useful at times in the treatment of the morphine-habit, 
especially for the extreme restlessness and insomnia resulting from the final 
withdrawal of that drug. In such cases, however, it must be used only in emer- 
gencies and should not be given habitually, as it excites a high degree of de- 
lirium in most subjects at first, followed after about 2 hours by its secondary 
sedative influence. Excessively or carelessly employed, it is liable to seriously 
derange the mental faculties in the same manner as atropine, and is probably 
responsible for many of the impaired intellects which emerge from the so-called 
"bichloride of gold cures." Dr. Lionel Weatherly has found it particularly 
useful in that form of mental disturbance which renders the patient violent 
and abusive, restless and domineering — a nuisance to every one who has any- 
thing to do with him. Under the administration of repeated small doses of 
hyoscine such a patient becomes a changed man. Violence and abusiveness 
give place to an amiable politeness, and instead of indulging himself in the free 
exercise of an extensive, if somewhat shady vocabulary, the patient subsides 
into silence. 

Scopolamine-Morphine in Anesthesia. — Some surgeons give Scopolamine 
and Morphine prior to the induction of general anesthesia with the belief that 
it lessens the amount of anesthetic required, induces a state of mental tran- 
quility prior to its administration and lessens the amount of mucus secreted 
and the post-anesthetic nausea. It has been used to lessen the pains of 
labor in what has been called "twilight sleep;" scopolamine gr. y^o and mor- 
phine gr. I are given hypodermically when the pains are about 5 minutes 
apart. Such a dose acts in about half an hour causing sleep between pains 
(Hare). If the pains are not relieved the scopolamine without morphine 
may be repeated. An important part of "twilight anesthesia" consists in 
maintaining an absolute quiet in the room with lowered shades. This com- 
bination of drugs has been used by some surgeons for general anesthesia but 
though used in many cases by Bios and others, this method is not generally 
approved, as it is sometimes ineffective, requires a previous test to determine 
the susceptibility of the patient, and is dangerous to the respiration for some 
time after the narcosis has disappeared. In nearly 2000 cases the mortality 
was 9, or 1 in 221; and in 69 per cent, ether or chloroform was required to 
produce sufficient anesthesia for operation (H. C. Wood, Jr.). 

Stramonium is chiefly used as an antispasmodic and to relieve local pain. 
In asthma the leaves are smoked with advantage at the commencement of a 
paroxysm, the smoke being drawn into the lungs. In other spasmodic affections, 
as hepatic colic, laryngeal cough, chorea and stammering, it is very beneficial. 
In dysmenorrhea and neuralgia it is used in combination with opium and hyos- 
cyamus, and in tic douloureux and sciatica it is often efficient. In nympho- 
mania with great mental depression it is frequently effective, and in mania of 
furious character, particularly the puerperal form with suicidal tendency, it 



302 ILLICIUM IODUM. 

is highly serviceable in 10 to 20 minim doses of the tincture every 3 or 4 hours. 
The ointment is much used in irritable ulcers, and as an anodyne application 
in painful hemorrhoids and certain cutaneous diseases. 

ILLICIUM, Star Anise, — is the fruit of Illicium verum, an Asiatic shrub of the nat. ord. 
Magnoliaceae. It contains a Volatile Oil which is» chemically and practically identical with 
the Oil of Anise. Another species, Illicium anisatum (Illicium religiosum), is very poisonous, 
causing vomiting, epileptiform convulsions, dilated pupils and cyanosed countenance. Its 
carpels are more woody, shrivelled and wrinkled, and end in a curved beak. Illicium is 
recognized officially as a source of the Oil of Anise, and has actions and uses similar to those of 
Anisum 

IODUM, Iodine, I, — is a non-metallic element, existing in sea-weed, sea- 
water, some fresh waters and fresh-water plants, also in sponge, oysters, eggs, 
cod-liver oil, rock salt and several ores. It occurs in bluish-black rhombic 
plates, of metallic lustre, peculiar odor, acrid taste and neutral reaction; spar- 
ingly soluble in water, readily so in ether, and in 10 of alcohol, also in an aqueous 
solution of potassium iodide or sodium chloride. It volatilizes slowly at ordi- 
nary temperatures, and produces a dark-blue color with gelatinized starch in 
a cold solution. Internally it is generally administered in the form of an iodide 
or as the compound solution of iodine. Dose, gr. i>V -J [av. gr. ^V-] 

Preparations of Iodine. 

Tinctura Iodi, Tincture of Iodine, — strength 7 per cent. Dose, Ttjjj-iij [a v. ttj?jss]; but 
it is generally used as a local application, or for injection into cavities. 

Liquor Iodi Compositus, Compound Solution of Iodine, (Lugol's Solution) — has of Iodine 
5, Potassium Iodide 10, in Distilled Water to 100. Dose, ngj-x, [av. Trjmj], well diluted. 

TJnguentum Iodi, Ointment of Iodine, — has of Iodine 4, Potassium Iodide 4, Glycerin 12, 
Benzoinated Lard 80. 

Churchill's Tincture of Iodine (Unofficial), — contains Iodine gr. lxxv, Potassium Iodide 
5jss, Alcohol §j, and is used locally, chiefly in gynecology. 

Iodides and their Preparations. 

Ammonii Iodidum, Ammonium Iodide, NH 4 I, — a deliquescent, granular, white salt 
soluble in 0.6 of water and in 3.7 of alcohol at 25 C. Dose, gr. ij-x [av. gr. v.] 

Potassii Iodidum, Potassium Iodide, KI, — a colorless, deliquescent, crystalline salt, of 
saline and bitter taste; soluble in 0.7 of water and in 22 of alcohol. § j of this salt dissolved 
in 5j of water makes nearly 5jss of fluid, so that njivijss of the solution would be required to 
obtain gr. v, a fact to be remembered in prescribing. Dose, gr. v-xx [av. gr. v.] 

Sodii Iodidum, Sodium Iodide, Nal, — minute, deliquescent crystals; soluble in 0.6 of 
water and in 2 of alcohol. Dose, gr. v-xx [av. gr. v.] 

Strontii Iodidum, Strontium Iodide, SrI 2 (H 2 0) 6 , — colorless, hexagonal plates, of bitter 
saline taste; very soluble in water and in alcohol. Dose, gr. v-xx [av. gr. v.] 

lodoformum, Iodoform, Triiodomethane {Formyl Iodide), CHI 3 , — usually obtained by 
the action of iodine upon alcohol or acetone in the presence of an alkali, occurs in small, 
lemon-yellow crystals, of saffron-like and penetrating odor; very slightly soluble in* water, 
soluble in about 60 of alcohol, 16 of boiling alcohol, and in 7.5 of ether; very soluble in chloro- 
form, benzin and fixed and volatile oils. Its solutions have neutral reaction. Dose, gr. 
j-vj [av. gr. iv.] 

To remove its odor without forming a compound the best agents are Thymol (gtt. ij ad 
§ j of Iodoform), Oil of Mirbane (gtt. vj ad gr. xv), Oil of Bitter Almonds, or Oil of Rose 
(gtt. j ad 5j). Oil of Turpentine is particularly serviceable in removing the odor from the 
hands, or from spatulas, mortars, etc. 



IODUM. 303 

Unguentum Iodoformi, Iodoform Ointment, — Iodoform, finely pulverized, 10, Lard 90, 
thoroughly mixed by trituration. 

Thymolis Iodidum, Thymol Iodide, DithymoUdiiodide, commonly known under the 
trade name Aristol, — contains not less than 43 per cent, of Iodine, and occurs as a reddish- 
yellow, bulky powder, insoluble in water and in glycerin, slightly soluble in alcohol, readily 
soluble in ether, chloroform, collodion, and in fixed and volatile oils. It should not be 
mixed with alkalies, metallic oxides, starch or water; and no heat should be used in dispens- 
ing it, as it readily parts with its iodine. It is used locally as" a substitute for Iodoform. 

Other Iodides and preparations thereof are — Arseni Iodidum, Liquor Arseni et Hydrar- 
gyri Iodidum, Hydrargyri Iodidum Rubrum, Hydrargyri Iodidum Flavum, Syrupus Ferri 
Iodidi, and Pilulae Ferri Iodidi. As these preparations are allied in action and uses less 
closely to Iodine than to the other elements in their composition, they are described under 
other titles. (See Arsenum, Hydrargyrum, etc.) Ethyl Iodide or Hydriodic Ether is 
described under Ether. 

Hydriodic Acid Preparations. 

Acidum Hydriodicum Dilutum, Diluted Hydriodic Acid, — contains from 9.5 to 10.5 per 
cent, by weight of Hydriodic Acid HI. Dose, ttjjv-xv [av. irjviij.] 

Syrupus Acidi Hydriodici, Syrup of Hydriodic Acid, — contains about 1 per cent, of the 
absolute acid. Dose, 3ss-ij [a v. 5j], well diluted. 

Unofficial Iodine Compounds. 

Iodized Phenol, Carbolated Iodine, — is a mixture of Iodine and crystallized Phenol 
in varying proportions, generally 1 of the former to 4 of the latter: for local use, especially 
in gynecology. 

Iodipin, — is a compound of Iodine with the fatty acids of Sesame Oil, and occurs as a 
yellow, oily fluid, which is marketed in two strengths, containing respectively 10 and 25 
per cent, of Iodine, the latter being intended for hypodermic use. Dose, of the 10 per cent, 
preparation 3j~ij thrice daily, in emulsion or capsules; of the 25 per cent, preparation 3 j- 
jss daily. 

Europhen, Isobutyl-orthocresol Iodide, — is produced by the action of Iodine upon Iso- 
butyl-orthocresol in a solution of Potassium Iodide, and contains about 28 per cent, of 
Iodine, which it gives up readily when moistened and rapidly when heated to 70 C, par- 
ticularly in the presence of alkalies. It occurs as a very fine, amorphous, yellow powder, 
of faint, aromatic odor like that of saffron; insoluble in water and in glycerin, soluble in 
alcohol, ether, chloroform and fatty oils; readily decomposed by heat and by starch, 
slowly by light. It is five times lighter and more bulky than Iodoform, and is used as a 
substitute therefor in all local applications where a dry antiseptic is required. It is incom- 
patible with starch, metallic oxides, mercurials, and other substances which readily unite 
with iodine. A 3 to 10 per cent, solution in olive oil is employed as an embrocation. Dose, 
gr. iij-v. 

lodoformogen, Iodoformalbumen, — a nearly odorless mixture of iodoform and albumen* 
It is a light yellow, voluminous, odorless powder used locally for the same purposes as 
Iodoform which is slowly liberated when the drug is in contact with wound surfaces. 
Mixed with equal parts of boric acid it may be used as a snuff in ozena. 

Vioform, Nioform, Iodochloroxyquinolin, — is a voluminous, greenish-yellow, odorles s 
powder which is claimed to be an ideal substitute for Iodoform. It is said to be antiseptic, 
hemostatic, non-toxic and non-irritant. 

Nosophen, Iodophen,—is a patented preparation, chemically entitled Tetra-iodo-phenol- 
phthalein, and obtained by the action of Iodine on a solution of phenolphthalein. It contains 
60 per cent, of Iodine and occurs as a yellow, insoluble powder, of feebly acid character, with 
alkalies forming soluble salts, the sodium salt being of blue color and named Antinosin. 
Nosophen is highly germicidal and is used as an antiseptic dusting powder for wounds 
and ulcers. 

Bismuthi Subiodidum, Bismuth Subiodide, BiOI,— is described on page 173. It is 
odorless, non-irritant, and highly antiseptic, and a powerful stimulant of granulation in wounds. 

Airol and Eudoxin are Iodine compounds, but are described under Bismxjthtjm, on 
page 173. 



304 IODUM. 

Iodalbin, — a compound of Iodine and blood albumin containing approximately 21.5 per 
cent, of Iodine. It is acted upon in the intestines and after absorption it exerts an action 
like the iodides. It is used for the same indications as the soluble iodides. Dose, gr. v-x. 

Iodo-Casein, — a compound of Iodine with milk casein containing about 18 per cent, of 
Iodine in organic combination. It passes through the stomach unchanged, split up and 
absorbed in the form of soluble iodides in the intestine. It is indicated for the same con- 
ditions as the iodides. Dose, gr. v-xx. 

Iodo-Mangan, — a solution of Iodopeptone in Ferro-Mangan corresponding to 0.15 per 
cent, of Iodine. It is used as a reconstructive tonic. Dose, 5 j - iv. 

Incompatibles. 

Incompatible with Iodine are: Alkalies, Alkaline earths, Alkaloids, Chloral Hydrate, 
Ferrous salts, Hypophosphites, Hyposulphites, Mercurous salts, Metals, Oils, Turpentine, 
Starch, Tannic Acid. With Iodides are: Alkaloids, Arsenic salts in acid solution, Bromine, 
Chlorine, Hydrogen Peroxide in acid solution, Metallic salts (ic and ous), Nitrites in acid 
solution. With Iodoform are: Alkalies with heat, Balsam of Peru, Calomel, Mercuric Oxide, 
Oils in the light, Silver Nitrate, Tannic Acid. 

Potassium Iodide decomposes nearly all the metallic salts and is incompatible with many 
other substances. Added to Potassium Chlorate in solution it forms a poisonous compound. 
It is best prescribed alone or in some simple vehicle, a favorite one being the Compound Syrup 
of Sarsaparilla. It may be prescribed with Tincture of Cinchona, an ounce of which dis- 
solves 30 grains, or in combination with Liquor Potassii Arsenitis, which prevents the iodic 
eruption to some extent. In the "mixed treatment" of syphilis it is combined with the 
Biniodide of Mercury. Its efficacy is increased by uniting it with Ammonium Carbonate, 
2 parts to 1 or 1 \ of the Iodide (Gull). 

Physiological Action. 

Iodine is irritant to the mucous membranes and to the skin. Applied to 
the latter it stains a deep yellowish-brown color and combines with the albumin 
of the tissue, causing considerable pain and subsequent exfoliation of the epi- 
dermis. Vesication may be quickly produced if the quantity used be large. 
Inhaled its vapor irritates the respiratory mucous membrane, producing sneez- 
ing, cough, dyspnea, also pain in the chest and in the frontal sinuses. In the 
gastro-intestinal canal it is equally irritant, but is gradually converted into the 
iodide or iodate of sodium, in which form or as an albuminate it is absorbed 
into the blood. Iodine is an efficient antiseptic, disinfectant and deodorant 
to the skin and mucous membranes. 

Iodides are rapidly absorbed and less rapidly excreted, the potassium salt ap- 
pearing in the urine and saliva in about 15 minutes after its ingestion. About 
80 per cent, of it escapes within 24 hours, and the remainder is slowly eliminated 
during a period of about 5 days. At the points of elimination there is irri- 
tation of the mucous membranes, causing violent coryza, with soreness of the 
throat, acute conjunctivitis, profuse mucous discharges, headache and irrita- 
tion of the kidneys and the skin. If used for any length of time they induce 
great w r aste and rapid elimination of waste products, causing anemia, emacia- 
tion and mental depression; but these effects are credited chiefly to the 
metallic constituent, being most severe from the potassium salt. They com- 
bine with certain poisons in the system, particularly lead, mercury and the 
products of the syphilitic disease, hastening their elimination. Iodism is the 



IODUM. 305 

term applied to the general condition produced by these agents, and com- 
prises the symptoms above noted together with frontal headache, ptyalism, 
a saline taste in the mouth, dysphagia, temporary impotence, and an acne- 
form eruption on the face and limbs. Sometimes the eruption is urticarial, 
vesiculo-pustular, furuncular or even purpuric. The copious dilution of 
these preparations with water promotes their excretion, and to a great extent 
prevents the development of unpleasant results. The ptyalism occasionally 
produced by iodides occurs most frequently in persons who have previously 
taken mercurials. In such cases the mercury, which had been deposited in 
the tissues as an albuminate, is set free by the iodide and coming again into 
the circulation it produces its constitutional effects. (Murrell.) 

Potassium Iodide occasionally gives rise to some peculiar symptoms in 
certain susceptible persons. Among these are diuresis, cerebral excitement as 
from alcohol, hemorrhages from the urethra and the vagina, glossitis (Gross), 
also laryngitis and sudden edema of the glottis. The latter may be of so in- 
tense a character as to require the instant performance of tracheotomy in order 
to avert death.' On the circulation the iodides have practically no effect in 
therapeutic dose upon normal persons but in those with arterial disease and 
high blood pressure there is a tendency toward reduction of the arterial 
tension. The exact nature of this action is not clear but is probably due to 
a diminished viscosity of the blood. The influence of iodine and the iodides 
upon the thyroid secretion is considered under that title. 

Iodoform contains from 94 to 97 per cent, of Iodine and naturally resembles 
the latter in action. Locally its action is anesthetic and powerfully antiseptic. 
It is one of the best agents to prevent decomposition and to inhibit the growth 
of germs of putrefaction and of disease, which it does by lessening the wound 
secretions and perhaps to a certain extent by stimulating^hagocytosis. It 
must be carefully employed, as when used in quantity on an extensive raw 
surface it has often produced fatal results with symptoms of narcotic poison- 
ing. The first sign of its dangerous absorption is increase of temperature, 
which may reach 104 F. or more, then headache, quick and feeble pulse, 
marked anxiety and restlessness. Collapse and death may suddenly super- 
vene. The quantities which have produced fatal results from local absorp- 
tion vary from 525 to 4,500 grains. 

Therapeutics of Iodine. 

The tincture and the compound solution are much employed locally as 
counterirritants in chronic synovitis and arthritis, sprains, aching muscles 
and enlarged lymphatic glands, due to chronic inflammation. It is useless 
in the glandular enlargements of leukemia and Hodgkin's disease. In various 
skin diseases, as chloasma, lentigo, lupus, the tincture or a glycerite is well 
applied and it is exceedingly efficient in tinea tonsurans and tinea circinata. 



306 IODUM. 

In sores, ulcers, and fissures, a mixture of Iodoform and Tannin is strongly 
recommended, and the tincture is much used locally to promote absorption 
of the products of acute inflammations. In acute catarrh and hay-fever in- 
halations of Iodine-vapor or that from Iodized Phenol are very serviceable, 
and in the vomiting of pregnancy i- to 5-drop doses of the tincture every 
hour are often efficient. In strumous conditions Iodine internally is gener- 
ally considered to be more efficient than any of the iodides. It ought not 
to be used if acute pulmonary tuberculosis is present, although it will be 
found quite useful in certain types of chronic lesions in which excessive cough 
and expectoration are persistent in spite of improvement in the general con- 
dition of the patient, e.g., patients with developing fibrosis. 

As an antiseptic Iodine is one of the best germicides, in aqueous solution 
(1 to 400) it kills all organisms in less than a minute. Dissolved (2 per cent.) 
in carbon tetrachloride it has given uniformly good results in sterilization of the 
skin before operation. It is the ideal surgical antiseptic and disinfectant, espe- 
cially for sterilizing the field of operation, instruments, and suture material. 
The tincture applied by a mop is an efficient application for tonsillitis and 
other acute affections of the throat, and is used as a spray to abort colds. 
It is a valuable application in scalp, incised, punctured and lacerated wounds, 
in erysipelas, and to stimulate sluggish granulations. 

Therapeutics of the Iodides. 

Potassium Iodide is the most frequently used iodide, and is the form in 
which iodine is generally administered internally. It is best given in simple 
solution or in the compound infusion or syrup of Sarsaparilla. Though its 
mode of action has never been explained satisfactorily, it is known by clinical 
experience to counteract many pathological conditions, to promote the absorp- 
tion of morbid products, and the elimination of several metallic poisons. It 
is almost of specific rank in tertiary syphilis; the gummata, ulcerations, syphi- 
loma of the internal viscera, lupus, chronic arthritis and other tertiary lesions 
responding promptly as a rule to large doses of the Iodides. So also in mer- 
curial poisoning and other chronic metallic toxemiae, the best treatment is 
by rapid saturation with Potassium Iodide. The products left behind by 
pneumonia, pleurisy and pericarditis often yield to moderate doses (5 grains), 
which if used for a prolonged period seem to retard the changes of chronic 
nephritis. It is the best remedy for the early stage of hepatic cirrhosis, and 
acts as a most efficient expectorant in chronic bronchitis. In acute catarrh 
and hay-fever, it is useful with Arsenic, the Iodized Phenol being at the same 
time used locally in weak solution. In tonsillitis and simple sore throat a 
weak solution (gr. ij-v to the 5 ) is a good gargle, and in large doses it is 
often efficient in spasmodic asthma induced by bronchial catarrh. Sodium 
Iodide may be used instead of the potassium salt, in all affections in which 



IODUM. 307 

the latter is indicated; but requires to be administered in somewhat larger 
doses, being less active and less toxic. 

Ammonium Iodide is preferred by some physicians and in grain dose re- 
peated frequently is an excellent remedy in acute catarrh, hay-fever, duodenal 
catarrh and its accompanying jaundice, in chronic and capillary bronchitis. 
In the first stage of hepatic cirrhosis and in chronic malarial poisoning it is 
equally efficient administered in conjunction with arsenic. Being somewhat 
more irritating than the other iodides it is usually given in smaller quantity, 
but being less stable it is more energetic in action. 

Strontium Iodide is analogous in action to potassium iodide. It has been 
used with good results in scrofuloderma, scrofulous otorrhea, and enlarged 
lymphatic glands; also in lupus vulgaris and ozena. It is said to be less 
liable than the other iodides to produce cutaneous eruptions, and less irritant 
to the stomach. 

Hydriodic Acid is used as a substitute for iodine and the iodides. As an 
alterative it is believed by some to possess all the powers of Iodine while it is 
much less offensive to the taste and the stomach. It has been used with benefit 
in asthma and bronchitis. 

Iodalbin, Iodo Casein and a number of other compounds of Iodine with 
fats and proteins, some of which were described on page 304, have been intro- 
duced with the belief that they may be given internally for a long time with- 
out disturbing the digestion or producing iodism. These preparations are 
certainly tolerated much better by the stomach but it is questionable whether 
they will ever supplant the official Iodides. The absence of Iodism suggests 
a lack of Iodide effect from their administration. 

Iodoform is chiefly employed in local diseases as an antiseptic, anesthetic 
and alterative agent. It may be dusted in fine powder over a wound or sore, 
or used in ethereal solution to saturate gauze or absorbent cotton. It is a use- 
ful application to sloughing and phagedenic ulcers, gunshot wounds, chancroids, 
fistulae, sinuses and painful affections of the rectum or uterus. Triturated 
with tannin it forms a good application to the cervix uteri in erosions and 
ulcerations thereof, or an lodo-tannin may be prepared by saturating the 
tincture of iodine with tannic acid, and applied on a cotton tent to the uterine 
mucous membrane in many chronic affections of that organ. Tuberculosis 
has been successfully treated by Iodoform, which is credited with some spe- 
cific action in that disease, though it has proved almost inert against the bacil- 
lus. Its disagreeable odor is a serious bar to its general use, and many other 
iodine compounds have been introduced as substitutes for it. 

Thymol Iodide (Aristol) is praised by those who have used it in the local treat- 
ment of ulcers, wounds, and other breaches of the tissues; in which it is con- 
sidered nearly if not quite as efficient as Iodoform, with the great advantage 
of being odorless. It contains approximately 45 per cent, of Iodine. Excel- 
lent results have been obtained with it in the treatment of indolent soft 



308 IPECACUANHA. 

ulcers, lupus, psoriasis, syphilitic ulcerative processes, eczema, severe burns, 
affections of the ear, nose, and pharynx, as well as in the various cases in 
gynecological and dermatological practice in which Iodoform has hitherto 
stood supreme. Its prolonged use may give rise to chronic iodine poisoning. 
Aristol is best applied in powder or solutions in Oil or Ether (5 to 10 per cent.), 
or as ointments with a base of Lanolin or Vaselin (5 to 10 per cent.). A use- 
ful application is a liniment, prepared by dissolving 5 grains of Aristol in 3ij 
of a mixture of equal parts of Ether and Alcohol, then incorporating § j of soft 
Soap. 

Europhen is said to be fully equal to Iodoform as a local antiseptic appli- 
cation, readily liberating free, nascent iodine when in contact with aqueous 
fluids. It contains approximately 28 per cent, of Iodine. It may be dusted 
on a wound or ulcer, or applied as an ointment of 10 per cent, strength with 
Lanolin as the base. 

Other Iodine dusting powders, Iodoformogen, Vioform, etc., are widely 
used as substitutes for Iodoform mainly because of the offensive odor which 
attends its use even in small quantities. Many of these lack the maximum 
efficiency of Iodoform and in some instances are extremely expensive. 

IPECACUANHA, Ipecac, — is the dried root of Cephaelis Ipecacuanha or 
C. acuminata, small plants of the nat. ord. Rubiaceae, growing in Brazil and 
Columbia. It contains Cephaeline, C l4 Hi 9 N0 2 , a crystalline alkaloid; Emetine 
C 14 H 1D (CH 3 )N0 2 , an amorphous alkaloid and a methyl compound of cephae- 
line; also a third alkaloid Psychotrine in very small quantity, I pecacaanhic 
Acid, starch, gum, and a trace of a volatile oil. Dose of the powdered root, 
as an expectorant gr. ss-ij [av. gr. j] ; as an emetic gr. x-xx [av. gr. xv.] 

Official Preparations. 

Fluidextractum Ipecacuanha, Fluidextract of Ipecac, — Dose, as an expectorant nj;ss-ij 
]av. H£j]; as an emetic tt^x-xx [a v. ttjjxv.] 

Syrupus Ipecacuanha, Syrup of Ipecac, — strength 7 per cent. Dose, as an expectorant, 
ttjjx-xx [av. ttj^xv]; as an emetic 5ij-vj [a v. 5iv.] 

Pulvis Ipecacuanha et Opii, Powder of Ipecac and Opium {Dover's Powder), — has of 
Ipecac 10, Powdered Opium 10, Sugar of Milk 80, triturated together to a fine powder. Dose, 
gr. iij-xv [av. gr. viij.] 

Emetinae Hydrochloridum, Emetine Hydrochloride, — is a white or slightly yellowish 
crystalline powder, odorless and freely soluble in water and alcohol. Dose, gr. f-| [av. gr. \ .] 

Unofficial Preparations. 

Alcresta Ipecac, — Alcresta Ipecac tablets contain an adsorption product of ipecac alka- 
loids with fuller's earth (hydrated aluminum silicate), each tablet representing 10 grams 
of ipecac. Dose, Tablets ij-iij thrice daily. 

Cephaeline, Cephcelina, is more powerfully emetic than Emetine, but does not produce 
depressing effects in doses of gr. j2~&> an d i s s l° w °f action. 

Incompatibles. 

Incompatible with Ipecacuanha preparations are: Acids (vegetable), Salts of Lead and 
Mercury, Vegetable astringent infusions. 



ipecacuanha. 309 

Physiological Action. 

Ipecac is irritant, nauseant, emetic, expectorant, diaphoretic, hemostatic, 
and possesses a specific action on ameba. Applied to the skin it produces 
redness, itching and occasionally a pustular eruption; injected subcutaneously 
it causes pain and inflammation often terminating in absceSs. Used as snuff 
it excites violent sneezing and profuse mucous secretion; in some persons the 
inhalation of the smallest quantity induces an asthmatic paroxysm, with 
swelling and injection of the conjunctival and nasal mucous membranes, 
salivation, tears, sneezing, coughing and bronchial catarrh. Its action on the 
gastro-intestinal mucous membrane is also decidedly irritant. Internally, 
small doses (gr. J-J) act as a stomachic and hepatic tonic and increase the 
gastric secretions; larger doses (gr. v-xx) are nauseant and emetic in from 
20 minutes to half an hour, but the emesis produced is not violent nor is it 
followed by much depression. The emetic action of ipecac is largely periph- 
eral, that is, due to direct action upon the stomach and only to a slight de- 
gree, if at all, due to stimulation of the vomiting centre. If these doses are 
repeated a tolerance of the stomach to the drug becomes established and a 
cathartic action is produced, the stools having a bilious appearance. The 
circulation is only slightly affected by Ipecac, but it relaxes the skin and in- 
creases the broncho-pulmonary mucus. In large doses it is decidedly irri- 
tant to the intestinal canal, but here also it is capable of tolerance as in the 
stomach. In poisonous doses it has frequently produced hemoptysis and 
other hemorrhages. 

Emetine possesses strong constringent action on the blood-vessels and is 
powerfully emetic and expectorant. It causes death in animals by respira- 
tory failure. 

Therapeutics. 

Ipecac is much used as an emetic, being safe, efficient and non-depressant, 
though slow of action. It is the best agent of the kind to relieve the stomach 
in acute indigestion and bilious sick-headache. The syrup is a favorite 
domestic emetic to cut short an attack of spasmodic croup, and may be used 
beneficially in laryngismus stridulus and in capillary bronchitis. In small 
doses Ipecac is an excellent stimulant of the gastric and hepatic functions, 
and an expectorant of great value. In atonic dyspepsia, catarrhal jaundice, 
intestinal colic, bronchial asthma, hay fever, bronchial catarrh, acute laryn- 
gitis and pharyngitis, also in nervous and other coughs, it has rendered good 
service. In still smaller doses, TUss of the fluidextract frequently repeated, 
it is an efficient antiemetic in vomiting of nervous origin, and especially in 
the vomiting of pregnancy, also in that of gastric atony as seen in chronic 
alcoholism; its action in this affection being due perhaps to its possessing a 



3IO IPECACUANHA IRIS. 

sedative influence upon the pneumogastric in small doses. As an antihemor- 
rhagic it has been used in epistaxis, menorrhagia and post-partum hemor- 
rhage, in the latter affection given with # ergot. Trousseau lauded the value 
of this drug in hemorrhages and recently there has been an effort to revive 
its use in pulmonary hemorrhage. There can be no doubt that in some cases 
of hemoptysis of the type in which the sputum remains streaked for many 
days, suggesting a capillary oozing, that emetine in doses of i to | grain 
hypodermically daily for several days is of distinct value. 

In acute tropical dysentery Ipecac has achieved its greatest reputation 
as a remedy, one of its oldest titles being radix antidysenterica. Its power over 
acute dysentery was known to Piso and Helvetius in the 17th century, and was 
mentioned by Balmain (1797), Playfair (1813), Twining (1831) and Delioux 
(185 1). The reports thereon by Docker (1858) attracted general attention, and 
since the latter date it has been universally recognized as a specific remedy for 
acute amebic dysentery. Under large doses, 20 to 60 grains, the tormina 
and tenesmus disappear, the character of the stools improves and the consti- 
tutional symptoms are relieved. Such doses are not necessarily emetic in 
all persons, especially if administered in the powder, with a very small quan- 
tity of water, preceded by a full dose of opium or a hypodermic injection of 
morphine and followed by a mustard plaster applied to the epigastrium and 
perfect quiet in the recumbent posture. Salol and keratin coated pills form 
another method of giving ipecac; the salol and keratin acting as a protective 
coating during the passage of the drug through the stomach, lessening thereby 
the tendency to vomiting. The value of Ipecac in amebic dysentery has 
been shown to be due to its constituent Emetine, which even in dilutions of 
1 to 100,000 will kill amebae. It is practically without effect on dysentery 
bacilli. The older method of using the drug is being replaced by the use of 
Emetine which can be administered hypodermically. It is usual to give \ to 
f grain of Emetine hydrochloride dissolved in sterile saline by injection into 
the subcutaneous tissues. Vedder gives § grain three times daily, others 
give 1 grain daily for 10 days. By this method there is practically no nausea. 

Diarrheas of simple but painful form, especially the summer diarrhea of 
young children and that of teething infants, are often greatly relieved by Ipecac 
in doses of 1 to 5 grains, the bilious character being restored to the discharges 
and a healthy stimulation of the alimentary mucosae produced. 

Ipecac is said to be destructive to the bacillus of anthrax though not to its 
spores. As the latter are not present in malignant pustule, this drug may prove 
efficient therein and success has followed its employment. It is used locally 
after excision of the pustule, also in moderate doses internally. 

IRIS, Blue Flag (Unofficial), — is the rhizome and roots of Iris versicolor, an indigenous 
plant of the nat. ord. Irideae, growing in moist meadows and on the borders of swamps, having 
large blue flowers. It contains tannin, sugar starch, gum, an acrid resin, fixed oils, and 
traces of an alkaloid. Dose of the powdered root, gr. v-xx; of the extract, gr. j-v; of the 
fluidextract, ngv-xx. 



JALAPA. 311 

Iris when fresh is actively purgative, emetic and diuretic, producing severe nausea and 
prostration. Iridin, a resinoid of undetermined composition, has been the subject of ex- 
perimentation upon dogs, and is shown to be a powerful hepatic stimulant with consider- 
able influence on the intestinal glands, being more purgative than euonymin and less irri- 
tant than podophyllin. In very small doses it causes obstinate constipation by producing 
rectal inactivity. 

Iris was formerly used in many hepatic and intestinal disorders as a cholagogue and 
purgative of mild action, also as a diuretic in dropsies. 

JALAPA, Jalap, — is the dried tuberous root of Exogonium Purga, a Mexican 
plant of the nat. ord. Convolvulacese. It should contain not less than 7 per 
cent, of total Resin, which is composed of two glucosides, Jalapin, soft, soluble 
in ether, and Convolvulin, which is hard, insoluble in ether, and the more active 
of the two. Dose, gr. v-xx [av. gr. xv.] 

Preparations. 

Resina Jalap se, Resin of Jalap, — prepared from a tincture by precipitation by water. Is 
insoluble in water, soluble in alcohol. Dose, gr. j-v [a v. gr. ij.] It is an ingredient of Pil. 
Catharticae Comp. 

Pulvis Jalapas Compositus, Compound Powder of Jalap, Pulvis Purgans, — has of Jalap 
35, Potassium Bitartrate 65, thoroughly mixed. Dose, gr. x-xlv [av. gr. xxx.] 

Jalap is an evacuant acting principally upon the small intestine and in 
full doses is an active cathartic, producing copious and watery stools, with 
considerable griping and tenesmus, and sometimes nausea. Its action is not 
due to any one of the contained principles, but all the active constituents are 
found in the resin. Compared with other agents of the same class its action 
most nearly resembles that of scammony. It is more drastic than senna 
and less irritant than gamboge, but in overdoses may produce dangerous 
hyper catharsis. 

Convolvulin in sufficient dose is an active irritant poison, producing gastro- 
enteritis and narcotism. Its action as a purgative seems to be wholly local, 
as from its intravenous injection no catharsis results, yet it exerts little if any 
irritant action on the conjunctiva, nasal mucous membrane or skin. It is not 
eliminated in the urine or the feces, and is therefore probably destroyed in the 
system by oxidation. 

In olden bowel-moving times Jalap and Calomel were used together in 
doses of gr. x each, "ten and ten," as a routine purgative prescription. Less 
ponderous doses are now considered equally efficient, and one grain of each 
agent with the same quantity of extract of hyoscyamus as a corrective may be 
used with advantage at the onset of fevers and inflammations. As the com- 
pound powder it is much employed to produce free watery evacuations in as- 
cites and anasarca. Being nearly tasteless it is a useful cathartic for children, 
and may be administered in syrup of rhubarb (gr. ij-v in § ss) . As a vermifuge 
it is efficient as an adjunct to more powerful agents, and is employed with cal- 
omel and santonin for the expulsion of lumbrici. Jalap is contraindicated in 
all inflammatory conditions of the intestinal mucous membrane, but in proper 
doses it is one of the most manageable and efficient cathartics. 



312 JUGLANS JUNIPERUS. 

JUGLANS, Butternut (Unofficial), — is the bark of the root, collected in autumn, of 
Juglans cinerea, the Butternut or White Walnut, an indigenous forest tree of the nat. ord. 
Juglandaceae. It contains an orange-yellow, crystalline and acrid substance named Juglandic 
Acid or Nucin, resembling Chrysophanic Acid, also some resin, volatile acid, etc., but neither 
tannin nor any alkaloid. Dose of the extract, gr. v-xx. 

Juglans is a mild cathartic operating without the production of pain or irritant symptoms. 
It is never used in substance, but the extract is a good laxative in doses of gr. v-x, and a pur- 
gative in larger doses. 

JUNIPERUS, Juniper,— the source of the official Oleum Juniperi, is the 
fruit of Juniperis communis, an evergreen shrub of the nat. ord. Coniferae, 
growing in Europe and N. America. It contains a Volatile Oil, which con- 
sists of terpenes and camphors in complex combination, also a non-crystal- 
lizable principle named Juniperin, and grape sugar, resin, formic, acetic and 
malic acids, etc. The Oil, a Spirit, and a Compound Spirit are official. 

Preparations. 

Oleum Juniperi, Oil of Juniper, — the volatile oil, a colorless or faintly greenish-yellow 
liquid, of terebinthinate and sweetish taste and the odor of juniper; soluble in 4 volumes of 
alcohol. Dose, ny-v [av. TTjtiij.] 

Spiritus Juniperi, Spirit of Juniper, — has of the Oil 5 in Alcohol 95. Dose, 3j-iv 
[av. ttjtxxx] or more, according to the quantity of alcohol desired. 

Spiritus Juniperi Compositus, Compound Spirit of Juniper, — has of the Oil 8, Oil of 
Caraway 1, Oil of Fennel 1, Alcohol 1400, Water to 2000. It approximates closely to a good 
grade of Gin. Dose, o j~iv [a v. 5ijss] or more, according to the quantity of alcohol desired. 

Oleum Cadinum, Oil of Cade (Empyreumatic Oil of Juniper), — is a product of the dry 
distillation of the wood of Juniperus Oxycedrus. It is a tar-like substance, of uncertain com- 
position and purity; insoluble in water, partially soluble in alcohol, completely so in ether, 
chloroform or carbon disulphide. Used locally as a stimulant. 

Infusum Juniperi, Infusion of Juniper (Unofficial), -has of Juniper Berries oj in 
Oj of boiling water. Dose, oj-ij- 

Physiological Action and Therapeutics. 

Juniper is a stomachic tonic, diaphoretic, diuretic and aphrodisiac. The 
oil is the active principle, and is readily diffused, exciting increased cardiac 
action, stimulating the kidneys and the action of the skin, and causing a sub- 
jective sense of heat throughout the system. It is eliminated chiefly by the 
kidneys, and may set up renal irritation, in large doses producing strangury, 
priapism, hematuria, suppression of the urine and uremic convulsions. It 
imparts a violet odor to the urine, and will produce diuresis when inhaled. 

The Oil is used to flavor gin and to impart the diuretic power popularly 
ascribed to that liquor. The medicinal use of the juniper preparations (spirit 
and compound spirit) is restricted to their employment as vehicles for less ir- 
ritant diuretics. The oil acts therapeutically like the oil of turpentine, and 
may be used in chronic pyelitis and cystitis, prostatorrhea, and gleet, but is con- 
traindicated in all cases in which acute nephritis exists. 

Oil of Cade is used locally in chronic skin diseases as a stimulant applica- 
tion. It is too active for acute eruptions, but has been used with benefit in 
chronic eczema and psoriasis. The Oil of Tar (see under Pix) is equally effi- 
cient for all the purposes to which oil of cade has been applied. 



K AM ALA — KRAMERIA. 3 1 3 

KAMALA, Rottlera (Unofficial), — the glands and hairs from the capsules of Mallotus 
philippinensis, or Rottlera tinctoria, a small tree of the nat. ord. Euphorbiaceae, growing in 
Abyssinia, Arabia, India, China, etc. It occurs as a granular, mobile, brick-red powder, 
inodorous and nearly tasteless, partly soluble in alcohol and in ether. It contains several 
resins, one of which is named Rottlerin, also tannin, starch, gum, and red coloring matter. 
Dose, 5ss-iij. 

Kamala is anthelmintic and purgative, sometimes causing nausea and colic, seldom vomit- 
ing. It is used as a teniafuge and to expel the round worm. One or two drachms are 
given suspended in water, mucilage or syrup, and repeated in 8 hours if necessary. A 
tincture (Bvj in §xvj of alcohol) may be used in doses of 3j-§ss. In India it is used locally 
in scabies and other skin affections and has been found of especial service in herpetic ring- 
worm. 

KAVA-KAVA, Ava-Kava (Unofficial), — the root of Piper methysticum, a. shrub of the 
nat. ord. Piperaceae, growing in South America and the South Sea Islands. It contains a 
crystalline principle, Kavahin or Methysticin, which is analogous to Piperine, an acrid 
greenish-yellow resin, Kawin, which is probably the active principle, also a Volatile Oil. 
Dose, 5ss-j macerated in water, or the same quantity of a fluidextract. 

Kava is intoxicant, diuretic and motor-depressant. A beverage is prepared in the Hawaiian 
Islands by chewing the root and then infusing it in water or cocoanut milk, which produces 
a drowsy intoxication with pleasant dreams often of erotic character, and followed by severe 
headache. A moderate dose is tonic and stimulant, lessening the sense of fatigue and sharp- 
ening the mental faculties. It is highly recommended in gonorrhea and in chronic gleet 
and obstinate cystitis. 

KINO., Kino, — is the inspissated juice of Pterocarpus Marsupium, a tall tree 
of the nat. ord. Leguminosae, growing in India. It contains 75 per cent, of a 
variety of tannin named Kinotannic Acid, which gives a greenish precipitate 
with persalts of iron ; also a crystalline, neutral substance, Kinoin, and Kino-red, 
gum, pectin, etc. There are several other varieties of Kino in the market, 
brought from S. America, Africa, and Australia, which are products of other 
trees than the official one. Dose, gr. v-x [av. gr. viij.] 

Tinctura Kino, Tincture of Kino. Dose, 3ss-ij [av. 5j-] 

Pulvis Kino Compositus, Compound Powder of Kino (Unofficial), — contains 5 per cent, 
of Opium, and has of Kino 15, Opium 1, Cinnamon 4. Dose, gr. v-xx. 

Physiological Action and Therapeutics. 

The action of Kino is the same as that of Tannic Acid, though less powerful, 
and it may be used for the same purposes, both internally and locally. It is 
chiefly employed as an astringent gargle and as a constituent of diarrhea- 
mixtures. The tincture, in drachm doses, is one of the most efficient means of 
combating the atonic diarrhea which results from the disuse of opium or mor- 
phine. Its incompatibles are the same as for Galls (see page 63). 

KRAMERIA, Krameria (Rhatany), (Unofficial), — is the dried root of Krameria triandra, 
or two other species, nat. ord. Krameriaceae, shrubs which grow in Peru and Brazil. It 
contains 20 to 45 per cent, of Rhatania-tannic Acid, also Rhatanine, an alkaloid, and wax, 
gum, etc. Dose* gr. x-xx [av. gr. xv.] 

Extractum Krameriae, Extract of Krameria (Unofficial). Dose, gr. v-x [av. gr. vijss.] 
Fluidextractum Krameriae, Fluidextract of Krameria (Unofficial). Dose, ttjjv-xx [av. 

TTJJXV.] 

Trochisci Krameriae, Troches of Krameria (Unofficial), — each troche contains nearly gr. j 
of the extract, with Tragacanth, Sugar and Orange-flower Water. 

Krameria possesses the same astringent qualities as Tannic Acid and may be employed 
for the same purposes, except as an antidote to Antimony. It has long had a high reputa- 



314 LACTUCARIUM LAVANDULA. 

tion as an injection for fissure of the anus, as a local application to spongy gums, as a tonic 
for debilitated subjects, in chronic diarrhea, also in passive hemorrhages and mucous dis- 
charges, as menorrhagia and leucorrhea. Its incompatibles are the same as for Galls (see 
page 65). 

LACTUCARIUM, Lettuce, — is the dried milk- juice of Lactuca virosa, the Acrid Lettuce, 
a biennial European plant of the nat. ord. Composite. It is partly soluble in alcohol and 
in ether, and yields a turbid mixture when triturated with water. Lactucarium is a mix- 
ture of several substances, the most important being Lactocin, which is thought to be the 
active principle. Lactucarium also contains three bitter principles, Lactucin, Lactopicrin 
and Lactucic Acid; also Lactucerin, an inert, waxy substance, constituting nearly one-half 
of the drug. Dose, gr. x-xx [av. gr. xv.] 

Tinctura Lactucarii, Tincture of Lactucarium, — 50 per cent. Dose, ngx-Sij [av. ttj>xxx]. 
according to the activity of the drug. 

Syrupus Lactucarii, Syrup of Lactucarium, — has of the Tincture 10 per cent. Dose, 
5J-SJ [av. Sijss.] 

Lactucarium is feebly hypnotic and somewhat sedative. It is supposed to act similarly 
to Opium, but very feebly and without depressing after-symptoms. As much as half an 
ounce has been given to a dog without causing any special effect. Its preparations are 
very uncertain in activity, and are chiefly used as placebos, to allay cough and quiet nervous 
irritability. The syrup is a good vehicle for expectorants and antispasmodics. 

LAPPA, Lappa, (Burdock), (Unofficial), — is the dried root of Arctium Lappa, and of 
other species of Arctium, the common burdock, a biennial weed of the nat. ord. Composite, 
found in waste places and along roadsides in Europe, Asia and N. America. It contains 
a bitter principle, traces of a volatile oil, also inulin, resin, tannin, mucilage, sugar, etc. 
Dose, gr. xx-xlv [av. gr. xxx.] 

Fluidextractum Lappae, Fluidextract of Lappa (Unofficial), — made with diluted alcohol- 
Dose, njjxx-xlv [av. ngxxx.] 

Lappa promotes all the secretions and is considered aperient, diuretic and diaphoretic, 
without irritating qualities. In decoction it has been a popular domestic remedy for many 
morbid conditions, especially rheumatism, gout, pulmonary catarrhs, and chronic cutaneous 
affections. By several practitioners it is praised as an external application to swellings, 
hemorrhoids and chronic sores. 

LAVANDULA, Lavender, — the source of the official Oil of Lavender, is 
the fresh flowers of Lavandula officinalis, a small European shrub of the nat. 
ord. Labiatae, largely cultivated in England. They have a fragrant odor, 
and an aromatic, camphoraceous taste; and contain resin and tannin, also a 
Volatile Oil. 

Preparations. 

Oleum Lavandulae, Oil of Lavender, — is a volatile oil distilled from fresh Lavender, and 
having the fragrant odor of the flowers. It is soluble in 3 volumes of 70 per cent, alcohol. 
Dose, ngj-v [av. ngiij.] 

Spiritus Lavandulae, Spirit of Lavender, — has of the Oil 5, in Alcohol 95. A perfume 
and flavoring agent. Dose, njjx-xlv [av. ttjjxxx.] 

Tinctura Lavandulae Composita, Compound Tincture of Lavender, — an aromatic stimu- 
lant, composed of the Oil 8, Oil of Rosemary 2, Saigon Cinnamon 20, Cloves 5, Nutmeg 
10, Red Saunders to, Alcohol 750, Water to 1000. Is a constituent of Liquor Potassii 
Arsenitis. Dose, njjx-xlv [av. ttjjxxx.] 

Physiological Action and Therapeutics. 

Lavender is aromatic, stimulant and carminative, but is rarely used alone 
as a medicine. It is an agreeable flavoring and perfume, in the form of the 
official spirit, which is sold under the name of Lavender-water, after the addi- 
tion of Oil of Bergamot and Essence of Ambergris. The compound tincture 
is a very agreeable combination of spices, and is much used as a remedy for 






LEPTANDRA — LIMON. 315 

gastralgia, nausea, and flatulence, and as an adjuvant or corrigent of other 
medicines. 

LEPTANDRA, Leptandra (Culver's Root), (Unofficial), — is the rhizome and rootlets of 
Veronica virginica, an indigenous perennial plant of the nat. ord. Scrofulariacese. It con- 
tains a glucoside named Leptandrin, which is probably the active principle, also Saponin, 
resin, tannin, etc. The Leptandrin of the shops is an impure alcoholic extract. Dose of 
Leptandra, gr. x-xx [av. gr. xv.] 

Leptandra in the form of the extract and fluidextract was formerly much used as an 
ingredient of laxative and purgative medicines in chronic constipation associated with 
torpid liver. 

LICOPERDON GIGANTEUM, Puff-Bail (Unofficial),— is a common fungus of the 
nat. ord. Trichogastres, found in hilly and wooded districts. The dust, which consists of the 
capillitium and spores, is hemostatic, and dusted over bleeding surfaces acts promptly 
in arresting hemorrhage. It has been proposed as a surgical dressing, but while useful in 
emergencies where other agents are unattainable, the fetor which results from its applica- 
tion to wounds will prevent its use becoming general for this purpose. 

LIMON, Lemon, — is the fruit of Citrus Limonum, a tree of the nat. rod. 
Rutaceae, native in Asia, but cultivated in Southern Europe and many other 
countries. It is official in the form described below. The Orange, Citrus 
vulgaris and C. Aurantium, the Citron, Citrus medica, and the Lime, Citrus 
acris, belong to the same genus. 

Limonis Cortex, Lemon Peel, — is the rind of the ripe fruit, and contains 
a Volatile Oil which is omcial, and a bitter crystalline glucoside, Hesperidin, 
chiefly contained in the white of the rind. 

Acidum Citricum, Citric Acid, H 3 C 6 H 5 7 -f-H 2 0, — is obtained from the 
juice of the Lemon or the Lime by adding chalk to form calcium citrate, which 
is then decomposed by dilute sulphuric acid. It occurs in colorless, rhombic 
crystals which are very soluble in water. A solution of gr. xvij in § ss of water 
corresponds to § ss of fresh lemon-juice, and this quantity of either will neu- 
tralize of Potassium Bicarbonate gr. xxv, of Sodium Bicarbonate gr. xx, and of 
Ammonium Carbonate gr. xivss. Dose, gr. v-xv [av. gr. viij .] 

Citrates of Bismuth and Ammonium, Iron, Iron and Ammonium, Iron and Quinine, 
Lithium, Magnesium, Potassium and Sodium, eight in all, are official. They are described 
under their respective bases, to which their medicinal qualities are due. 

Preparations, 

Oleum Limonis, Oil of Lemon, — is the volatile oil, extracted from fresh lemon peel by 
mechanical means. It is used for flavoring and is an ingredient of Spiritus Aurantii Compos- 
itus, and Spiritus Ammoniae Aromaticus. Dose, Ti£j-v[av. TTRiij.] 

Tinctura Limonis Corticis, Tincture of Lemon Peel, — a 50 per cent, tincture, made with 
alcohol. Dose, according to the amount of alcohol desired to be given, 5ss-iv. 

Syrupus Acidi Citrici, Syrup of Citric Acid, — has of Citric Acid 1, Distilled Water 1, 
Tincture of Lemon Peel 1, Syrup to 100. Used for flavoring. Dose, indefinite. 

Incompatibles. 

Incompatible with Citric Acid are: Acetates, Acids (mineral), Carbonates, Potassium 
Tartrate, Sulphides. With Citrates are: Alcohol, Lead Acetate, Potassium Permanganate in 
acid solution, Silver Nitrate. With Tincture of Lemon Peel are: Acacia, Aqueous fluids, 
Gelatin. 



3 1 6 LINUM. 

Lemon-peel is bitter and probably tonic to the stomach, but is used only 
for flavoring purposes. Lemon-juice, on the other hand, is refrigerant and anti- 
scorbutic, entering the blood as alkaline citrates, potassium salts and phosphoric 
acid, the citrates being therein partly oxidized into CO2 and H 2 0. Citric 
Acid has the same general action as Acetic and the other vegetable acids. 
Lemon-juice is employed largely in the treatment and prevention of scurvy, 
in which disease it possesses powers of specific rank, but whether its action 
therein is due to the citric acid, the phosphoric acid or the salts of potassium 
is not known. Lime-juice is equally efficient but citric acid itself is not so. 

As refrigerants and diuretic mixtures in fevers, Lemon- juice and Citric Acid 
are much used, entering into the composition of lemonades and effervescing 
draughts, to allay thirst and subdue restlessness, and to promote the action 
of the skin and the kidneys. Long continued they will impair digestion and 
impoverish the blood. Obesity is treated by the laity by using the juice 
of limes or lemons in large quantity, but when reduction occurs it is done at 
the expense of the digestion. Lemon-juice has been found of service in acute 
rheumatism, probably through the alkalies which it conveys into the blood. 

LINUM, Linseed, Flaxseed, — is the seed of Linum usitatissimum, flax, a 
cultivated annual plant of the nat. ord. Linaceae. It contains 15 per cent, of 
Mucilage in the epithelium, also 30 to 40 per cent, of Fixed Oil in the embryo. 
Ground linseed should yield not less than 30 per cent, of the fixed oil. 

Preparations. 

Oleum Lini, Linseed Oil, — the fixed oil expressed from Linseed without the use of heat. 
A yellow, oily liquid, of slight odor, bland taste, and neutral reaction, slightly soluble in 
alcohol, miscible with ether. Consists chiefly of the Glyceride of Linoleic Acid, C 16 H 28 4 , 
which having a powerful affinity for oxygen becomes resinoid on exposure to the air, making 
it a "drying oil." Dose, §ss-ij [av. o j-] 

Infusum Lini, Linseed Tea (Unofficial), Linseed 3iij, Licorice-root 3j, Boiling Water 
5 x, infused for four hours and strained. Dose, indefinite. 

Linimentum Calcis, Lime Liniment, (Carron Oil), — consists of equal volumes of Linseed 
Oil and Lime-water, emulsified by agitation. A favorite application for burns. 

Linseed is demulcent, emollient, expectorant and diuretic. The oil is laxa- 
tive in a dose of § j, and in smaller doses is oxidized in the system and excreted 
as a resinoid body by the kidneys, which it stimulates slightly. The Infusion 
contains the mucilaginous principle and a small portion of the oil, and is ad- 
vantageously used in inflammations of the mucous membrane of the throat, 
the gastro-intestinal tract and the urinary passages. It is an excellent demul- 
cent in coughs of various kinds, and will be found very serviceable in cystitis, 
irritable bladder, renal colic and strangury. The Oil may be administered inter- 
nally as a laxative, and has considerable reputation as a remedy for hemorrhoids 
in doses of 5ij twice daily. For laxative purposes, especially in children, it is 
usually administered as an enema. Externally it is a favorite application to 
burns, when made into an emulsion with lime-water as in the official Linimen- 



LITHIUM. 317 

turn Calcis. The ground seed, linseed or flaxseed meal, is commonly employed 
for making poultices, though objectionable from the aseptic point of view. 
[Compare the article on Poultices in Part III.] 

LITHIUM, Li, — is represented in the pharmacopoeia by three of its salts : 

Lithii Bromidum, Lithium Bromide, LiBr, — is classed with the Bromides and described 
under Bromtjm. Dose, gr. v-xx [av. gr. xv.] 

Lithii Carbonas, Lithium Carbonate, Li 2 C0 3 , — a light, white powder, permanent in the 
air, odorless, of alkaline taste and reaction, soluble in 78 of water; insoluble in alcohol. Dose, 
gr. ij-xv [av. gr. viij.j 

Lithii Citras, Lithium Citrate, Li 3 C 6 H 5 7 , — a white, deliquescent powder, odorless, of 
faintly alkaline taste and neutral reaction, soluble in 1.4 of water, almost insoluble in alcohol. 
Dose, gr. v-xx [av. gr. viij.] 

Unofficial Preparation. 

Alkalithia, — is the trade name of a granulated effervescent preparation, containing in 
each heaping teaspoonful 5 grains of Lithium Carbonate, 10 grains each of Sodium Bicar- 
bonate and Potassium Bicarbonate, and 1 grain of Caffeine. Dose, a heaping teaspoonful 
in a glass of warm water, 3 or 4 times daily. 

Incompatibles. 

Incompatibles depend on the acid constituent of the Lithium salt (see under Carbonates, 
Citrates, etc.). 



Physiological Action and Therapeutics. 

The Lithium salts have strong alkaline qualities and act on the system in 
the same manner as other alkalies (see under Potassium) . The high saturating 
power of this metal makes its salts more alkaline than those of potassium, sodium, 
or calcium, hence more efficient in alkalinizing the urine. The Carbonate 
and Citrate are the salts referred to in this connection, the others (the 
bromide and the unofficial benzoate and salicylate) partaking more of the 
qualities of their acid factors. Both these salts are antacid and diuretic; 
the carbonate being but slightly soluble should be given in carbonic acid 
water, and the citrate in dilute solution. They are rapidly absorbed, and 
rapidly eliminated by the kidneys, giving an alkaline reaction to* the urine. 
No case of poisoning by them is recorded, but large doses may cause gastro- 
enteritis, and if frequently repeated may produce depression of the circula- 
tion, malaise, and excessive muscular weakness. In the test-tube lithium 
and uric acid have a combining affinity for each other, forming lithium urate, 
which is the most soluble of the alkaline urates, but when taken internally 
the lithium salts have a greater affinity for the acid sodium phosphate in the 
blood than for uric acid. The Carbonate and Citrate are extensively used 
in gout and lithemia, in which affections they have an established reputation, 
though their value is a limited one, and their reputed solvent power on uric 
calculi is very doubtful. Their prolonged local application is said to relieve 
gouty joints, and gouty conjunctivitis is efficiently treated by washing the eye 



3*8 LOBELIA. 

with a solution of the carbonate. They are useful in the indigestion and 
rheumatic pains of obese subjects, also in irritable bladder from excessive 
acidity of the urine. Lithiated arsenical water, made by dissolving the car- 
bonate gr. v-x, and sodium arsenate, gr. 3V, in half a pint of water for one 
dose, repeated thrice daily, has proved an efficient remedy in diabetes mellitus. 
Many mineral waters contain small quantities of the carbonate, varying from 
a mere trace to grain 0.0 1 in a pint, an amount so minute as to be prac- 
tically inert in comparison with the much greater quantities of potassium and 
sodium salts in the same waters. 

LOBELIA, Lobelia, (Indian Tobacco), — the dried leaves and tops oiLobelia 
inflata, nat. ord. Campanulaceae, collected after a portion of the capsules have 
become inflated. The plant is a common annual weed growing on roadsides 
throughout the United States, having pale-green alternate leaves, and small, 
pale-blue flowers. It contains gum, resin, fixed oil, wax, lignin, salts of cal- 
cium, potassium and iron, a liquid alkaloid Lobeline, C 16 H 24 NO, also Lobelic 
Acid, and an acrid substance named Lobelacrin. Dose, gr. ij-x [av. gr. ijss.] 

Preparations. 

Fluidextractum Lobeliae, Fluidextract of Lobelia. Dose, ttbj-x [a v. ttjujss.] 
Tinctura Lobeliae, Tincture of Lobelia, — 10 per cent. Dose, ttjv-xx [av. ttrxv.] 
Lobelinum, Lobelin (Unofficial), — an impure resinoid. Dose, gr. ss-j. 
Libradol (Unofficial), — is the trade name of an external remedy for localized pain and 
inflammation, compounded from Lobelia, Sanguinaria, Capsicum, Tabacum, Dracontium, 
Melaleuca Leucodendron, Camphora and Ipecacuanha, in the form of an antiseptic plastic 
dressing, to be thinly applied after a hot moist towel to the affected part. 

Incompatibles. 

Incompatible with Lobelia preparations are: Caustic Alkalies, Alkaloidal precipitants 
(see page 6). 

Physiological Action and Therapeutics. 

Lobelia has an acrid, nauseous taste, and a heavy, unpleasant odor. Its 
active prin'ciple is lobeline which resembles nicotine, the active principle of 
tobacco, in its pharmacology. Lobeline in small doses stimulates and in 
large doses depresses or paralyzes the ganglia of the sympathetic and para- 
sympathetic systems; stimulates and later depresses the medullary centres. 
In large doses it excites an abundant flow of saliva, much gastric mucus, pro- 
fuse urination and sweating, with nausea, vomiting and great depression. The 
heart's action is enfeebled and the blood-pressure, at first increased, soon falls; 
muscular debility, reduced temperature and coma follow, and death occurs by 
paralysis of the respiratory apparatus. The drug in fatal doses produces 
paralysis of the motor nerve-trunks, the peripheral vagi, and the respiratory 
and vaso-motor centres. It strongly resembles tobacco in its action, and is 
highly dangerous in full medicinal doses, having caused many deaths when 



LYCOPODIUM — MAGNESIUM. 319 

administered therapeutically, the most important instance of its fatal results 
being the case of Ezra Lovett, Jr., who in 1809 was poisoned by Lobelia 
administered by the founder of the Thomsonian sect of medical practitioners. 
The responsible party escaped conviction on the plea that he gave the drug 
in ignorance of its qualities. 

Lobelia was a favorite remedy with the Indians at the time of the first set- 
tlement of the United States, and was introduced into regular practice as an 
anti-asthmatic, after having served as the main stock-in-trade of irregular prac- 
titioners for many years. Its principal therapeutic action is that of an anti- 
spasmodic, and in cautious hands it is extremely useful in paroxysmal spas- 
modic asthma, also in dry cough with constant tickling in the throat. In 
constipation from atony and deficient secretion a 10-minim dose of the 
tincture at bedtime acts excellently, and in poison-oak eczema the infusion 
is a good local application. The tincture with an equal quantity of glycerin 
is an efficient application for the pain of acute epididymitis. As an emetic 
it is dangerous and unreliable, and is no longer used for that purpose. 

LYCOPODIUM, — is a very mobile, pale-yellow, fine powder, consisting of the spores 
of the Club-moss, Lycopodium clavatum, and other species of Lycopodium, nat. ord. Lyco- 
podiaceae, a native of Europe and the United States. Lycopodium is odorless, tasteless, floats 
on water, which does not wet it, and burns quickly when thrown on a flame. It should be 
free from pine-pollen, starch, sand and other impurities, which are detected by means of the 
microscope, the lycopodium spores being about ¥ £o °f an mca m diameter, four-sided and 
reticulated, with short projections on the edges. They contain about 47 per cent, of a bland, 
fixed oil. 

The powder is employed quite extensively in pharmacy to facilitate the rolling of a 
pill-mass and to prevent adhesion of pills to each other. It makes an excellent absorbent 
and protective powder when dusted over an excoriated surface, as between the thighs of 
infants. 

By the homeopathic practitioners Lycopodium is elevated to the rank of an active drug 
when triturated with sugar of milk sufficiently long to break up the seeds and liberate their 
oily contents. In their first centesimal trituration (x^-q) it is said to have produced symptoms 
of excitement of the circulation and irritation of the urinary organs, and they profess to use it 
with benefit in affections of the mucous tracts, dyspepsia, pyrosis, flatulence, constipation, 
ileo-colitis of infants, hepatic congestion, aneurism, chronic affections of the lungs and bronchi, 
diphtheria, lithiasis, intertrigo, porrigo capitis, plica polonica and pruritus ani, in all of which 
as an internal remedy and in high attenuation. 

MAGNESIUM, Mg— This metal is represented by its Carbonate, Citrate, 
Oxide, and Sulphate, of which the last occurs native in sea-water, caves, etc., 
the others being prepared from it. Its salts are either white or colorless, and 
those which are official are as follows: — 

Official Salts of Magnesium. 

Magnesii Carbonas, Magnesium Carbonate (MgC0 3 ) 4 Mg(HO) 2 + 5H 2 0, — light, friable 
masses, or powder, odorless and of slight, earthy taste, insoluble in alcohol, almost in- 
soluble in water. Dose, gr. x-5j [av. gr. xlv.] 

Magnesii Oxidum, Magnesium Oxide, Magnesia, MgO, — is made by heating the light car- 
bonate in a crucible to expel nearly all the carbonic acid. A white, fight and very fine powder, 
almost insoluble in water, insoluble in alcohol, and gelatinizes with 15 of water after standing 
J hour, having become hydrated. Is a constituent of Pulvis Rhei Compositus, and Fern 
Hydroxidum cum Magnesii Oxido. Dose, gr. x-xlv [av. gr. xxx.] 



320 MAGNESIUM. 

Magnesii Oxidum Ponderosum, Heavy Magnesium Oxide, Heavy Magnesia, MgO, — 
is a white, dense and very fine powder, corresponding in other properties and reactions to 
Magnesia, except that it does not gelatinize with water. It is made by calcining the heavier 
carbonate, and is much slower in action than the light magnesia. Dose, gr. x-xlv [av. gr. xxx.] 

Magnesii Sulphas, Magnesium Sulphate, (Epsom Salt), MgS0 4 + 7H 2 0, — colorless 
prisms or acicular needles, slowly efflorescent, odorless, of cooling, saline taste, and neutral 
reaction, very soluble in water, insoluble in alcohol. Is a constituent of Infusum Sennae 
Compositum. Dose, 5j~oj [av. 3iv.] in plenty of water. 

Preparations. 

Magnesii Sulphas Effervescens, Effervescent Magnesium Sulphate (Unofficial), — is 
prepared from the Sulphate 50, Sodium Bicarbonate 40.3, Tartaric Acid 21. 1, Citric Acid 
13.6. A coarsely granular, white, deliquescent salt, of acid taste and reaction, soluble in 
water, insoluble in alcohol. Dose, 5j~5j [av. 5iv.] 

Liquor Magnesii Citratis, Solution of Magnesium Citrate, — prepared from the Carbonate 
15, Citric Acid 33, Syrup 60, Talc 5, Potassium Bicarbonate 2§, Water to 350. Dose, 
5vj-xx [av. §xij], for catharsis. 

Mistura Magnesiae et Asaf oetidaj Magnesia and Asafetida Mixture, Dewees' Carminative 
(Unofficial), — contains of the Carbonate 5, Tincture of Asafoetida 7, Tincture of Opium 1, 
Sugar 10, and Distilled Water to 100. Dose, 3ss-iv. Used for flatulent colic and diarrhea 
in infants. 

Magnesium Peroxide, Magnesium Dioxide (Unofficial), — a white powder, practically 
insoluble in water, but yielding by such contact hydrogen peroxide and magnesium hydrox- 
ide; the hydrogen peroxide being further acted upon with the liberation of oxygen. Be- 
cause of the power of liberating oxygen it has been used in dentifrices and as an intestinal 
antiseptic. Dose, gr. iv-vij thrice daily. 

Incompatibles. 

Incompatible with Magnesium Oxide are: Acids, Copaiba (forms of solid mass), Water 
(in small quantity hydrates it). With Magnesium Salts are: Alkalies, Arsenates, Carbonates, 
Lead Acetate, Lime-water, Oxalates, Phosphates, Silver Nitrate, Sulphites, Tartrates. 

Physiological Action. 

Magnesia and the Carbonate are mildly laxative and antacid, neutraliz- 
ing free acids in the stomach and forming therewith laxative salts. If used 
in large quantity for any length of time an accumulation of the insoluble 
carbonate may occur and produce intestinal concretions. The freshly pre- 
cipitated Hydroxide is an antidote to arsenic in solution, but less effective 
than the hydroxide of iron, with which it is combined in the official Ferri 
Hydroxidum cum Magnesii Oxido. Magnesia may also be used in poisoning 
by acids or phosphorus. 

The Citrate and Sulphate are saline cathartics, the latter being the more 
powerfully hydragogue, producing large watery discharges. It is the chief 
aperient constituent of many popular laxative waters, as Friedrichshall, Piillna, 
and Hunyadi. If administered in plenty of water the Sulphate usually pro- 
duces a prompt and free discharge from the intestines with little irritation or 
griping, but often accompanied by a sense of coldness and depression. The 
purgative action is chiefly due to its causing a greatly increased secretion of 
intestinal fluids, not by outward osmosis from the vessels as was formerly taught, 
but by stimulation of the intestinal glandular appendages. If the purgative 



MAGNESIUM. 32 1 

action should not take place a diuretic one may result, but to secure the desired 
catharsis the drug should be administered in a considerable quantity of water. 
When Magnesium Sulphate is given over a long period of time there is a 
tendency for the body to lose alkali as a result of the combination of the 
sulphuric acid liberated in the intestine with the alkalies which are absorbed 
and excreted in the urine. This loss of alkali is counteracted by the admin- 
istration of sodium bicarbonate. A saturated aqueous solution applied on a 
mask of several thicknesses of ordinary gauze exercises a powerful and bene- 
ficial influence over any kind of inflammation. When injected into the cir- 
culation it is powerfully toxic, paralyzing first the respiration and then the 
heart. It abolishes sensation and paralyzes the sensorimotor reflex centres 
(Murrell). Large doses taken internally may cause serious results, 5 j in a 
boy of 15 years produced cyanosis, a roseolous rash, tetanic spasms, cold 
hands and feet, imperceptible pulse, weak and rapid heart, and an axillary 
temperature of 105 F. (Neale). A boy of 10 years was killed by 5ij (Chris- 
tison), and an adult was fatally poisoned by § j (Luff). 

Therapeutics. 

Magnesia and the Carbonate are used as antacids and laxatives, in acidity, 
sick headache, and flatulent colic, also as antidotes in poisoning by acids, ar- 
senic, phosphorus, and mercuric and cupric salts. The Citrate is an agreeable 
laxative, cooling and acceptable to the stomach. The Sulphate is one of the 
most efficient of the saline cathartics and has a wide field of application. In 
acute inflammatory conditions, renal and cardiac dropsy, ascites from obstruc- 
tion of the portal circulation, increased blood-pressure within the cranium, 
the constipation of lead poisoning, and habitual constipation from deficiency 
of the intestinal secretions, it is an excellent remedy. As it has but little 
influence on intestinal peristalsis it is sometimes combined with Senna, as in 
the Black Draught, which increases its purgative action. Acute dysentery 
is well treated by magnesium sulphate combined with diluted sulphuric acid, 
and followed by opium and starch enemata. Bleeding from hemorrhoids and 
uterine hemorrhage are often relieved by the same combination when other 
agents fail. In acne vulgaris and other obstinate eruptions due to derange- 
ment of the stomach and intestinal canal, good results are often obtained by 
a purgative dose of the sulphate daily before breakfast, or by doses of 5 
grains in water three or four times a day; and finely triturated it makes an 
excellent dusting powder for acne rosacea. 

A saturated solution of Magnesium Sulphate, continuously applied, has 
extraordinarily beneficial influence on local inflammation, especially erysipelas 
and orchitis; having been used in over 700 cases of all varieties of inflammation 
with uniformly good results (Tucker) . In tetanus 1 mil. of a 2 5 per cent, solution 
to each 25 lbs. of the patient's body- weight, administered by subarachnoid injec- 



322 MANACA MANGANUM. 

tion, achieves complete muscular relaxation in almost all cases, preventing the 
rapid exhaustion due to convulsions. The same result may be accomplished 
hypodermicaHy; and according to one observer referred to by Hatcher and 
Wilbert, it should be started with tentative doses of not over 5 mils (75 
minims), increasing until slight general anesthesia is induced. He reports 
that as much as 20 mils (5 drams) of a 10 or 15 per cent, solution may be 
injected subcutaneously three or four times daily, and that he never saw 
respiratory failure. 

MANACA (Unoffiical), — is the root of Franciscea uniflora, a shrub of the nat. ord. 
Scrophularineae, indigenous to Brazil, where it is known as Mercurio- vegetal, or vegetable 
mercury, a name applied by charlatans to a number of widely differing plants. Very little 
is known about Manaca, but it has been extensively advertised as an unfailing remedy for 
sub-acute and chronic rheumatism. It is also considered purgative, diuretic, emmenagogue 
and antisyphilitic, being official in the Brazilian Dispensatories, and noticed as follows in 
the Diet, de Botan. Brazileira. 

"This whole plant, but especially the root, excites powerfully the lymphatic system, 
eliminating morbid matter by the skin and kidneys. It is antisyphilitic; the interior bark is 
nauseating and stimulates the throat. In small doses it is resolvent; in larger purgative, 
diuretic and emmenagogue. In large doses it is an acrid poison." 

MANGANUM, Manganese, Mn. — This metal is represented in the Phar- 
macopoeia by : — 

Mangani Dioxidum Praecipitatum, Precipitated Manganese Dioxide, — is chiefly man- 
ganese dioxide, Mn0 2 , with small amounts of other oxides of manganese; a heavy, fine, 
black powder, odorless and tasteless, insoluble in water or alcohol, giving off oxygen gas at a 
red heat, and if heated with hydrochloric acid it causes the evolution of chlorine gas. Dose, 
gr. ij-x [av. gr. iv.] 

Potassii Permanganas, Potassium Permanganate, KMnO t , — deep, purple-violet prisms, 
of sweet, and astringent taste, neutral reaction, soluble in 13.5 of water with a scanty, brown 
residue, decomposed by alcohol and by heating to 240 C. It should be kept in well stop- 
pered bottles, and should not be triturated or combined in solution with organic or readily 
oxidizable substances. Dose, gr. ss-ij [av. gr. j] in pill. 

Unofficial Preparations. 

Zinci Permanganas, Zinc Permanganate, Zn(Mn0 4 )2 +6H 2 0, — is a dark brown or 
black, crystalline powder or mass, readily soluble in water. It gives up oxygen more readily 
than the potassium salt, hence great care should be exerted when bringing it in contact 
with easily oxidizable substances. It resembles the potassium salt in its oxidizing proper- 
ties and is astringent and antiseptic, and is used as an injection in urethritis, in a solution 
of 1 to 8000 to 1 to 4000. 

Syrupus Mangani Iodidi, Syrup of Manganese Iodide, — contains about 3j of the 
Iodide in each §. Dose, ttjjx-xxx. For formula see U. S. Dispensatory. 

Syrupus Ferri et Mangani Iodidi, Syrup of Iron and Manganese Iodide, — each § contains 
50 grains of the mixed iodides in the proportion of 3 of the Iodide of Iron to 1 of that of 
Manganese. Dose, ttjjx-xxx. For formula see U. S. Dispensatory. 

Ferro-mangan, Liquor Ferro-Mangani Peptonati, — a solution of a compound of peptone 
with iron and manganese containing 0.6 per cent, iron, 0.1 per cent, manganese and 1.5 per 
cent, peptone. It has the actions of Iron and Manganese. Dose, 5 j-iv, three or four times 
a day, in white wine or milk, or alone. 

Condy's Red Fluid, — is a solution of Potassium Permanganate in Distilled Water, of 
about if per cent, strength, 8£ grains to the ounce, or 176 grains in 20 ounces. It is used as a 
disinfectant and deodorant for closets and bed-pans, also to wash the hands and utensils, 
but it cannot be employed to disinfect rooms. It is not irritant, and shows by its change of 
color when it has lost its efficacy. A one per cent, solution is official in the Br. Phar., the dose 
of which is given as 3ij-iv. 



MANGANTJM. 323 

Incompatibles. 
Incompatible with Manganese Salts are Alkalies, Carbonates; Bromine, Chlorine and 
Iodine in alkaline solutions; Cyanides, Phosphates. With Potassium Permanganate are 
Acids (mineral), Alcohol, Ammonia, Arsenites, Bromides, Chlorides, Charcoal, Fats, Ferrous 
salts, Glycerin, Gums, Hydrogen Dioxide, Hypophosphites, Hyposulphites, Mercurous 
salts, Oils, Organic substances, Oxalic Acid, Oxalates, Phenol, Picric Acid, Piperazin, 
Sulphites, Tannic Acid, Tartaric Acid. 

Physiological Action. 

Manganese salts in toxic doses are gastro-intestinal and renal irritants, 
and the phenomena of acute poisoning are referable to these two systems. 
In medicinal doses manganese compounds have been used as hematinics and 
emmenagogues, but they are inferior to other more efficient remedies. Lo- 
cally the permanganates are antiseptic, disinfectant, deodorant and styptic. 
Traces of manganese are found in the blood and tissues, but the metal is 
apparently introduced accidentally with food, and is not considered to be an 
essential constituent of the organism. Chronic manganese poisoning possesses 
some semblance to a distinct clinical picture and in a series of cases described 
by Emden and von Jaksch there was " edema, general weakness or pareses 
without atrophy or degeneration reaction, a mask-like appearance of the face, 
disturbance of speech and of the voice, gross tremor of the head and extremi- 
ties much increased upon intentional movement, excited patellar reflexes 
and a spastic gait. The Romberg sign was absent. There were paresthesias 
and pains in the earlier stages but no other sensory symptoms. Sometimes 
there was uncontrollable laughter or weeping, and other psychic alterations 
were observed" (Edsall and Gwyn). 

Potassium Permanganate is a powerful oxidizing agent, and hence is actively 
antiseptic, disinfectant, and deodorant; but its germicidal power is limited, 
the salt being quickly reduced by surrendering its oxygen to all organic material 
present. A solution of i in 833 destroys the pus micrococci in two hours (Stern- 
berg). Taken internally it is quickly decomposed by the albuminous con- 
tents of the stomach, at the same time oxidizing any oxidizable material 
present, and is not absorbed in its own form. Concentrated solutions are 
irritant and corrosive to the skin, and if swallowed in quantity may cause 
gastro-enteritis. It is considered an efficient emmenagogue, increasing, ac- 
cording to some authors, the flow of blood in the pelvic organs. 

Therapeutics. 

Manganese salts have been administered by physicians in chlorosis with 
good results, but when so used are frequently prescribed with iron, which ex- 
plains perhaps the beneficial influence. The nature of the action of Man- 
ganese on the blood is not known, although Hannon maintains that the good 
effects are due to the protection of the food iron from the sulphides in the 



324 MANGO. 

intestines. The Dioxide is employed in gastrodynia and pyrosis, amenor- 
rhea and other derangements of the menstrual function, also in menorrhagia 
and metrorrhagia. It is used as an ointment in many skin diseases. 

Potassium Permanganate has generally been the preparation given when 
the effects of Manganese were desired; but as it causes great gastric irritabil- 
ity, with abdominal pains and burning sensations, besides other decidedly un- 
pleasant symptoms, it is a difficult matter to get patients to take it for any length 
of time. It is an efficient remedy in amenorrhea, and is used with benefit in 
dyspepsia, flatulence, lithemia, obesity, and acute rheumatism. For internal 
administration it should be given in pill or capsule, the taste of a solution being 
very disagreeable. The injection of a strong solution in the immediate vicinity 
of the bites of venomous reptiles is reported to be a very efficient antidote to 
their poisons. In the irrigation treatment of Gonorrhea, potassium per- 
manganate in solution of i to 8000, increasing in strength to 1 to 2000 is fre- 
quently used and with remarkably beneficial effect. Solutions of the strength 
5 j to the pint are employed as antiseptic and germicidal washes for wounds, 
ulcers, abscesses, and caries, also to correct fetor in cancer, ozena, leucorrhea, 
and perspiring feet. The local application of a 2 per cent, solution has been 
highly recommended in ivy-poisoning. It is used as a test and a corrigent 
for organic impurities in drinking water, also in strong solution (1 in 20), 
followed by a solution of oxalic acid to remove the stain, as a disinfectant 
for the hands of the surgeon. The stain left by it on fabrics may be removed 
by sulphurous acid, but as sulphuric acid is formed in the reaction the fabric 
should be immediately washed or rinsed in water. 

Potassium Permanganate is an efficient antidote for morphine in the stom- 
ach, and as the latter is constantly excreted into that viscus however admin- 
istered, the former may be used efficiently in any form of opium or morphine 
poisoning. If given soon after the ingestion of the poison, the dose should be 
double that of the morphine supposed to be present, and after washing out the 
stomach, small doses may be administered at intervals during the acute stage, 
to prevent reabsorption of the morphine excreted by the stomach. It is 
also the chemical antidote in Phosphorus poisoning in which it is preferred 
to copper sulphate. 

Zinc Permanganate resembles the Potassium salt but is more astringent. 
It is used chiefly in gonorrhea as an injection or irrigation in the strength of 
1 to 4000 of water. 

MANGO (Unofficial), — is the bark of Mangifera indica, an Indian tree of the nat. ord. 
Guttiferae. It is supposed to be an astringent with special tonic action upon mucous mem- 
branes. It is highly recommended by its vendors for nasal catarrh, hemorrhages and muco- 
purulent discharges from the intestines, uterus, vagina and bronchi. A fluidextract is sold, 
which may be used in doses of fl£x-3j. 

Mango-Fruit, or Mangosteen, is the fruit of Garcinia mangostana, nat. ord. Guttiferae, 
also from India. It is a powerful astringent, and is used for nasal catarrh, diarrheas, dysentery 
and leucorrhea. 



MANNA MEL. 325 

MANNA, — is the concrete, saccharine exudation of Fraxinus Ornus, the flowering ash, a 
tree of the nat. ord. Oleacese, growing in Southern Europe. Manna is produced also by 
several other trees, and substances resembling it are exuded by many plants. It contains 
from 40 to go per cent, of Mannit, CeH^Og, or Manna-sugar, which does not undergo vinous 
fermentation, and is chemically allied to the alcohols and to glycerin. It also contains glucose, 
mucilage, some acrid resin, and a small quantity of the fluorescent glucoside Fraxin. There 
are no official preparations, but Manna itself may be given in doses of 3 j-5 j [av. 3iv.] 

Manna is a mild laxative, with some tendency to produce flatulence and colic. It is 
usually combined with other purgatives, as Senna, Rhubarb, and Magnesia, to disguise the 
taste and increase the effect. It is a constituent of the official Infusum Sennae Compositum. 
Manna may be eaten by children if of good quali ty, or may be readily dissolved in milk and 
so administered. 

MARRUBIUM (Unofficial), — the leaves and tops of Marrubium vulgar e, Horehound, a 
plant of the nat. ord. Labiatae, native in Europe, but naturalized in America. It contains 
a bitter principle named Marrubiin, also a volatile oil, resin, tannin, lignin, etc. Dose, 
gr. xx- 5 j [av. gr. xxx.] 

Horehound in large doses is laxative, diuretic and diaphoretic, and in ordinary dosage a 
gentle tonic and stomachic. It was formerly used in catarrhal states of the air-passages, 
over which it seems to have a soothing effect, and is much employed in confectionery as an 
ingredient of "cough drops." 

MASTICHE, Mastic (Unofficial), — is a concrete, resinous exudation from Pistacia 
Lentiscus, a tree of the nat. ord. Anacardiaceae, growing in the island of Scio. Alcohol dis- 
solves about 90 per cent., including the resin Mastichic Acid, the remainder consisting of 
another resin, Mastichin, which is soluble in ether and resembles copal. Dose, gr. xx-xlv 
[av. gr. xxx.] 

Mastic was formerly used for supposed properties analogous to those of other oleo-resins, 
but its application is now confined to dentistry, being employed as a temporary filling for 
carious teeth. A solution in ether is applied on cotton with moderate pressure, and remains 
as a firm plug after evaporation of the solvent. 

MATICO (Unofficial), — the leaves of Piper angustifolium, a Peruvian shrub of the nat. 
ord. Piperaceae. It contains a crystallizable acid Artanthic Acid, also resin, tannin, and a 
volatile oil. Its odor is aromatic, and its taste astringent, spicy and somewhat bitter. 
Dose, 5ss-jss [av. 5J-] 

Fluidextractum Matico, Fluidextracl of Matico (Unofficial). Dose, 5ss-jss [av. 5j-] 
Matico is an aromatic tonic, stimulant, and hemostatic. It acts like cubeb on the urinary 
passages, and is an excellent alterative stimulant to mucous membranes. It has been 
used with success in mucous catarrhs, as gonorrhea, leucorrhea, and chronic cystitis. The 
under surface of the leaf is so formed as to promote coagulation of blood if applied to a 
bleeding surface, and is a good local hemostatic for trivial cuts or wounds. 

MATRICARIA, — the dried flower-heads of Matricaria Chamomilla, German Chamomile, 
a European annual plant of the nat. ord. Compositae. They contain \ per cent, of a blue 
Volatile Oil, the color of which is due to Azulen, also a bitter extractive, tannin, etc. There 
are no official preparations, but the flowers may be eaten or a decoction used almost ad libitum 
[av. 5iv.] 

Matricaria is a mild tonic, in large doses emetic, anthelmintic and antispasmodic. It is 
much used in Germany, and in this country is a popular domestic remedy among German 
people, who use it in infusions as a diaphoretic. This plant is the Chamomilla of the homeo- 
paths, who find in it remarkable power over morbid impressionability of the sensory and 
excito-motor nerves, and administer it in pains aggravated at night and by heat, clonic spasms 
of pregnancy, irritability of teething children, and flatulent colic. 

MEL, Honey, — is a saccharine secretion deposited in the honeycomb by 
Apis mellijera, the honey-bee; occurring as a pale-yellowish, syrupy liquid, 
gradually becoming crystalline and opaque, of peculiar and heavy odor, and 
a very sweet, faintly acrid taste. It is a strong aqueous solution of several 
sugars (cane and grape sugar, levulose), with wax-pollen, coloring and odorous 
matters, etc. The sugars, which may be resolved into levulose and dextrose, 



326 MENTHA PIPERITA. 

amount to 70 or 80 per cent. Honey is frequently adulterated with starch and 
artificial glucose, which may be detected by the official tests (see U. S. P.). 
Dose, 5 ss-ij [av. 5j.] 

Preparations. 

Mel Depuratum, Clarified Honey, — is honey heated, skimmed and strained, with Glycerin 
added in the proportion of 5 per cent. It is an ingredient of Mel Rosae, and Massa Ferri 
Carbonatis. Dose, 5 ss-ij [av. 5J-] 

Mel Rosae, Honey of Rose, — Fluidextract of Rose 12, Clarified Honey to 100. It is 
generally used as a local application to the throat for its astringency and flavor, in combination 
with more active agents. Dose, 5 ss-ij [av. 5j.] 

Oxymel, Oxymel (B. P.), — has of Honey 5, Acetic Acid 1, Distilled Water 1. Dose, 
o ss-ij as a pleasant addition to gargles, or as a vehicle for expectorant medicines. 

Honey is emollient, nutritive and laxative, in some persons giving rise to 
pyrosis, flatulence and colic, and in others to an eruption of urticaria, but gen- 
erally constituting an agreeable article of diet. It is sometimes actually poison- 
ous from the presence of toxic agents extracted by the bee from certain plants, 
in this country generally the mountain laurel, Kalmia latifolia. Honey is chiefly 
used as an emollient in diseases of the throat, to relieve dryness, pain, cough 
and dysphagia. Honey of Rose is somewhat astringent, and is used in gargles 
or in washes, for the treatment of inflammation and ulceration of the mucous 
membrane of the nasal passages, the mouth and the throat. 

MENTHA PIPERITA, Peppermint,— the dried leaves and flowering tops 
of Mentha piperita, a perennial herbaceous plant of the nat. ord. Labiatae, a 
native of Britain, but largely cultivated elsewhere. They contain 1 to i-| per 
cent, of a Volatile Oil, which is official, and a little tannin. 

Menthol, C 10 H 19 OH, — is a secondary alcohol, obtained from the official 
oil of peppermint, or from other oils of peppermint, by deposit therefrom on 
exposure to cold. It occurs in colorless, acicular crystals, of peppermint odor, 
and a warm, aromatic taste, followed by a sensation of cold when air is drawn 
into the mouth. Soluble only slightly in water, freely in alcohol, ether, or 
chloroform. Dose, gr. ss-iij [av. gr. j], in pill or spirituous solution, several 
times a day. 

Oleum Menthae Piperitae, Oil of Peppermint, — is the volatile oil distilled from the fresh 
herb; a colorless or pale yellow fluid, having the odor of peppermint, and a strongly aromatic 
taste followed by a cold sensation when air is drawn into the mouth. It consists of not 
less than 50 per cent, of Menthol, free and as esters Menthol (see above). Dose, njy-v 
[av. Trjmj.j 

Aqua Menthae Piperitae, Peppermint Water, — has of the Oil 2 parts in 1000 of distilled 
water. Dose, 3ij-vj [av. 5iv.] 

Spiritus Menthae Piperitae, Spirit of Peppermint (Essence of Peppermint), — is an alcoholic 
solution containing 10 per cent, of the Oil and 1 per cent, of the bruised herb. Dose, 
Tt£x-xlv [av. 17J7XXX.] 

Incompatibles. 

Incompatible with Menthol are: Bromal Hydrate, Butyl-chloral Hydrate, Chloral 
Hydrate, Camphor, Chromic Acid, Naphtol, Phenol, Potassium Permanganate, Pyro- 
catechin, Pyrogallol, Resorcin, Thymol. With Spirit of Peppermint are: Acacia, Aqueous 
fluids, Gelatin. 



mentha viridis^methylthionilsle hydrochloridum. 327 

Physiological Action and Therapeutics. 

Peppermint is an aromatic stimulant, also carminative and antispasmodic. 
The oil possesses these qualities in greater degree and is also a local anodyne 
and anesthetic when applied locally, especially if its evaporation be prevented 
The Chinese oil contains a large quantity of Menthol and is particularly anodyne. 
Menthol is antiseptic and locally anesthetic, but not corrosive, and acts also 
as a vascular stimulant when applied to the surface. 

Peppermint is used internally for the relief of nausea and colic, and to expel 
flatus by its local stimulant and after sedative action on the bowels. It is an 
agreeable corrigent for combination with purgatives to prevent griping, and 
efficiently covers the taste of many nauseous substances. The spirit is the best 
form for internal use. The oil is used locally to relieve the pain of superficial 
neuralgia, a cloth being wet with it, laid along the course of the affected nerve 
and covered with oiled silk to restrain evaporation. It is efficient in rheuma- 
tism as an anodyne and counterirritant application. 

Menthol is highly praised as an external application in various neuralgia?, 
sciatica, pleurodynia, and toothache. For neuralgia it is used in saturated 
alcoholic solution painted over the affected nerve. For toothache a crystal 
introduced into the carious cavity is promptly anodyne. In spray containing 
2 to 5 per cent, it is highly efficient in epidemic influenza and in tuberculous 
laryngitis. It is a good application in parasitic skin diseases, and has marked 
value as an antipruritic. Its vapor by inhalation is efficient against cough, and 
it has considerable power as an anti-emetic, having stopped nausea and. vomit- 
ing after the usual remedies had failed. For this purpose ten drops of a 20 
per cent, solution in olive oil are given on sugar. 

MENTHA VIRIDIS, Spearmint, — the dried leaves and flowering tops of Mentha spicata 
the "mint" of the kitchen garden, a plant of the nat. ord. Labiatae, indigenous to England, but 
naturalized in many countries. Its constituents and properties are identical with those of 
peppermint, but its odor and taste differ therefrom. Dose, gr. xx-5j. 

Oleum Menthae Viridis, Oil of Spearmint, — is the Volatile Oil distilled from the plant 
Dose, Ti£ij-v [av. TTRiij.] 

Aqua Menthae Viridis, Spearmint Water, — has 2 parts of the Oil in 1000 of Distilled 
Water. Dose, 5ij-vj [a v. 5iv.] 

Mistura Sodae et Menthae, Soda Mint (Unofficial), — has of Sodium Bicarbonate gr. 
cccxx, Spt. Ammonise Aromat. 3j, Spearmint Water §xvj. Dose, 1 or 2 tablets. 

Spiritus Menthae Viridis, Spirit of Spearmint, (Essence of Spearmint), — is an alcoholic 
solution containing 10 per cent, of the Oil and 1 per cent, of the bruised herb. Dose, ttjjx-xIv 
[av. TT£XXX.] 

Spearmint corresponds in action to Peppermint, but is less powerful. It is employed to 
correct flatulence and to relieve colic, and makes an agreeable flavoring for mixtures. 

METHYLTHIONINiE CHLORTDUM, Methylthionine Chloride, Methy- 
lene Blue, — a derivative of Aniline, occurs as a dark green crystalline powder, 
or as prismatic crystals of bronze-like lustre; readily soluble in water and 
alcohol, the solutions having a deep blue color. Dose, gr. j-v [av. gr. ijss], 



328 MEZEREUM MORRHTL*: OLEUM. 

up to gr. xx daily, with gr. ij of powdered nutmeg, given with each dose to 
prevent strangury. Incompatibles are Caustic Potash, Potassium Dichro- 
mate, Potassium Iodide, Sulphuric Acid and other reducing agents. 

Methylene Blue should not be confounded with Methyl Blue or Pyoktanin 
the dye, which is highly poisonous. It manifests a strong affinity for nerve tis- 
sue, and is the best staining agent for the malarial plasmodium. It destroys 
this organism, and is curative in the forms of malaria showing the crescents 
and full-grown parasites, while quinine is more efficient when the nuclei are 
more developed than the plasma (Ehrlich). Its best action in malarial affec- 
tions has been obtained in children, and being tasteless it may be admin- 
istered to them more easily than quinine, besides being free from the vomiting 
and headache which so frequently result from the latter drug. It has very 
considerable anodyne power over neuralgic and rheumatic affections and in 
diphtheria and simple ulceration of the throat a 10 per cent, solution is used 
locally with benefit. It has been employed successfully in chronic cystitis 
and in the early stage of gonorrhea its internal administration will shorten 
the duration of the disease. It is rapidly eliminated by the kidneys, and 
imparts a blue color to the urine, which characteristic was used, prior to the 
discovery of more accurate methods, as a test of renal function. 

MEZEREUM, Mezereum (Mezereon), — is the bark of Daphne Mezereum and of other 
species of Daphne, plants of the nat. ord. Thymeleaceae, growing in mountainous districts of 
Europe and Asia and cultivated as a garden shrub in Britain. It contains an inert, fixed oil, 
an inactive glucoside, Daphnin, and an acrid Resin, which is the anhydride of a resinous acid 
named Mezereinic Acid. Mezereum is an ingredient of the compound fluidextract of Sarsa- 
parilla. Dose, gr. j-x [av. gr. vijss.] 

Mezereum is a sialogogue, and an intensely acrid, irritant poison, producing violent 
vomiting, purging, nephritis and gastro-enteritis. In small doses it is laxative and diuretic > 
and has had considerable reputation as an alterative. Externally the recent bark is a powerful 
local irritant, speedily producing vesication. 

Mezereum is rarely used internally by itself, but is employed in mixtures with Sarsa- 
parilla, etc., as an alterative in syphilis, rheumatism and some skin diseases of chronic type 
but with doubtful efficacy. Its principal use is as a local irritant to stimulate indolent 
ulcers. 

MORRHIL® OLEUM, Cod Liver Oil {Oleum Jecoris Aselli),— is a fixed 
oil obtained from the fresh livers of Gadus Morrhua, the cod-fish, also from 
other species of Gadus. It is a colorless or pale yellow, thin, oily liquid, of 
slightly fishy odor and taste, and faintly acid reaction, soluble in ether. It 
contains the fixed bases Aselline and Morrhuine, volatile bases, acids, etc. (see 
below) ; also traces of iodine and bromine, the ordinary inorganic salts of animal 
tissue and products, and perhaps bile constituents. When saponified it does 
not yield glycerin, but oxide of propyl. Three kinds or varieties are found in 
the market, the pale, the light-brown and the dark. The pale is the official 
oil and the purest. Dose, 3j~vj [av. 3i v ]> beginning with a small dose, and in- 
creasing as assimilated. 

Preparations. 

Emulsum Olei Morrhuae, Emulsion of Cod Liver Oil, — has of the Oil 50, Acacia laj, 
Syrup 10, Methyl Salicylate 0.4, and Water to 100. Dose, 5j-vj [av. 3iv.l 






MORRHU^E OLEUM. 329 

Emulsum Olei Morrhuae cum Hypophosphitibus, Emulsion of Cod Liver Oil with 
Hypo phosphites (Unofficial), — has of the Oil 50, Acacia 12^, Calcium Hypophosphite 1, 
Potassium Hypophosphite 0.5, Sodium Hypophosphite 0.5, Syrup 10, Oil of Gaultheria 
0.4, and Water to 100. Dose, 3j _ vj [av. 5ij-1 

Morrhuol (Unofficial), — is obtained from cod liver oil by treating it with sodium bicar- 
bonate to remove the acids, then agitating with alcohol and evaporating the latter. Dose, 
gr. iij in capsule. 

Physiological Action. 

The action of Cod Liver Oil is that of any other fat, except that it is more 
easily assimilated than any other member of the class. Fat is an essential 
food material, and in association with the carbohydrates is concerned prin- 
cipally in the production of force. In body metabolism the proteins act as 
tissue builders, whereas the fats and carbohydrates yield energy either as 
heat or muscular work. When they are insufficient the proteins are utilized 
to provide energy, when abundant they spare the protein for its tissue-build- 
ing function. After oxidation it is excreted as carbon dioxide and water. 

Cod Liver Oil is the most easily digestible of fats, penetrating animal mem- 
branes with comparative ease after being emulsified by the pancreatic and 
biliary secretions, hence entering the lacteal vessels readily and appearing to 
carry with it the oily and nitrogenous elements of the food. The result is facili- 
tation of the digestive process, increase of the red blood-corpuscles and of the 
body-weight, and stimulation of healthy cell-formation throughout the tissues. 

Gautier and Mourgues of Paris have made an exhaustive series of analytical researches 
upon Cod Liver Oil, and find that it contains — (1) Fixed Bases, Aselline and Morrhuine, 
the latter constituting about £ of the total alkaloids, and being probably one of the most effi- 
cient principles in the oil. (2) Volatile Bases, Butylamine, \ of the total bases; Amylamine, 
£ of the whole; Dihydrotoluidine, ^ of the total alkaloids; Hexylamine, a small amount. (3) 
Acids, Morrhuic Acid i£ per cent., also a mixture of Formic and Butyric Acids; and a small 
proportion of Phosphoric Acid, derived from the phosphates, phospho-glycerates and lecithins 
of the extracts. As to the properties of these constituents they state that Butylamine, Hexyla- 
mine, and particularly Amylamine increase the urinary secretions. Dihydrotoluidine is a con- 
vulsivant toxic base. Aselline in sufficient doses produces dyspnea, stupor, convulsive dis- 
turbances, and if continued death. Morrhuine, the most important of the extractive principles, 
is a powerful stimulant of the functions of nutrition and assimilation, promoting metabolic 
changes; it produces a rapid circulation of the extractive residues of cell life towards the 
excretory organs, where they are eliminated, provoking in their way indirectly a powerful move- 
ment of assimilation correlative of the losses consequent upon the inverse movement of de- 
assimilation. This is considered to be proved by the super-excitation of appetite in animals 
brought under its influence. The physiological experiments with these substances demon- 
strate that cod liver oil is a reconstituent of the tissues through its richness in phosphates, 
phospho-glyceric acid, and organically combined phosphorus. Bromine and iodine, which are 
present in small quantities, also contribute to the reparative action, but chiefly to the active 
principles butylamine, amylamine, and especially morrhuine and morrhuic acid, does the oil 
owe its value. 

Therapeutics. 

The value of Cod Liver Oil is wholly that of a nutrient, its action being most 
marked in wasting diseases. In high febrile states or catarrhal conditions 
of the gastro-intestinal tract its use is contraindicated, but in phthisis a slight 
degree of fever will not interfere with its beneficial employment. It is found 



330 MOSCHUS. 

to be of most value in the chronic forms of phthisis, in chronic bronchitis 
and emphysema, chronic rheumatic disorders, atheroma of the arteries, stru- 
mous skin diseases and diarrhea, syphilodermata, neuralgia, chorea and epilepsy. 
In many disorders referable to exhaustion or debility of the nervous centres it 
is of great value as a nerve tonic, and in convalescence from acute diseases it 
is of marked benefit. It should always be considered as a supplementary 
food, and if its use endangers the appetite for other food it should be abandoned. 

The administration of this valuable agent is a serious matter, as many pa- 
tients cannot overcome their repugnance to its taste and smell. Various emul- 
sions are on the market, but they are objectionable because in no case do they 
conceal the taste, and the efficacy of the oil is seriously impaired by the proc- 
esses used in their preparation. Moreover, the temptation is very great to 
employ an inferior grade of the oil or to adulterate it with other fish oils in the 
manufacture of these preparations, and when the commercial spirit of gain is 
remembered one can never be sure of the quality of the oil so prepared. The 
oil itself is the best form for use, in small doses, say a teaspoonful thrice daily 
for an adult, after meals, in black coffee, beer or lemon-juice. The essential 
oil of eucalyptus in the proportion of i part to ioo of cod liver oil will effectu- 
ally extinguish the odor and taste to many persons. Alkaline stomachics given 
before meals, the oil after, and a teaspoonful of Liquor Pancreaticus given half 
an hour afterwards, would be a good routine in most cases, the latter agent 
preventing the fishy eructations which often give so much trouble. Extem- 
poraneous emulsions may be prepared with white of egg, mucilage of traga- 
canth, extract of malt, or any syrup, and flavored with lemon, cinnamon or 
bitter almond. The addition of Tfl,iv of Ether to each 3 of the oil may enable 
a patient to take it with whom it had previously disagreed. The Emulsion 
of Cod Liver Oil with Hypophosphites is no longer official, in fact, the use- 
lessness of such a combination is exceeded only by its disagreeable taste. 

Inunction by Cod Liver Oil is a method of value in the wasting diseases of 
children. A tablespoonful may be rubbed into the skin of the abdomen twice 
a day, and covered with a flannel binder having oiled silk or mackintosh-cloth 
outside. It readily passes through the skin and is absorbed, producing valu- 
able and lasting results. 

MOSCHUS, Musk, — is the dried secretion from the preputial follicles of Moschus mos- 
chiferus, the Musk-deer, an animal inhabiting the mountainous region of Central Asia. It 
occurs in irregular, unctuous grains, of a reddish-brown color, peculiar and penetrating odor 
and bitterish taste, contained in oval sacs about 2 inches in diameter, membranous on one side, 
hairy on the other. It is soluble in 10 of alcohol, and in 2 of water. Chinese Musk in the pods 
or sacs is the most valuable, but all varieties are adulterated, the price of the drug being high. 
The odor is destroyed by drying, but returns again on the addition of moisture. Trituration 
with Camphor or Hydrocyanic Acid destroys it. The odorous principle has not been isolated, 
but is probably a product of decomposition which is constantly being formed. The con- 
stituents of Musk are a bitter resinous substance, ammonia, fat, cholesterin, etc. Dose, gr. 
ij-vj [av. gr. iv.] 

Tinctura Moschi, Tincture of Musk, — 5 per cent. Dose, ff£xx-5jss [av. 3j-] 

Musk is a very diffusible stimulant, acting directly on the nervous and circulatory systems, 



MYRCLE OLEUM MYRISTICA. 33 I 

but without much energy. It is also an antispasmodic, and is employed with benefit in general 
prostration of the system with nervous agitation or irregular muscular action. It has been used 
with advantage in laryngismus stridulus, insomnia, the collapse of typhoid and typhus fevers, 
spasmodic affections of the stomach, obstinate hiccough and convulsions of children due to 
intestinal spasms. The pure Musk is very difficult to obtain, and its high price makes it an 
extremely expensive medicine, so that it is seldom used. 

MYRCIA OLEUM, Oil of Myrcia, Oil of Bay (Unofficial),— is a volatile oil distilled 
from the leaves of Myrcia acris, the Bayberry, a tree of the nat. ord. Myrtaceae, native of the 
West Indian Islands. It contains a hydrocarbon and Eugenic Acid. Used only as a perfume. 

Spiritus Myrcise, Spirit of Myrcia, Bay Rum (Unofficial), — contains Oil of Myrcia 16, Oil 
of Orange-peel 1, Oil of Pimenta 1, Alcohol 1220, Water to 2000. 

The Oil of Bay is an agreeable perfume chiefly used in cosmetic preparations. The spirit, 
known as Bay-rum, is used principally as a refreshing perfume, and is thought to relieve head- 
ache and faintness, by applications to the forehead or to the nostrils. 

MYRISTICA, Myristica {Nutmeg), — is the kernel of the ripe seed of 
Myristica fragrans, nat. ord. Myristicaceae, a native of the Banda Islands. Its 
odor is strongly aromatic; its taste is agreeably aromatic, warm and slightly 
bitter. Dose, gr. v-xv [av. gr. viij.] 

Macis, Mace (Unofficial), — is the arillode (fleshy covering) of the seed of 
Myristica fragrans, the Nutmeg-tree. It occurs in narrow bands about an 
inch long, branched and lobed, of brownish-orange color, fragrant odor, warm 
and aromatic taste. It yields a fixed oil by pressure and a volatile oil by dis- 
tillation, the latter being probably identical with Oil of Nutmeg. Dose, gr. 
v-xx. 

Preparations. 

Oleum My risticae, Oil of Nutmeg, — is the volatile oil, and consists chiefly of a terpene and 
an oxygenated oil, Myristicol. It is colorless or pale-yellow, of hot, spicy taste and neutral 
reaction, and is soluble in alcohol. Dose, irgj-v [av. TTjmj.] 

Nutmeg is an ingredient of Pulvis Aromaticus, Tinctura Lavandulae Comp., and 
Trochisci Sodii Bicarbonatis. 

Incompatibles are Mineral Acids, Cinchona infusion, Ferrous Sulphate, Mercuric Chloride 
Silver Nitrate. 

Physiological Action and Therapeutics. 

Nutmeg is an aromatic stomachic of agreeable flavor. In small doses it 
stimulates the production of gastric juice, promotes digestion, increases appetite, 
and relieves intestinal spasm and flatulence. In large doses it is powerfully 
narcotic, acting directly on the cerebrum, and producing stupor and delirium. 
It is used chiefly for flavoring purposes, and generally in substance grated as 
required, but has been employed as a carminative, anodyne and astringent 
in diarrheas and dysentery, also to relieve nausea and vomiting. Strangury 
is efficiently treated by small doses of powdered nutmeg given several times a 
day; and the same remedy is often used in the south of Germany to relieve 
the uncomfortable feeling experienced after drinking an excessive quantity of 
new beer. Grated nutmeg is used by women in England and Australia as an 
abortif acient, often with toxic results. The Volatile Oil is decidedly rubefacient 
when used externally, and has narcotic powers if used internally in sufficient 



33 2 MYRRHA MYRTI OLEUM. 

quantity. It is occasionally employed as an external stimulant in paralysis 
and chronic rheumatism. Mace is stimulant, carminative and aromatic. It 
is used solely as a spice or condiment. 

MYRRHA, Myrrh, — is a gum-resin obtained from Commiphora Myrrha, 
an Arabian tree of the nat. ord. Burseraceae. It occurs in roundish tears, hav- 
ing a waxy fracture, a balsamic odor and a bitter taste. When triturated with 
water it forms a brownish-yellow emulsion; treated with alcohol it yields a 
brownish-yellow tincture which turns purple on the addition of nitric acid. 
It contains Gum, 60 per cent.; Myrrhin, a resin, 35 per cent.; also Myrrhol, 
C 10 H n O, an oxygenated ethereal oil, 2 per cent. Dose, gr. v-xv [av. gr. viij.] 

Tinctura Myrrhae, Tincture of Myrrh, — 20 per cent. Dose, njx-xxx [av. ttjjxv.] 
Myrrh is contained in Compound Pills of Rhubarb. 

Locally applied Myrrh is stimulant and disinfectant to mucous membranes 
and ulcerated surfaces. Administered in small doses internally it acts as a 
gastric stimulant, but in large doses it irritates the gastro-intestinal mucous 
membrane, causing vomiting and purging. It quickens the action of the heart, 
diminishes bronchial secretion, and is a uterine stimulant and an emmenagogue. 
Myrrh was formerly much used in combination with other drugs, such as 
aloes and iron, for anemia, amenorrhea and bronchial catarrh. It is believed 
to diminish excessive secretion from the mucous surfaces of the uterus, va- 
gina, bladder and bronchi, also to have an especially beneficial influence on 
chronic pharyngitis. Locally used the tincture has a good tonic action on 
diseased mucous surfaces and is applied with benefit to spongy gums, relaxed 
throat, aphthous patches and unhealthy ulcers, and diluted with water it 
makes an excellent gargle for ulcerated sore throat. Myrrh has long been 
employed as an ingredient of dentrifrices. 

MYRTI OLEUM, Oil of Myrtle, Myrtol (Unofficial),— is a volatile oil 
distilled from the leaves of Myrtus communis, the myrtle, nat. ord. Myrtaceae, 
and consists of a mixture of Pinene, another hydrocarbon, and Cineol; the latter 
being identical with eucalyptol, and probably the active medicinal ingredient. 
Dose, Tflj-iij, in capsules. 

Myrtol is a very active antiseptic and parasiticide. Applied to a raw surface 
it is sufficiently irritant to excite inflammation, but it does not so affect the un- 
broken skin. Internally, in small doses, it excites a sense of warmth in the 
mouth, increases the saliva, and acts as a tonic to the stomach. Full doses are 
sedative to the nervous system, but large ones act as an irritant. It is eliminated 
by the lungs and kidneys, acting as an expectorant, an antiseptic and a stimulant 
to the mucous membranes at the- points of elimination. It imparts an odor 
like that of violets to the urine of the person taking it. 

Administered in small doses, Myrtol aids digestion, and is of value in 



NAPHTHALENUM. 333 

bronchorrhea, fetid bronchitis, gangrene of the lung, cystitis and urethritis. 
Locally it has proved curative in favus, herpes, pityriasis and parasitic skin 
diseases; also in otorrhea, ozena and other foul discharges from ulceration of 
the mucous membranes. It has been employed successfully against both the 
round and the thread worm. 

Chekan (Unofficial), — the leaves and shoots of Myrtus Chekan, nat. ord. Myrtaceae, a 
native of Chili. They contain a Volatile Oil resembling that of eucalyptus, also Chekanine, a 
volatile alkaloid, and tannin. Chekan is antiseptic, tonic, expectorant and diuretic; and is 
chiefly used in catarrh of the mucous membranes, especially those of the bronchi and the 
bladder. It has been employed with benefit in cases of phthisis, and in bronchitis with thick, 
purulent expectoration. The expressed juice diluted with water makes a good lotion for 
conjunctivitis, and a decoction of the bark is valued as an astringent in dysentery. A fluid 
extract is marketed, the dose of which is 3j-iij. 

NAPHTHALENUM, Naphthalene, Naphtalin {Tar-camphor), Ci H 8 
(Unofficial), — is a hydrocarbon obtained from coal-tar, and is formed during 
the manufacture of ordinary coal gas. Chemically,, it is one of the benzene 
derivatives, being formed by the union of two benzene groups in an overlap- 
ping ring. When redistilled, it crystallizes in colorless, rhomboid plates, of 
slightly tarry but strong odor, and burning, aromatic taste; insoluble in water, 
soluble in 15 of alcohol, very soluble in boiling alcohol, ether, chloroform, 
carbon disulphide, and fixed or volatile oils. It is seen frequently in the form 
of moulded blocks, under such names as Alabastrine and Camphylene, for 
preserving furs and flannels from moths, and for disinfecting urinals. Dose, 
gr. j-iij [av. gr. ij], in emulsion, or as a powder with sugar in wafers or capsules. 

Derivative. 

Betanaphthol, Betanaphthol (Naphtol), C10H7OH, — a phenol occurring in coal-tar, but 
usually prepared from Naphthalene. It is one of several naphthols, and occurs in color- 
less, shining, crystalline laminae, or a whitish, crystalline powder, of faint, phenol-like odor, 
and sharp taste. Soluble in 0.8 of alcohol, in about 1000 of water, and in 80 of boiling water; 
very soluble in boiling alcohol, ether, chloroform, olive oil and petrolatum. Used as oint- 
ment, 1 to 5 for adults, but for children it should be not over 2 per cent, strength. Dose, 
gr. iij-vj [av. gr. iv], in cachet or pill. Bismuth Betanaphthol is described under Bismuth. 

Unofficial Preparations and Derivatives. 

Betanaphthol Benzoate, Benzonaphthol (C10H17), — white, crystalline powder or colorless 
needles, tasteless, almost insoluble in water, readily soluble in alcohol. It is split up into 
its constituents in the intestines. Internally it is an intestinal antiseptic and diuretic. 
Dose, gr. v-xv; and externally it is parasiticidal, in 3 to 10 per cent, ointment. 

Betanaphthyl Salicylate, Betanaphtholis Salicylas, — white crystalline powder, tasteless, 
insoluble in water, soluble with difficulty in alcohol, easily soluble in boiling alcohol and 
linseed oil. Internally administered it is split up into its constituents in the intestines, 
acting as an intestinal antiseptic and urinary antiseptic and as an anti-rheumatic. Dose, 
gr. iv-viij [av. gr. iv.] 

Betol, — is the proprietary brand of Betanaphthol Salicylate. 

. Incompatibles. 

Incompatible with Naphthalene are: Chromic Trioxide, Phenol, Pyrocatechin, Salol. 
With Betanaphthol are Antipyrine, Camphor, Chlorinated Lime, Ferric Chloride, Menthol, 
Phenol, Potassium Permanganate, Pyrocatechin, Urethane. 



334 NITROGENII MONOXIDUM 

Physiological Action and Therapeutics. 

Naphthalene is destructive to all forms of low life, and hence is antiseptic 
in a high degree, but must be intimately mixed with the substances upon which 
it is to act. Internally it acts as an antiseptic in the intestinal canal. Being 
sparingly soluble but little of it is absorbed, and hence it does no injury to 
the organism. What is taken up by the blood is excreted by the urine, 
partly unchanged, partly as naphthol and perhaps some as phenol. In cats 
and rabbits when continuously administered for a considerable period of time 
it produces cataract (Hare). Betanaphthol is more easily absorbed and 
may induce vomiting, hematuria, convulsions and unconsciousness. An 
ointment containing 2 per cent, applied with friction for scabies to two broth- 
ers, aged 6 and 8 years respectively, caused nephritis in both and death in 
one, the diagnosis of nephritis being verified at the autopsy. 

Naphthalene is employed as an antiseptic for the intestinal ca,nal in 
typhoid fever, diarrhea, both acute and chronic, tuberculous diarrhea, and 
dysentery. It renders the urine aseptic and may be employed in vesical 
catarrh. It is occasionally used internally for asthma, chronic pulmonary 
catarrh of the aged, and chronic bronchitis with copious secretion. It is said 
to be effective as a teniacide, also as a vermifuge for seat- worms given by in- 
jection, gr. xv-5ss in giij of olive oil. Locally, Naphthalene has high value 
as an antiseptic for indolent ulcers, sloughing wounds, open cancers, and pus 
cavities. Painted over organic remains it effectually prevents the ravages of 
insects, and has largely supplanted camphor for protecting woolen clothing 
from moths. 

Betanaphthol is used in the form of a 2 per cent, soap in prurigo, herpes, 
ichthyosis and favus, also in a \ to 5 per cent, alcoholic solution, or as a 10 
per cent, ointment, for hyperidrosis, scabies, and eczema, but it is a dangerous 
and irritant application. Internally it has been employed in typhoid fever, 
dilatation of the stomach, intestinal dyspepsia, diarrhea and dysentery. Its 
germicidal rank is probably second to many other agents, but it has value as 
an internal antiseptic, being nearly free from toxic action on the higher ani- 
mals in medicinal doses. 

The Betanaphthol compounds, such as the benzoate and salicylate, pass 
through the stomach unchanged and are split up in the intestine. They 
were introduced with the belief that a greater antiseptic effect in the intes- 
tine could thus be produced with the additional benefit to be derived from the 
special radicle in combination with the Betanaphthol. They have been 
found useful as intestinal and urinary antiseptics, diuretics, antirheumatics 
and locally in psora^is, scabies and eczema in 2 to 10 per cent, ointment. 

NITROGENII MONOXIDUM, Nitrogen Monoxide, Nitrous Oxide, 
Laughing Gas, N2O, — is a colorless gas possessing a slightly characteristic 
odor and sweetish taste, produced by the distillation of Ammonium Nitrate, 



nux vomica. 335 

and supplied by the manufacturers in condensed form. Inhaled it causes 
mental excitation, followed by brief general anesthesia, during which the 
blood pressure is raised, and the face is bloated and cyanosed by venous 
stasis as in other forms of asphyxia. The anesthetic effect is partly due to 
its depriving the subject of oxygen, but chiefly to its own inherent cerebral 
action. It stimulates the vaso-motor centre, has no definite action on the 
heart, does not affect the motor nerves, and has only a feeble influence on the 
spinal cord. The after-effects are slight, and usually consist of dizziness and 
light-headed sensations lasting a few hours. Death occurs by asphyxia 
from paralysis of respiration. 

Nitrous Oxide is the safest of all anesthetics. It is used most frequently 
for minor operations, its anesthesia being of brief duration with a rapid return 
to consciousness. Some operators administer it mixed with oxygen, in 
order to lessen the asphyxial symptoms and use it by this method for major 
operations. Its administration over any length of time requires considerable 
skill to maintain uniform anesthesia. Gatch uses an apparatus which permits 
rebreathing of the gas, thus reducing the cost, and in addition, prevents acapnia 
by stimulating the respiratory centre with the patient's own carbon dioxide. 
It is sometimes difficult to obtain complete relaxation under its influence and 
it may be necessary to give a small quantity of ether, or its administration 
may be preceded by a hypodermic injection of morphine. It is contraindi- 
cated when there is any impediment to free breathing, also when atheroma or 
other arterial disease exists on account of the high blood pressure which it 
produces. It gives rise to erotic sensations which may result in false accusa- 
tions, hence it should not be administered to women without the presence of a 
witness. It may be used as a preliminary inhalation before the use of ether, 
but chloroform should not be inhaled immediately after the gas without 
giving time for the cyanosis to clear up. 

NUX VOMICA, Nux Vomica {Poison Nut, Quaker Button) , — is the dried 
ripe seed of Strychnos Nux-vomica, a tree of the nat. ord. Loganiaceae, grow- 
ing in India, Cochin-China and the neighboring countries, all parts of which 
are bitter and poisonous. The seeds are flattened and nearly circular, about 
one inch in diameter, ashy-gray in color, covered with short, satiny hairs, in- 
ternally translucent, tough and horny, with a large cavity; inodorous, but of 
intensely bitter taste. They should yield not less than 2.5 per cent, of the al- 
kaloids of Nux Vomica. They contain the alkaloids Strychnine, C21H22N2O2, 
and Brucine, C23H26N2O4, in combination with Igasuric (Strychnic) Acid, 
also the glucoside Loganin, a yellow coloring matter, a concrete oil, gum, 
starch, wax, and earthy phosphates. Dose, gr. ss-jss [av. gr. j.] An allied 
plant is — 

Ignatia, St. Ignatius' Bean (Unofficial) , — the seed of Strychnos Ignatia t 
a small tree of the nat. ord. Longaniaceae, native in the Philippine Islands, 



336 NUX VOMICA. 

also called Ignatia Amara. It contains the alkaloids Strychnine and Brucine, 
about i per cent, of each. A tincture (10 per cent.) is on the market, the dose 
of which is Tflij-x. 

Preparations of Nux Vomica. 

Extractum Nucis Vomicae, Extract cf Nux Vomica, — should contain from 15.2 to 16.8 
per cent, of alkaloids of nux vomica. Dose, gr. f-f [av. gr. \] up to a maximum in 24 hours 
of gr. ij. 

Fluidextractum Nucis Vomicae, Fluidextract of Nux Vomica,- — should contain in each 
100 mils from 2.37 to 2.63 Gm. of the alkaloids of nux vomica. Dose, Ti£ss-jss [av. ttjj.] 

Tinctura Nucis Vomicae, Tincture of Nux Vomica, — should contain in each 100 mils 
from 0.237 to 0.263 Gm. of the alkaloids of nux vomica. Dose, tt£v-xv [av.TTjrviij.] 

Alkaloids and their Salts. 

Strychnina, Strychnine, — is an alkaloid obtained from Nux Vomica, Ignatia, and other 
plants of the order Loganiaceae; crystalline, intensely bitter even in 1 to 700,000 solution, of 
alkaline reaction, soluble in 5 of chloroform, 136 of alcohol, 6420 of water. Dose, gr. 
T-oWo [av. gr. +\.} 

Strychninae Sulphas, Strychnine Sulphate, — crystalline, efflorescent, odorless, of intensely 
bitter taste, even in 1 to 700,000 solution, neutral reaction, soluble in 32 of water, in 81 of 
alcohol, and in 7 of boiling water, insoluble in ether. Dose, gr. T oo _ 2V fav. gr. ¥ VL but 
after tolerance is attained much larger doses may be safely used. 

Strychninae Nitras, Strychnine Nitrate, — forms colorless needles of a silky lustre and very 
bitter taste, soluble in 42 parts of cold water, 9 of boiling water, in 150 of alcohol, and in 
50 of glycerin, insoluble in ether. Dose, too^V t av - S r - 40L or more after tolerance is 
attained. 

Brucina, Brucine (Unofficial), — occurs in colorless prisms, pearly flakes or masses, bitter, 
soluble in 850 parts of water and in 1 % of alcohol. It is separated with difficulty from Strych- 
nine, in many samples of which it occurs as an impurity. It is seldom used. Dose gr. jo-%. 

Incompatibles. 

Incompatible with Nux Vomica and Strychnine are Alkalies and their Carbonates, Bro- 
mides, Iodides, Chlorides, and all other alkaloidal precipitants (see page 6). Oils and fats 
retard the absorption of strychnine salts. Physiologically incompatible are Aconite, Alcohol, 
Amyl Nitrite, Atropine, Chloral Hydrate, Chloroform, Curarine, Digitalis, Hydrocyanic Acid, 
Morphine, Nicotine, Paraldehyde, Physostigmine, Potassium Bromide, Urethane. 

Tests for Strychnine and Brucine. 

Strychnine and its salts dissolve without color in concentrated Sulphuric Acid, but, on 
adding to the solution some deoxidizing substance, a play of colors results, Lead Peroxide pro- 
ducing a beautiful blue, passing into violet, then red, and finally yellow (Marchand). A 
minute quantity of Potassium Dichr ornate produces similar results (Otto), while Ceroso-ceric 
Oxide causes a blue, changing to violet and then to a permanent cherry-red. If these tests are 
carefully applied, as minute a quantity as 1 part in 900,000 of the solution may be detected 
(Wenzell). A similar blue-violet reaction is produced when a mixture of Hydrastine 1 and 
Morphine 9 is acted on by Sulphuric Acid and Potassium Dichromate, or by Sulphuric Acid 
alone (Lloyd); but the occurrence of the reaction with the acid alone reserves to distinguish the 
mixed alkaloids from Strychnine, which dissolves in sulphuric acid without producing any 
color. 

Brucine is detected by the red color which it yields with Nitric Acid. Neither Nitric nor 
Sulphuric Acid colors Strychnine unless Brucine is present as an impurity, a test which dis- 
tinguishes this alkaloid from several others. Brucine does not decompose Iodic Acid, and is 
thereby distinguished from Morphine. 

Physiological Action. 

The action of Nux Vomica is that of its principal alkaloid Strychnine. Ex- 
ternally, the latter is a very powerful antiseptic, but is too poisonous for safe 



nux vomica. 337 

use, and in concentrated solution hypodermically it has a decided irritant action 
on the tissues. It is intensely bitter and is perceptible in solutions of i to 
1,000,000. Internally in small doses its bitter quality makes it a good stom- 
achic tonic. After absorption its principal influence is exerted upon the 
central nervous system, particularly the cord, increasing its reflex excitability. 
Upon the brain it acts by stimulating the psychic centres producing a sense 
of well being and lessening fatigue. This action is uncertain and absent 
in many cases. The special senses are intensified and vision, taste, smell, 
hearing and touch become more acute. The medullary centres are stimu- 
lated in the following order of intensity, — respiratory, vasomotor and vagus. 
The respiratory stimulation is powerful resulting in an increase in the rate 
with deepening of the respirations. It is one of our most valuable respiratory 
stimulants. In poisonous dose death usually results from respiratory paraly- 
sis. Toxic doses produce in animals a distinct increase in blood pressure due 
to stimulation of the vasomotor centres, but there is no proof that an appre- 
ciable increase of blood pressure occurs either in normal man or animals 
when the drug is given in therapeutic dose. When, however, the blood pres- 
sure is reduced abnormally as in pathological states, an increase in blood 
pressure may be observed when administered in full doses. Every clinician 
has noted its value in circulatory failure in certain of the acute infections, as 
pneumonia, and although it is difficult to correlate certain pharmacological 
studies in animals with clinical knowledge, yet it is well to remember that it is 
of the greatest value in those conditions in which there is marked depression of 
the vital centres with threatened circulatory and respiratory failure. Strych- 
nine stimulates the vagus centre but the vagal effects are distinctly less 
prominent than those due to influence upon the respiratory or vasomotor 
centres. In toxic doses the heart is slowed but in therapeutic doses the 
vagus influence is not appreciable. 

The most marked feature of the action of Strychnine is the great increase 
which it causes in the reflex excitability of the spinal cord. When the dose 
is large this increase is so great as to induce convulsions and cause death by 
asphyxia. After a large dose (gr. tV) the pupils dilate, the limbs take 
on jerking movements, respiration becomes spasmodic and the lower jaw 
stiff, a sensation of cerebral tension may be felt, and sudden shuddering and 
anxiety follow, the face taking on an unmeaning smile, the risus sardonicus. 
A toxic dose (gr. J to gr. ij) produces powerful and characteristic convulsions 
of a tetanic character. Within an hour after its administration, sometimes after 
only a few minutes, the patient feels a sudden sense of suffocation and dyspnea, 
the muscles begin to shudder and jerk, the limbs are suddenly stretched out 
rigidly, with hands clenched and feet arched, then the head is bent backward 
and the whole body becomes stiffly arched resting on the head and the heels, 
the belly tense, the chest muscles fixed and the breathing all but arrested. In 
the height of the paroxysm the face is dusky and congested and the eyeballs 



333 NUX VOMICA. 

project. Nearly all the muscles of the body are affected, but those of the jaw 
are not seriously implicated until near the end, and never so powerfully as in 
tetanus. The pulse is very rapid and the body-temperature is above normal, 
but the intellect remains unclouded and the patient often expresses a sense of 
impending dissolution. After the paroxysm has lasted a minute or two it usu- 
ally relaxes for a time. In the interval the patient suffers from soreness of the 
muscles, feels exhausted and sweats profusely, but soon becomes aware that 
the spasm is returning and may cry out for some one to hold him or to rub his 
limbs. The convulsions rapidly increase in severity, a breath of wind, the 
slightest noise, even a bright light, being sufficient to, bring them on, and in 
one the patient may jerk himself out of the bed. At last the respiration stops 
in the middle of a fit and the heart soon ceases to beat. Death occurs, after 
two or three hours at most, by asphyxia from tetanic fixation of the muscles 
of respiration, with possible factors in spasm or exhaustion of the heart, con- 
sciousness being preserved until carbon dioxide narcosis sets in. 

Strychnine exalts all the functions of the spinal cord, reflex, motor, and 
sensory, the latter being the least affected. Various pharmacological experi- 
ments would seem to indicate that the action of strychnine is on the cord, 
increasing the conduction of impulses therein. The peripheral nerves and 
posterior root ganglia are unaffected. The result is a greater response by the 
motor cells to ordinary stimuli which may produce varying degrees of in- 
creased tonicity of the muscles to spasticity and convulsions. It is not 
proved that direct stimulation of the motor cells themselves occurs (Bastedo). 
The spasms of Strychnine may be distinguished from those of tetanus by 
their intermittency (the latter being constant), by the meaningless smile, 
the less marked and later development of trismus, the absence of a wound, 
and the rapid course of the symptoms. Thebaine, the tetanizing alkaloid 
of opium, is also a spinal exaltant, and acts much the same as strychnine. 

Strychnine does not directly affect the muscular tissue, although it 
increases muscular tone, perhaps by increasing the reflex excitability of the 
cord. Occasionally, large medicinal doses cause a greatly heightened sensi- 
bility of the optic and auditory nerves, so that brilliant lights and loud 
sounds produce painful impressions; and in a few cases there occurs a true 
cerebral intoxication resembling a slight degree of drunkenness. Its action 
upon the nervous system has been compared to caffeine, but it differs from 
this drug, which affects principally the higher centres and the medulla, while 
strychnine exerts its principal action upon the cord. 

It is promptly absorbed and in therapeutic dose promptly eliminated, 
although not entirely so, the complete elimination requiring from two to 
eight days (Cushny). It is to some extent oxidized and destroyed in the 
body, the remainder being eliminated chiefly in the urine. It is much more 
poisonous when injected into the rectum than when swallowed. 

The fatal dose of Strychnine is placed by Taylor at gr. \ to gr. ij for an 



i 



nux vomica. 339 

adult, but recovery has taken place after larger doses, even 7 and 8 grains, cases 
probably of imperfect absorption, due perhaps to the presence of fat or tannin 
in the contents of the stomach. A child, aged 2\ years, died in four hours from 
a dose of gr. yV. After death from this poison cadaveric rigidity is marked, 
with opisthotonos, clenched hands, and arms flexed across the chest. The 
muscular rigidity may persist for several months after death. The face is 
usually pale, but sometimes livid, the internal organs are gorged with dark 
blood, and the bladder is generally contracted. 

On other animals Strychnine acts as it does upon man, but in different de- 
grees. Birds, guinea-pigs and perhaps monkeys, are comparatively insuscep- 
tible to it, while ruminants are less easily affected than other quadrupeds, and 
cats resist it singularly. Very minute portions in the soil will destroy the life 
of growing plants. 

Therapeutics. 

Nux Vomica and its chief alkaloid, Strychnine, are exceedingly useful rem- 
edies, having a wide range of therapeutic efficacy. They are chiefly employed 
as stomachic tonics, and as stimulants to the heart, the respiratory apparatus, 
and the muscular and nervous systems. As the quantity of strychnine in nux 
vomica varies, it is best to use the alkaloid when its physiological action 
is desired, more definite dosage being thus obtained. The tincture in 5-drop 
doses is excellent in atonic dyspepsia and gastric catarrh, especially in drunk- 
ards, and in constipation from atony of the bowels it may be given in 10-drop 
doses with good results, not as a purgative but to increase peristalsis. The 
extract is much used in laxative pills for habitual constipation. In the vomit- 
ing of pregnancy the tincture is frequently an efficient remedy, and in the 
vomiting of phthisis Strychnine is one of the very best agents. 

Headaches are often controlled by Nux Vomica, especially the sick head- 
ache of gastric origin, in which minim-doses of the tincture every ten or fif- 
teen minutes frequently give marked relief, and a dose of Tfl.x before each 
meal will prevent frontal headache in many persons liable thereto. A sense 
of heat and weight on top of the head, accompanied or not by flatulence, 
and usually occurring in women at the climacteric, will often yield to the 
tincture in doses of Tfl.v before each meal. It is a valuable remedy for many 
kinds of cough, even those of phthisis, bronchitis, pneumonia and emphy- 
sema, but it is particularly efficient in coughs of neurotic origin, such as peri- 
odical cough, night cough, and the paroxysmal laryngeal cough without lung 
or bronchial symptoms, but characterized by a persistent tickling sensation 
in the throat. In all these, drop-doses of the tincture frequently repeated 
are more serviceable than larger doses at longer intervals. In bronchial 
asthma and asthma of neurotic origin, in the dyspnea of pulmonary affec- 
tions and that with cardiac palpitation in hysterical subjects, in irregular 
action and over-action of the heart, in functional anesthesia, hypochondriasis, 



34© NUX VOMICA. 

abdominal cramps, nervous movements accompanying pregnancy, cold hands 
and feet due to languid capillary circulation, prolapsus ani and urinary in- 
continence in children, and paralysis of the bladder in old people, small doses 
of Strychnine frequently repeated are remarkably beneficial. In many of 
these affections the therapeutic action of the drug is unmistakably that re- 
sulting from increased tone of muscular structure. 

Nux Vomica is a most efficient remedy in impending cardiac failure from 
almost any cause. Even with the pulse imperceptible, the extremities cold, 
and death apparently imminent, the administration of a drop of the tincture 
every five minutes has frequently given renewed strength to the cardiac con- 
tractions after five or six doses, and initiated an improvement which resulted 
in eventual recovery. Local paralyses of various forms are well treated by 
the hypodermic injection of Strychnine into the substance of the affected 
muscles, and diphtheritic paralyses are almost invariably cured by its internal 
administration. It may prove useful in hemiplegia when degeneration has 
not set in, and when the paralyzed muscles are completely relaxed; but it 
is of no avail in recent cases or when electrical contractility is lost. If used 
early in cerebral paralyses, especially when due to hemorrhage, it may do 
serious harm; and in the early stage of organic spinal lesions it may be de- 
cidedly injurious, particularly if given in large doses. It should never be 
used in spinal paralysis when there are symptoms of congestion or inflam- 
mation of either the cord or its membranes. In hysterical paralysis and that 
caused by lead it is decidedly beneficial, also in the form which is limited 
to one or two groups of muscles, especially infantile paralysis of long stand- 
ing, even when the atrophic process has gone so far as to greatly impair the 
electrical sensibility. In multiple peripheral neuritis the hypodermic injec- 
tion of strychnine has proved eminently serviceable. 

Strychnine is very useful in cases of nervous impairment of the sight, 
especially in amblyopia from lead, tobacco or alcohol, from atrophy of the 
optic nerve, and from functional disorders of the retina without apparent 
lesion, also in muscular asthenopia. In these affections it may be used in- 
ternally, but it is usually administered by injection into the tissues around the 
temple, beginning with gr. 4*0, and gradually increasing the dose up to gr. J 
or &. Improvement may not be apparent until the larger doses are reached. 

In acute and chronic alcoholism, Strychnine is undoubtedly of great service. 
In small doses it is an effective remedy for the morning vomiting and dys- 
pepsia of drunkards, for the tremor of chrome dipsomaniacs, in the forming 
stage of delirium tremens, and for the depression due to enforced . abstinence 
from alcohol. In doses of gr. -§V to ^0, hypodermically three or four times 
daily for a week, and less frequently for two weeks longer, it removes the 
craving for stimulants, and is in many respects a true antagonist to the action 
of that narcotic poison on the human organism. The published reports of 
its efficacy in dipsomania, by Luton, Dujardin-Beaumetz, Portugaloff and 



OLIV.E OLEUM. 34 1 

others, have been fully confirmed by other observers, so that Strychnine is 
now of acknowledged benefit in inebrity, and the efficient constituent of the 
numerous "cures" therefor so widely advertised in the religious and secular 
press. 

Strychnine is a physiological antagonist to chloral, physostigmine and 
morphine, and may be used as a respiratory stimulant in poisoning by these 
drugs, also in narcotic poisoning by any agent when the respiration is fail- 
ing. It is inferior, however, to Caffeine which is the best of all respiratory 
stimulants. 

It is used in shock but less so than formerly since Crile and others have 
shown that its use is not only of no value, but actually harmful. Our knowl- 
edge of shock is so incomplete that it is difficult to establish a rational therapy 
for the condition. If we accept the view that in some cases, at least, shock is 
due to vasomotor exhaustion or failure caused by overstimulation from im- 
pulses arising at the point of injury, then it would seem that strychnine might 
aggravate, or if given before operation predispose to the condition. In cases 
in which respiratory depression is the primary cause it is perhaps of some 
value. It is, however, decidedly inferior to atropine. 

Brucine acts precisely as strychnine except that it is absorbed more slowly, 
is much less powerful as a convulsant, and is more poisonous to the sensory 
nerves (Reichert). It has been employed in 5 per cent, solution for the local 
pruritus of inflammation about the external ear, in which Dr. Burnett claims 
for it more satisfactory results than are obtained with cocaine. 

Ignatia closely resembles Nux Vomica in action, a poisonous dose producing the same 
exaltation of the spinal functions, with muscular twitching, tetanic spasms, and death by 
asphyxia through tetanic fixation of the respiratory muscles, but as it contains a greater quan- 
tity of Strychnine than the latter it is more powerful in the same dose. It exalts the sus- 
ceptibility of the sensory nerves and the nerves of special sense for a time, but an opposite 
condition soon succeeds, manifested by numbness and torpor with great mental depression. 
It causes a feeling of constriction about the throat and a sensation of anguish at the pit of the 
stomach. Its antagonists and incompatibles are the same as those for nux vomica. 

Ignatia is but little used in modern therapeutics in which strychnine serves a better 
purpose for many of the various conditions in which it was formerly used. 

OLIV JE OLEUM, Olive Oil {Sweet Oil, Salad Oil),— is a fixed oil expressed 
from the ripe fruit of Olea europcea, the olive tree, nat. ord. Oleaceae, which is 
cultivated in southern Europe,' California and Australia. It is a pale-yellow or 
greenish-yellow oily liquid, of nutty, oleaginous taste and neutral reaction, 
sparingly soluble in alcohol but readily soluble in ether. Dose, §ss-jss [av. 5J-] 

Olive Oil consists in the main of the combined glycerides of oleic, palmitic and arachic 
acids. It is frequently adulterated with cheaper fixed oils, especially poppy oil, lard oil, and 
cotton-seed oil, quantities of the latter being exported every year to Italy, whence it is returned 
to us as Olive Oil under a French label. (See Gossypium.) It is the source of the official 
Soap. 

Externally used Olive Oil is a good protective from the air, and renders the 
skin soft and flexible. If rubbed into the integument it is absorbed by the lym- 



342 OPIUM. 

phatics and is directly nutritive in effect. Internally it is nutritious and mildly 
laxative, and in quantity acts as a protective to the mucous membrane against 
acrid or poisonous substances. Like other oils it is partly emulsified, partly sa- 
ponified in the intestines, its glycerin being set free and its fatty acids combining 
with the free alkalies to form soap, which with the emulsion forms the molecular 
basis of the chyle, entering the blood through the lacteals and being finally 
oxidized into carbon dioxide and water. Oils are therefore a food w T ithin 
certain limits, increase the fat of the tissues, furnish heat and force, and 
lessen the waste of nitrogenous tissue, but are unable of themselves to 
support life. 

Olive Oil possesses some very marked therapeutic powers over any other 
bland oil or fat. It is a good laxative for infants administered internally, 
and may be used as an enema followed by warm water. In large doses it has 
proved very efficient in the treatment of severe dysentery. It is much em- 
ployed locally. Applied to burns and other acute inflammatory affections of 
the skin it is an excellent protective, coating the surface and excluding the air; 
and as an ingredient of liniments it acts as a diluent for more active agents. 
It is used to facilitate friction over enlarged or stiff joints, and in the desquama- 
tive stage of scarlet fever is a very useful and grateful application. As an anti- 
dote in corrosive poisoning it acts mechanically by protecting the mucous mem- 
brane of the stomach and preventing absorption. In pharmacy its bland, 
unirritating qualities have procured its common employment as an ingredient 
of liniments, plasters, ointments and cerates, but the foreign article is so fre- 
quently adulterated with inferior oils that Cottonseed Oil is now directed in its 
place in many official preparations. 

OPIUM, — is the concrete, milky exudation, obtained by incising the unripe 
capsules of the White Poppy, Papaver somniferum, an annual herb of the nat. 
ord. Papaveraceae, indigenous to Western Asia, but cultivated extensively else- 
where. Its capsules are globular, two or three inches in diameter, and are 
crowned by a sessile, stellate stigma, which distinguishes them from Colocynth 
and Bael fruits. Opium occurs in irregular lumps or cakes, of dark-brown 
color, sharp, narcotic odor, and bitter taste; and in its normal, moist condition 
should yield not less than 9.5 per cent, of Morphine when assayed by the 
official process. Dose, gr. ss-ij [av. gr. j.] 

Opium contains 20 alkaloids in combination with meconic, lactic and sulphuric acids; the 
neutral principles Meconin and Meconoiasin; also glucose, mucilage, resin, pectin, caoutchouc, 
fats, essential oil, odorous substances, salts of ammonium, magnesium and calcium, and water. 
Its principal alkaloids are the following six, viz. — 

Morphine, C 17 H 19 N0 3 , 2\ to 20 per cent., — the principal alkaloid, occurring in the drug 
in the form of the tribasic meconate. Its properties are anodyne, hypnotic and narcotic. 
From it by a process of dehydration by heat and hydrochloric acid is prepared the artificial 
alkaloid Apomorphine, a powerful emetic and expectorant. 

Codeine, C 1S H 21 N0 3 , 0.3 to 0.5 per cent., — is calmative and when pure a not very active 
alkaloid, but is frequently contaminated with other alkaloids. Apomorphine may be prepared 
from it. 



opium. 343 

Narceine, C 22 H 29 N0 9 , 0.2 to 0.7 per cent., — was said by Bernard to be a powerful nar- 
cotic, but the preparation used by him was probably impure, and it is now believed to have 
little or no action. 

Narcotine, C22H23NO7, 2 to 10 per cent., — is a nauseant and a tetanizer, but wholly 
devoid of narcotic properties. 

Thebaine, or Par amorphine, C 19 H 21 N0 3 , 0.2 to 1 per cent., — is a powerful spinal exaltant 
and tetanizer, resembling Strychnine in its action. 

Papaverine, C 20 H 21 NO 4 , 1 per cent., — stands midway between morphine and codeine 
in its action on the central nervous system, but is a comparatively weak poison. 

Other Alkaloids are — Codamine, Cryptopine, Gnoscopine, Hydrocotarnine, Lanthopine, 
Laudanine, Laudanosine, Meconidine, Oxynarcotine, Papaveramine, Protopine, Pseudo- 
morphine, Rhoeadine, and Tritopine. Many of them occur only in traces, and some are 
regarded as probable derivatives of morphine. Porphyroxin is said to be a complex combina- 
tion of several of the alkaloids, and not a proximate principle. 

Official Preparations of Opium. 

Opii Pulvis, Powdered Opium, — is Opium dried at a temperature not exceeding 70 C, 
and reduced to a very fine powder. It should contain not less than 10 nor more than 10.5 
per cent, of anhydrous Morphine, when assayed by the official process. Dose, gr. ss-iij 
[av. gr. j.] 

Opium Granulatum, Granulated Opium, — is Opium dried and reduced to a coarse pow- 
der. It should yield from 10 to io| per cent, of anhydrous Morphine. Dose, gr. ss-iij 
[av. gr. j.] 

Opium Deodoratum, Deodorized Opium (Denarcotized Opium), — is powdered Opium 
freed from the constituents which are soluble in Petroleum Benzin, namely, Narcotine and the 
odorous principles, which are supposed to cause the unpleasant after-effects of the drug. It 
should yield 10 to iof per cent, of anhydrous Morphine, and is a good preparation, being 
a purified opium with a fixed morphine standard. Dose, gr. ss-iij [av. gr. j.] 

Extractum Opii, Extract of Opium, — an aqueous extract containing 19.5 to 20.5 per cent, 
of anhydrous Morphine, and freed from principles insoluble in water. Dose, gr. |-ij [av. 
gr. ss.] 

Tinctura Opii, Tincture of Opium, Laudanum, — Opium-strength 10 percent, or 48 grains 
to the fig . Ten minims equal 1 grain of Opium or | grain of Morphine. Sixty minims 
equal on the average about 120 drops. Dose, ttrv-xxx [av. njy/iij], according to the effect 
desired. 

Tinctura Opii Deodorati, Tincture of Deodorized Opium, — an aqueous extract is prepared 
and shaken with Benzin, which being separated the residue is dissolved in water, and enough 
alcohol is added to preserve it. An excellent liquid preparation, being freed from all the 
noxious and useless ingredients soluble in alcohol and ether. Opium-strength, Morphine- 
strength, and Dose, as of Tinctura Opii. Drops of this preparation nearly equal minims. 

Tinctura Opii Camphorata, Camphorated Tincture of Opium, Paregoric, — has of Pow- 
dered Opium 4, Benzoic Acid 4, Camphor 4, Oil of Anise 4, Glycerin 40, Diluted Alcohol to 
1000. oss contains nearly one grain of powdered Opium. It is about ^ of the strength of 
Laudanum. Dose, for an infant gtt. v-xx, for an adult 3j-iv [av. 5ij.] Is an ingredient of 
Mistura Glycyrrhizae Composita, 

Pulvis Ipecacuanhae et Opii, Powder of Ipecac and Opium, (Dover's Powder) — has of 
Ipecac 10, Powdered Opium 10, Sugar of Milk 80, rubbed together into a very fine powder. 
Dose, gr. v-xv [av. gr. viij.] 

Official Preparations of Morphine. 

Morphina, Morphine, C 17 H 19 N0 3 +H 2 0, — white, prismatic crystals, or fine needles, or a 
crystalline powder, odorless, of bitter taste and alkaline reaction, almost insoluble in water. 
Its comparative insolubility makes the salts preferable for use, and as a very small proportion 
of acid neutralizes it, the dosage is about the same for the alkaloid and its salts, viz., gr. T V-J 
[av. gr. |.] 

Morphina? Hydrochloridum, Morphine Hydrochloride, — white, feathery crystals of 
silky lustre, of bitter taste and neutral reaction, soluble in 17.5 of water and in 52 of alcohol 



344 opium. 

Morphinae Sulphas, Morphine Sulphate, — white, feathery, acicular crystals of silky( lus- 
tre, of bitter taste and neutral reaction, soluble in 15.5 of water and in 565 of alcohol, and 
in 0.75 of boiling water. Contains about 80 per cent, of morphine. Dose, gr. £-£ [av. gr. £]; 
gr. I is a small dose for an adult, gr. \ a moderate one, gr. £ a full dose, and gr. £ a large dose, 
admissible only under exceptional circumstances. 

Injectio Morphinae Hypodermica, Hypodermic Injection of Morphine (B. P.),— is a 
solution of the Tartrate, containing 2.5 parts per 100 of distilled water. Dose, by hypo- 
dermic injection, ttjjv-x. 

Tinctura Chloroformi et Morphinae Composita, Compound Tincture of Chloroform and 
Morphine (B. P.), — a substitute for Chlorodyne (see page 215^. Dose, ttjtv-xv. 

Unofficial Preparations of Opium and Morphine. 

Tinctura Opii Composita, Compound Tincture of Opium, Squibb's Diarrhea Mixture, — 
has of Tinct. Opii, Spt. Camphorae and Tinct. Capsici oj of each, Purified Chloroform 3iij, 
Stronger Alcohol q. s. ad 5 v. Each A3 or teaspoonful contains about 100 drops or rr^xij of 
each of the first three ingredients and njyvss or 18 drops of Chloroform. Dose, for infants 
gtt. j-x, for children gtt. x-xxx, for adults 3ss-j. 

Liquor Morphinae Sulphatis, Solution of Morphine Sulphate, Magendie's Solution, — has 
gr. xvj of Morphine Sulphate in each fl<5, or gr. j in ttjjxxx, or gr. \ in tr^vijss. If containing 
Benzoic Acid, the solution will not spoil, and is not irritant hypodermically. The same result 
is attained by adding Phenol, TTjnij to the 5 • 

Oleatum Morphinae, Oleate of Morphine, — Morphine-strength 10 per cent, with Oleic 
Acid 90. For local use. 

Liquor Opii Sedativus, Sedative Solution of Opium, Battley's Sedative, — is about 50 per 
cent, stronger than Tinct. Opii. It was formerly a favorite preparation. 

Dalby's Carminative, — contains Opium, about gr. £ to the ounce, also Oil of Pepper- 
mint, Nutmeg, Anise, and Magnesium Carbonate. 

Godfrey's Cordial, — contains Laudanum, Sassafras and Treacle, its opium strength 
being gr. \ to the ounce. 

Nepenthe, — is a purified alcoholic solution of Morphine Meconate in sherry wine. 

Mrs. Winslow's Soothing Syrup, — contained Morphine, with Essence of Anise and 
Syrup of Tolu. After years of persistent denial, its proprietors admitted that it contained 
\ grain of Morphine in each fluidounce (Squibb). 

Derivatives of Morphine. 

Apomorphinae Hydrochloridum, Apomorphine Hydrochloride, C 17 H 17 N0 2 HC1,— is the 
hydrochloride of the artificial alkaloid Apomorphine, which is prepared from morphine or 
codeine by the action of strong acids or zinc chloride, the morphine losing in the process a 
molecule of water. The salt occurs in minute, whitish or grayish-white crystals, odorless, 
of bitter taste, and neutral reaction; soluble in about 50 of water and in the same quantity 
of alcohol at 25 C, almost insoluble in ether or chloroform; decomposed by boiling water 
or boiling alcohol. Dose, as an expectorant gr. 5V" 27 [ av - S r - 2V] 5 as an emetic gr. -^-\ 
[av. gr. \ by mouth, y 1 ^ by hypodermic]. For young children, gr. -^ should not be exceeded. 
Solutions should be fresh when used, and as they alter rapidly by keeping should have a 
few drops of hydrochloric acid added to them, to prevent decomposition. 

Injectio Apomorphinae Hypodermica, Hypodermic Injection of Apomorphine (B. P.), 
— has of Apomorphine Hydrochloride 1, Diluted Hydrochloric Acid 1, Distilled Water to 
100; and is a 1 per cent, solution. Dose, hypodermically, njrv-x. Should be recently 
prepared. 

Cotarnine, C12H15O4N (Unofficial), — is an artificial alkaloid produced from Narcotine 
by oxidation. It is official as Cotarnina Hydrochloridum, which is obtained by treating 
Cotarnine with hydrochloric acid. The Hydrochloride has the trade name Stypticin, and 
occurs as a yellow powder, soluble in water and in alcohol. Dose, gr. ss-iij (av. gr. j)_ by 
the mouth or hypodermically, 4 or 5 times daily, as a uterine hemostatic and sedative. 
Styptol is the unofficial Cotarninae Phthalas, having the same uses as the hydrochloride. 

iEthylmorphinae Hydrochloridum, — the hydrochloride of the ethyl ester of morphine, 
occurs as a white powder, soluble in 8 of water and in 22 of alcohol. It seems to stand 
intermediate between morphine and codeine in all respects. It is sometimes used as a 
sedative, but principally for its effect upon the eye when locally applied. Dose, gr. \-i 



1 



opium. 345 

(av. gr. I); externally in 10-20 per cent, solution. This product was first introduced under 
the trade name Dionin. 

Diacetylmorphina, Diacetylmor phine, occurs as a fine, white powder, insoluble in water, 
but soluble in 31 of alcohol and 1.4 of chloroform. It is one of the most toxic agents of 
the morphine group, and is considered even more poisonous than morphine itself, having 
a bad influence on the respiratory apparatus. Doses of gr. T ^ have caused suppression of 
urine and threatening coma (Cohen). It was originally introduced under the trade name 
Heroin as a substitute for morphine. Recent experience would seem to indicate that it is 
extremely liable to produce a habit and toxic effects. Dose, gr. 2¥~&. f av - S r - 2V! m pill 
or powder, or in aqueous solution with a few drops of diluted acetic acid. 

Diacetylmorphinae Hydrochloridum, Diacetylmor phine hydrochloride, — occurs as a white 
crystalline, odorless powder, soluble in 2 of water and in alcohol. Dose, gr. ^-j^ [av. 
gr- M 

Other Alkaloids and Their Preparations. 

Codeina, Codeine, C 18 H 2 iN03+H 2 0, — colorless, rhombic prisms, efflorescent in warm 
air, of bitter taste and alkaline reaction, soluble in 120 of water, very soluble in alcohol, 
chloroform and ether. Dose, gr. |-j [av. gr. ss.] but gr. f has caused alarming symptoms 
in children. 

Codeinae Phosphas, Codeine Phosphate, — white crystals of slightly bitter taste, soluble 
in 2.3 of water and in 325 of alcohol. Is the most soluble salt of codeine and comparatively 
unirritant, hence it is well suited for hypodermic use in solution of 1 part in 20 of water. Dose, 
gr. H [av. gr. ss.] 

Codeinae Sulphas, Codeine Sulphate, — a crystalline powder, soluble in about 30 of water, 
and in 1280 of alcohol. Dose, gr. £-j [av. gr. ss.] 

Narcotinae Hydrochloridum, Narcotine Hydrochloride (Unofficial), — Dose, gr. ij-x, 
as an antiperiodic. 

Incompatibles. 

Incompatible with Opium preparations are Alkalies, Alkaloidal precipitants (see page 6), 
Carbonates, Catechu, Cinchona, Copper salts, Galls, Iron salts, Kino, Lead Acetate and 
Subacetate, Lime-water, Mercuric Chloride, Silver Nitrate, Zinc Sulphate. With Morphine 
Salts are Alkaloidal precipitants (see page 6), Borax, Chlorates, Ferric Chloride, Iodides, 
Iodine, Lead Acetate and Subacetate, Magnesia, Spirit of Nitrous Ether, Silver Nitrate. 
With Apomor -phine Hydrochloride are Alkali Hydrates and Carbonates, and other alka- 
loidal precipitants (see page 6), Ferric Chloride, Iodides, Lime-water, Permanganates, 
Picric Acid, Tannic Acid, Silver Nitrate. With Codeine are Alkalies and other alkaloidal pre- 
cipitants (see page 6), Ichthyol, Salts of Copper, Iron and Lead. Physiological Incompatibles 
are Atropine, Caffeine, Chloral Hydrate (with apomorphine and codeine), Chloroform, 
Cocaine, Gelsemium, Hyoscyamine, Nicotine, Paraldehyde, Physostigmine, Picrotoxin, 
Strychnine (with apomorphine), Veratrum. 

Tests for Morphine. 

Nitric Acid produces an orange-red color, turning yellow, then disappearing. Test- 
solution of Ferric Chloride gives a blue color changing to green with excess of the reagent, and 
destroyed by free acids or alcohol, but not by alkalies. Iodic Acid liberates Iodine which may 
be tested by starch. Vaughn has shown that certain intestinal ptomaines will give the same 
reactions with these reagents. 

Physiological Action. 

Opium is analgesic, hypnotic, antispasmodic, diaphoretic and narcotic. It 
first stimulates and afterwards depresses the cerebrum, heart and respiratory 
apparatus, and is classed among the cerebral depressants, though it kills by 
paralyzing the respiratory centres in the medulla. 

In medium dose (gr. j) it diminishes all the secretions except the sweat, 
the latter being increased; producing dryness of the mouth and throat, re- 
tarded digestion from decrease of the gastric juice, and decided loss of appe- 



346 opium. 

tite. The action of the heart is increased, arterial tension is raised and the 
pupils are slightly contracted. The cerebral faculties are stimulated to a 
pleasant activity by increased blood-supply, ideas follow each other rapidly 
through the mind, and an exhilaration bordering on mild intoxication is ex- 
perienced, succeeded by a calm of variable length. Sleep generally follows, 
disturbed by dreams, and after waking, headache, malaise, constipation, digest 
tive disturbance and some depression result. The conductivity of the nerves is 
not affected. Frequently the stage of mental activity is absent, but in persons 
habituated to the use of opium it is usually well marked. In some subjects a 
lengthened period of calm repose takes the place of sleep, in others neither 
calm nor sleep occurs, but the stimulant action of the drug prevails, the spinal 
functions as well as the cerebral are exalted, and great restlessness results. 

In full dose (gr. iij) the same symptoms are produced but in greater in- 
tensity; the stage of stimulation is much shorter, digestion is arrested, nausea 
and vomiting produced, also profuse diaphoresis. The conductivity of the 
nerves is more or less impaired, the respiration, heart and circulation are 
depressed, oxidation being interfered with and the body-temperature low- 
ered. The pupils are contracted by stimulation of the motor oculi through 
the basal ganglia, intense pruritus is produced, especially at the nose, and 
often spasmodic retention of the urine. Profound sopor soon comes on, with 
irregular and slow respiration, but in some subjects this is replaced by coma- 
vigil and delirium. After-effects are nausea, depression, constipation, racking 
headache, vertigo, anorexia, nasal pruritus, and fetid pathological secretions. 

A toxic dose produces cold and clammy sweat, very slow pulse, slow and 
stertorous respiration gradually becoming feeble and irregular, cyanosed 
face, abolished reflexes, coma gradually deepening, the pupils minutely con- 
tracted but dilating as the end approaches, and finally death by paralysis 
of the respiratory centre. Postmortem examination shows only a wet brain, 
congested lungs, and engorgement of the venous trunks and of the right heart. 

The coma produced by opium-narcosis, when deep and when a history of the case cannot 
be obtained, is almost impossible of differential diagnosis from that due to alcohol, apoplexy, 
uremia, epilepsy, etc. [See under Alcohol, page 97.] The odor of the breath may point to 
laudanum or some other preparation of opium. The pupils are very much contracted in opium 
poisoning, but they may dilate just before death. In alcoholic coma they may be either 
contracted or dilated; and in apoplexy they are generally contracted unequally, though in 
apoplexy of the pons varolii they may be equally and minutely contracted. The rectal 
temperature may be an important sign, for in most cases of apoplexy there is an initial fall 
of temperature with a subsequent rise. A previous history of convulsions points to epilepsy, 
and the presence of albumin in the urine, with sometimes edema of the legs, indicates 
uremia as the cause of the coma. 

The principal action of Opium is exerted upon the nervous system, first 
affecting the cerebral convolutions, which are briefly stimulated and soon 
depressed. Next the perceptive and sensory centres in the higher brain are 
blunted, and the conductivity of the afferent nerves is impaired. Soon the 
ganglia at the base of the brain are involved, evinced by the contraction of 



opium. 347 

the pupils, vomiting, and slowing of respiration; the cardiac, vascular and 
other centres are depressed, but to a less degree than the respiratory and 
perceptive. The gray matter of the cord, at first stimulated, as shown by 
the increase of reflex excitability, is also depressed, and locomotion becomes 
difficult, the motor nerves being paralyzed from the centre outward, but 
muscular irritability is never lost. Death occurs generally by paralysis of 
respiration, rarely by cardiac failure. 

Metabolism is greatly reduced in activity by Opium, the quantity of urea 
excreted being markedly lessened, and the biliary and glycogenic functions 
of the liver being affected, resulting in whitish stools, perhaps jaundice, and 
certainly decided decrease of the sugar excreted by diabetics when the drug 
is given to them by the stomach. 

The vaso-motor centre is slightly if at all affected by small doses of Opium, 
but large doses depress it. On the vessels of the skin the first effect of the 
drug is to cause their dilatation, shown by turgescence of the vessels of the 
external ear and a sense of heat therein, and often giving rise to a roseolous 
cutaneous eruption accompanied by itching. Large doses or continued use 
of opium cause marked contraction of the cutaneous vessels and dilatation of 
the Splanchnic due to vaso-motor depression; the skin is excessively pale and 
the subject feels cold at the ordinary temperature of the atmosphere. In 
those accustomed to its use it acts as a vaso-motor and cardiac stimulant, 
raising the blood pressure and increasing the force of the heart. The symp- 
toms of its withdrawal are chiefly due to the fall in blood pressure which 
occurs when the habitual stimulus is removed. 

On the uterine and generative functions Opium exerts a marked influ- 
ence, stopping menstruation if its use be continued, and in men causing im- 
potence. Both male and female functions, however, return as soon as the 
drug is discontinued, but the female organs of generation suffer atrophy from 
its long-continued use. In one case, intra-uterine measurements, taken dur- 
ing a period of two years, showed a diminution in the size of the cavity from 
5.1 to 1.9 inches. 

The hypnotic action of Opium is produced by a direct depression of the 
perceptive centres, inducing sleep by lessening the perception of pain. Its 
constipating action is shown experimentally to be produced by depression 
of the nerve centres (Auerbach's plexus) in the walls of the intestines. 

Morphine was discovered by Serturner in 1805. Its action is generally 
similar to that of Opium, it being the principal alkaloid therein, but when 
used by itself its influence is not complicated with the effects of the convul- 
sive alkaloids (thebaine, codeine and narcotine) which must influence the 
action of opium to a considerable degree. As compared with the latter, 
Morphine acts more quickly, and for a shorter time, has less influence on 
the intestines and skin, is less constipating, less stimulating, less convulsant 
and less diaphoretic, but more sedative, more anodyne and hypnotic and 



34$ OPIUM. 

produces more intense pruritus. Its elimination commences quickly but 
may not be completed for as much as 48 hours, and is effected by the intes- 
tines, the urine, and the salivary glands. It is also eliminated by the gas- 
tric mucous membrane, is reabsorbed by the intestinal vessels, and constantly 
reappears in the stomach until finally excreted. When injected hypodermi- 
cally more than one-half the amount administered may be recovered by repeat- 
edly washing out the stomach. It is probably retained in the organism to 
a great extent when the action of the kidneys is defective, and when given 
continuously in renal disease may accumulate with fatal result. 

Apomorphine in dose of gr. y 1 ^- given hypodermically is a systemic emetic, 
acting directly on the vomiting centre, and is the quickest, most certain and 
least irritating of all emetics, acting in about ten minutes with but moderate 
nausea. Small doses (gr. ^) given by the mouth are expectorant, and the 
same quantity, administered hypodermically, is said to have a hypnotic effect 
lasting from one to two hours. Large doses depress the heart and respi- 
ration, cause delirium and convulsions, and finally paralyze the motor and 
sensory nerves and the voluntary muscles. In a weak adult gr. -j 1 - caused 
death by cardiac failure. 

Codeine differs chemically from morphine in having the radicle methyl 
(CH 3 ) replacing an atom of hydrogen, and may be considered a methyl- 
morphine. It is less depressant to the respiration, less constipating and less 
likely to create a habit than morphine. On man it has some hypnotic action, 
but far less than that of morphine. It exalts the spinal cord more than mor- 
phine does, producing muscular tremor and increased reflex excitability in doses 
in excess of that employed for its sedative action. It has a special sedative 
influence on the pneumogastric nerve, contracts the pupils, and is remark- 
ably analgesic to the nerves of the abdominal and pelvic viscera. When 
administered for several consecutive days it lessens the irritability of the di- 
gestive tract to such an extent that arsenic produces neither vomiting nor 
purging (Murrell). It markedly reduces the amount of sugar excreted by 
diabetics, but has no advantage over morphine in that respect. 

Narcotine should be named Anarcotine, as it has little or no narcotic 
power. It is a convulsant in the lower animals. 

Narceine is said by some observers to be remarkably hypnotic, and free 
from convulsant action; by others equally deserving of credit it is considered 
almost inert. This alkaloid is difficult to obtain pure, hence the samples 
heretofore used have probably been contaminated with other alkaloids. 

Thebaine is a powerful convulsant, exalting the spinal cord almost like 
strychnine and brucine. It is not used medicinally. 

Cotarnine is prepared from Narcotine and is closely related to Hydras- 
tinine, both chemically and physiologically, being powerfully styptic and 
hemostatic by producing contraction of the arterioles. 

The opium alkaloids in their action on the central nervous system form 



1 



opium. 349 

a series, in which Morphine stands at one end and Thebaine at the other. 
In this series the narcotic action is gradually replaced by reflex stimulation, 
the latter being most marked in the action of thebaine, which closely resem- 
bles that of strychnine. The most important members of the series may be 
arranged in the following order — morphine, papaverine, codeine, narcotine, 
thebaine, — the most narcotic being placed first and the most stimulant 
standing last. 

Fatal Doses. 

In a child one day old tt#j of Laudanum caused death. A medicinal dose given to a 
nursing mother proved fatal to the infant. A few drops of Paregoric have killed a child of 
nine months. In the adult gr. \ of Morphine in one case, and gr. iv of crude Opium in another 
have proved fatal. 

Therapeutics. 

The chief indications for the use of Opium or Morphine are: to relieve 
pain from any cause; to produce sleep, particularly in the insomnia of 
low fevers with delirium, in which a mixture of morphine and chloral is 
very efficient; to allay irritation in the various forms of acute nervous 
erethism; to check excessive secretion, as in diarrheas, dysentery, diabetes, 
and ptyalism; to support the system in low fevers and other adynamic 
conditions, when sufficient food cannot be retained; and as a sudorific, 
to produce sweating in coryza and other affections. It is a valuable 
remedy in irritative conditions of the stomach, bladder, or bronchi, also in 
severe vomiting, both forms of diabetes, gastralgia, colic and muscular spasm. 
In diabetes mellitus Morphine by the mouth reduces the sugar promptly, but 
when used hypodermically it has little or no effect thereon, even in the same 
case. In peritonitis and inflammation of other serous membranes, used freely 
even to narcotism it has often saved life. In cerebrospinal meningitis it is 
the chief remedy if given early, before exudation has set in. Cholera morbus 
and dysentery are often treated efficiently by a full dose of Opium, after empty- 
ing the bowel by castor oil or a saline cathartic. In muscular rheumatism and 
acute colds, Dover's powder as a diaphoretic, conjoined with hot drinks and 
foot-baths, is old but excellent treatment. In chronic mania and melancholia, 
nervous prostration and the delirium of fevers, Opium is one of the best hyp- 
notics. In acute mania it does not act so well as Scopolamine, and in delir- 
ium tremens it should be used only in cases which show great prostration, 
and then for temporary effects alone, as a stimulant. In chronic melancholia 
smal doses of Opium three times a day give better results than any other 
treatment. Severe pain from any cause (except cerebritis) is relieved by 
Opium with an efficiency possessed by no other drug, as the pain of sciatica, 
neuralgia, lumbago, cancer, renal and hepatic colic. 

Cough of harassing and frequent character with but little secretion is 
best treated by Opium, but when there is profuse expectoration it should not 



350 opium. 

be used, as the lowering of excitability of the respiratory centre which it pro- 
duces would be dangerous in such a case. In nearly all acute inflammations 
it is valuable, especially when it becomes advisable to lock up the bowels. 
Its tranquilizing power over the circulation makes it invaluable in the various 
forms of hemorrhage. Dyspnea from any cause is relieved by Morphine, 
especially that of cardiac disease; "it gives the power to breathe" (Huchard). 
In cardiac disease, especially aortic stenosis or insufficiency, with dyspnea, 
paroxysms of angina pectoris, or signs of cerebral anemia, Morphine hypo- 
dermically affords great temporary relief. Loomis used and recommended 
Morphine in full dose hypodermically for the uremic convulsions of acute 
parenchymatous nephritis, and this use of the drug has been endorsed by many 
clinicians and condemned by others of equal ability and experience. It is 
employed in puerperal convulsions with comparative safety when the nephri- 
tis is parenchymatous, but is highly dangerous in cases due to interstitial 
nephritis (Tyson). It is generally considered to be a dangerous agent in 
uremia, especially when due to chronic renal disease, either parenchymatous 
or interstitial. 

Apomorphine as an emetic is of much service in poisoning, especially when 
swallowing is difficult, and it may be used with advantage in narcotic poison- 
ing. It is a valuable emetic in any case of poisoning where time is of great 
importance. As an expectorant it is one of the most efficient and useful 
agents at our command. In catarrh of the bronchi gr. -^o by the mouth 
every three or four hours is very beneficial, but the drug must be used in all 
cases with caution, especially in young children, w T ho bear it very badly. 
In hacking coughs without expectoration it will prove serviceable, if given 
in very minute doses, not exceeding gr. iV in the entire 24 hours. In phthisis 
it may be given in combination with morphine with advantage, especially in 
cases where there are dyspnea, continual and harassing cough, and thick, 
tenacious expectoration. The two agents do not destroy each other's action, 
but from the combination we get increased secretion from the mucous mem- 
brane, with diminished irritability of the respiratory centre and consequently 
lessened cough (Brunton). In doses of gr. 2V hypodermically Apomorphine 
has proved efficient as a sedative in epilepsy, hystero-epilepsy, hiccough, 
spasmodic contractions and angina pectoris, and as a hypnotic in acute alco- 
holism; also in somewhat larger doses as a sedative and soporific in mental 
disease characterized by excitement with restlessness and a disposition to 
violence or suicide. In small doses, gr. -fa hypodermically, it has been used 
as a hypnotic, and produces a sleep lasting from one to two hours (Douglas) . 

Codeine is much employed as a palliative for cough, especially the ir- 
ritable, hacking cough of phthisis unaccompanied by much expectoration. 
It seems to have a special influence on the nerves of the larynx, and will re- 
lieve a tickling night-cough better than any other opiate, if given in one dose 
of gr. % an hour before bed-time. In vomiting from almost any cause, doses 






OPIUM. 351 

of gr. J, repeated two or three times at hourly intervals, are usually very effi- 
cient. In the milder forms of diarrhea, gr. % to gr. j will generally check 
the disorder without inducing any unpleasant after-effects. In diabetes 
Codeine lessens the amount of sugar in the urine and often removes it entirely, 
but it must be given in large doses, beginning with gr. ij-iv, and rapidly in- 
creasing to gr. xv or xx. The use of drugs in the modern treatment of Dia- 
betes is of minor importance in comparison with dietetic regulations (see 
article on Diabetes) and many physicians who obtain the best of results use 
no drugs at all in this condition. Codeine is highly efficient in abdominal 
and pelvic pain, especially when ovarian in origin. 

Cotarnine Hydrochloride is used internally as a hemostatic in hematemesis, 
pulmonary hemoptysis, and every form of uterine hemorrhage not due to 
fungus, neoplasms, or retained fragments of placenta; also locally in nasal 
and dental hemorrhage. Its sedative action is utilized in dysmenorrhea, and 
its contractile power on the uterine vessels is beneficial in subinvolution of 
the uterus. As it is not ecbolic it is available in the hemorrhage of threat- 
ened abortion. 

Diacetyl Morphine, originally introduced under the name Heroin, is pre- 
ferred by some in the treatment of excessive cough as it is said to be less 
narcotic and less analgesic. Heroin is more toxic than morphine and is not 
without danger as a depressant. It is likely to form a habit and is certainly 
inferior to codeine in every instance in which it would seem specially indicated. 

Applications of the Various Preparations. 

Superficial pain is often alleviated by the plaster or by extemporaneous 
liniments containing laudanum or some other fluid preparation. It is, how- 
ever, very doubtful whether such applications are of direct value, as mor- 
phine is not absorbed by the unbroken integument. Intense pain, as from 
the passage of calculi, is best met by the hypodermic injection of morphine 
sulphate in full doses (gr. J-f) with atropine sulphate (gr. yM- Either 
morphine or the liquid preparations of opium may be given by the mouth 
in corresponding doses for the same purpose. Severe pain enables the sys- 
tem to resist the action of opium, which in such cases should be repeated 
at short intervals for effect, regardless of dosage. 

Sedative action is obtained by different preparations for various organs. 
The stomach is best affected by the solution of morphine or the extract in a 
small pill. The intestines may be influenced by laudanum in an enema of 
starch, or internally by paregoric, Dover's powder, pulvis opii, or opium 
pills, or hypodermically by morphine, for which purpose it quiets the bowels, 
as in peritonitis, hernia, and intussusception. The rectum and other pelvic 
organs are promptly affected by a suppository of the extract of opium, 
gr. \, with gr. y 1 ^ of the extract of belladonna. The ovaries and the abdom- 



1 



352 OPIUM. 

inal and pelvic organs generally are markedly susceptible to the analgesic 
action of codeine in doses of gr. j to gr. ij for an adult in severe pain. 

To produce sleep the most efficient preparations are the tinctures, the solu- 
tion of morphine, and Dover's powder, in doses corresponding to the degree 
of insomnia and restlessness present. 

Cough is relieved by the tinctures, and the solution of morphine in small 
doses with syrup of wild cherry or syrup of tolu; also by codeine in the last- 
named syrup. Diaphoresis is obtained by the use of Dover's powder. 

A dministration. 

Probably no drug in the materia medica is so useful as Opium or has so wide 
a range of application. At the same time no other drug requires such careful 
handling, by reason of the many influences which modify its action and uses. 
Many persons are found with idiosyncrasies in respect to opium, some being 
easily narcotized, others being remarkably insusceptible to its action, and many 
suffer from a decided shock after its hypodermic administration, which may 
even produce alarming symptoms of collapse. In subjects of kidney disease it 
may accumulate and act more powerfully than expected, and generally it may 
be said to be contraindicated or to be used with great care in alcoholism, conges- 
tion of the brain, and advanced disease of the respiratory organs, heart and kid- 
neys. Children bear Opium badly, and for them its proportionate dosage 
should be much below that for other agents. Morphine should not be given to 
children below 10 years of age, and never hypodermically to those beneath the 
age of 15. Opium given to a nursing mother will affect the child, being partly 
excreted in the milk. 

The conjoint administration with opiates, of the spiritus aetheris, spiritus 
aetheris compositus, or spiritus aetheris nitrosi, an equal part with tinctura 
opii deodorati, will prevent the nausea often excited by the latter, and cor- 
rect the drying-up effects of opium, due to its checking secretion. Some of 
its cerebral effects, as vertigo and mental confusion, are removed by a full 
dose of potassium bromide, others are antagonized by quinine, and the gen- 
eral intra-cranial effects of the drug are to some extent opposed by digitalis 
and by tartar emetic. 

Morphine and Atropine are sufficiently antagonistic to each other to make 
their combination extremely valuable as a therapeutic measure, and their 
use as mutual antidotes in poisoning forms a most efficient procedure if 
employed with due precautions, and intelligent consideration of their limi- 
tations (see the article on Poisoning in Part III). When Morphine is given 
as a hypnotic or anodyne, Atropine should generally be administered at the 
same time in the proportion of gr. T \^ of the latter to gr. \ of the former. By 
this means the anodyne and hypnotic qualities of morphine are increased, 
while the nausea and depression with the subsequent dyspepsia and con- 



OXYGENIUM. 353 

stipation due to it are avoided. Moreover, in the doses above mentioned 
atropine is a cardiac and respiratory stimulant, and will counteract the de- 
pressing tendency of morphine on the heart and respiration in subjects who 
are unduly susceptible to its action. For Morphine-Scopolamine Anesthesia 
see under Hyoscyamus, page 301. 

OXYGENIUM, Oxygen, O, — in official requirement contains not less 
than 95 per cent, by volume of O (16). Its two combinations with Hydrogen, 
Water H 2 0, and Hydrogen Dioxide, H2O2, are official, also ten other Oxides, 
namely — those of Arsenum, Calcium, Chromium, Ethyl, Lead, Magnesium, 
Manganese, Mercury, Silver and Zinc. It enters into the composition of most 
of the acids and their salts, many of the organic bases, and all the alkaloids 
except a few. 

Oxygen is the most universally diffused element in nature, forming about one-fifth of the 
atmosphere, one-third of water, and a great part of the earth and the tissues of plants and ani- 
mals. It is a colorless, odorless, and tasteless gas, of sp. gr. 1.1057, and can be liquefied by 
subjection to extreme cold and pressure combined. It was discovered by Priestley in 1774, 
and given its name, Oxygen (acid producer) by Lavoisier in 1778. It may be obtained pure 
from many of its combinations, but is usually prepared by heating Manganese Dioxide or 
Potassium Chlorate, or preferably both together. It is furnished by manufacturing chemists 
in all large cities, compressed in iron cylinders furnished with a rubber bag and mouth-piece 
by which to administer it. 

Ozone, O3 (Unofficial), — is an allotropic form or condensed condition of Oxygen, three 
atoms of which are contained in a molecule of the former, instead of two as in the molecule 
of oxygen. Ozone exists in the atmosphere in the general proportion of 1 part in 10,000, 
but it is more abundant in the open country and on the ocean than in the air of cities. It 
is formed when an electric spark is passed through air, being then manifested by its peculiar 
odor. In the sick-room it may be produced by dissolving in water a mixture of manganese 
dioxide, potassium permanganate and oxalic acid. ' 

Official Preparations. 

Liquor Hydrogenii Dioxidi, Solution of Hydrogen Dioxide {Solution of Hydrogen Perox- 
ide), commercially known as Peroxide of Hydrogen, — consists of water to which nascent 
Oxygen has been presented, whereby an additional atom thereof has entered into combina- 
tion withthe hydrogen, producing H 2 2 . It is officially described as a slightly acid, aque- 
ous solution of Hydrogen Dioxide, containing when freshly prepared not less than 3 per 
cent, of the pure dioxide, corresponding to about 10 volumes of available oxygen. It 
occurs as a colorless liquid, without odor, slightly acidulous, producing a peculiar sensation 
and soapy froth in the mouth, and liable to deteriorate by age, heat or protracted agitation. 
Dose, 3 ss— i j lav. 5j], diluted with 3 to 4 parts of water. 

Aqua, Water, H 2 0, — is described under its own title. 

Oxides of Arsenum, Calcium, Chromium, Lead, Magnesium, Mercury, Silver and Zinc 
and the Dioxide of Manganese are described under the titles of their metallic bases. 

Unofficial Preparations. 

Acetozone, Acetyl-benzoyl Peroxide, — is an unstable compound, which undergoes hydro- 
lysis in the presence of water, its solution containing Aceto-peracid (acetyl-hydrogen per- 
oxide) and Benzo- per acid, both intensely oxidizing and germicidal bodies. It is marketed 
in the form of a powder, one-half of which is infusorial earth acting as a diluent and pre- 
servative. By adding gr. xxx of the powder to half a gallon of warm, distilled water, shak- 
ing, settling, and decanting, the solution is obtained, and this is administered internally in 
doses of §iv, up to J gallon in 24 hours. Acetozone is also used in oil solution as an in- 
halant. Dose of the powder, gr. iij-v, diluted with sugar of milk, and dispensed in capsule. 

23 



354 OXYGENIUM. 

Alphozone, Succinic Peroxide, — corresponds to hydrogen peroxide in which the hydro- 
gen has been replaced by two succinic acid groups. It like Acetozone, belongs to the class 
of organic peroxides which by virtue of their oxidizing power are germicidal and antiseptic. 
Alphozone is also deodorant and possesses bleaching qualities. It is used in 1-3000 to 
1-1000 solution. 

Calcium Peroxide, — a mixture containing not less than 60 per cent. Calcium Peroxide 
and equivalent to 13.3 per cent, available oxygen. It is a light, cream colored, odorless 
and tasteless powder, practically insoluble in water but decomposed by such contact with 
the liberation of oxygen. Dose, gr. j-v. 

Magnesium Peroxide, — a mixture containing not less than 15 per cent, of Magnesium 
Peroxide and equivalent to 4.3 per cent, available oxygen. It is a white powder, practi- 
cally insoluble but decomposed in water. Dose, gr. iv-vij. 

Sodium Peroxide, — the sodium salt of hydrogen peroxide containing not less than go 
per cent, of Sodium Peroxide, equivalent to 18.4 available oxygen. It is a white or yellow- 
ish amorphous powder, soluble in water with liberation of oxygen. Used externally only. 

Strontium Peroxide, — a mixture containing not less than 84 per cent. Strontium Per- 
oxide, and equivalent to 11.2 per cent, available oxygen. It is a fine white, odorless and 
tasteless powder, practically insoluble in water but decomposed by it with liberation of 
oxygen. Used externally and in dentifrices. 

Zinc Peroxide, — a mixture containing not less than 45 per cent. Zinc Peroxide, and equiv- 
alent to 7.4 per cent, available oxygen. It is a yellowish- white powder, tasteless and odor- 
less, practically insoluble in water but generally decomposed by it with the liberation of 
oxygen. Used externally as a dusting powder or an ointment. 

Incompatibles. 

Incompatible with Hydrogen Dioxide are: Alkalies, Albumin, Ammonia, Arsenous salts 
Balsam of Peru, Charcoal, Chlorides, Chlorine-water, Citrates of alkalies, Ferric salts, Glycerin 
Gold salts, Hydrocyanic Acid, Hypophosphites, Iodides, Lime-water, Manganese Dioxide, 
Mercurous salts, Nitrates, Phenol, Potassium Bromide, Potassium Permanganate, Sulphates, 
Solution of Chlorinated Soda, Tartrates, Tinctures. 



Physiological Action. 

Oxygen is essential to respiration, blood-formation, nutrition and tissue- 
change, in fact to life itself, and to fully describe its physiological action would 
involve a complete description of these processes, which would be a treatise 
on physiology. Applied to the unbroken skin it has no apparent effect, but 
when applied to a wounded tissue it increases the circulation therein and acts 
as a stimulant. Inhaled in the pure state (not as air) it causes very little con- 
stitutional disturbance. A slight sense of heat is felt in the mouth and may 
extend along the larynx, trachea and bronchi. The pulse is usually lessened 
in frequency, the arterial pressure slightly increased, the temperature 
slightly raised, and a sense of mental exhilaration and a disposition to greater 
bodily activity are produced, but no constant influence on the excretions has 
been noticed. Hill and Flack found that it revived in a remarkable way the 
exhausted athlete and prevented the stiff muscles which follow strenuous 
exercise. 

Hydrogen Dioxide, in fresh solution, is one of the most powerful oxidiz- 
ing agents known, by reason of the facility with which it parts with oxygen 
to oxidizable substances brought in contact with it. It is consequently a 
powerful yet non-toxic antiseptic, destroying morbid products to which it is 



OXYGENIUM. 355 

applied. In contact with a suppurating surface it generates a white foam, 
as the result of its action on the pus. This soon subsides, leaving the sub- 
jacent tissue cleansed of all morbid secretions. It acts as a styptic when 
applied to a bleeding surface by coagulating the albumin. 

Therapeutics. 

Oxygen is employed principally in cases of disease of the respiratory 
apparatus characterized by dyspnea, as emphysema, bronchial dilatation, 
phthisis and gangrene of the lungs, also spasmodic asthma, and asphyxia 
from the inhalation of toxic gases or due to opium and chloroform narcosis. 
In carbon monoxide poisoning the prompt removal of the patient to the open 
and the administration of oxygen may save life if changes in the tissues 
resulting from the asphyxia have not occurred. It has been employed with 
benefit in the dyspnea of cardiac disease and that of anemia from loss of 
blood. Although oxygen is frequently recommended for use in the respira- 
tory embarrassment of pneumonia, it is seldom of value and the reason is 
perfectly evident when it is recalled that the dyspnea is dependent more 
upon toxemia than reduction of the respiratory surface. The use of oxygen 
in association with nitrous oxide has been mentioned under that heading and 
the administration of the gas with ether and chloroform has lessened, mate- 
rially, the dangers of these anesthetics. 

Hydrogen Dioxide in solution has long been employed as a bleaching 
agent for delicate fabrics, and on the human hair for the production of the 
"bleached blonde" hue so fashionable lately in certain circles of society. 
As a cleansing agent for foul wounds, ulcers, sores, and the like, it is highly 
efficient; and has been used with great benefit as a gargle or spray to the throat 
in tonsillitis, quinsy, croup, diphtheria, scarlet fever, and other morbid con- 
ditions of these parts. In the foul mouths of patients with pyorrhea alveo- 
laris it acts as a valuable antiseptic and deodorant. In colitis with dysentery, 
lavage of the intestine with a dilute solution thrice daily has proved efficient 
in cases where other approved measures had failed to make any impression. 
It should never be used in cavities without a free opening as the rapid libera- 
tion of gas may destroy tissue, spread infection and cause great pain. It 
is recommended as a disinfectant of drinking water but in the quantity 
necessary for its effective action it impairs the potable qualities. 

A number of metallic (Calcium, Magnesium, Sodium, Strontium, Zinc) 
and organic (Acetyl-benzoyl and Succinic) peroxides have been introduced as 
substitutes for hydrogen peroxide. They are compounds in which oxygen is 
readily liberated but not as rapidly as from hydrogen peroxide. The metal- 
lic peroxides differ in their action dependent upon their solubility and the 
nature of the metal which goes into solution. Sodium peroxide when dis- 
solved in water yields heat and a strong base and is not used internally but 



35° PAREIRA PEPO. 

externally in the form of a paste prepared with liquid paraffin in acne, or as a 
soap to remove comedones. Calcium peroxide, Magnesium peroxide, 
Acetyl-benzoyl peroxide and Succinic peroxide have been used as gastro- 
intestinal antiseptics, for which purpose they have been recommended in the 
treatment of acid dyspepsia, fermentative diarrhea, summer diarrhea of 
children, typhoid fever, etc. Magnesium and Strontium peroxides have been 
found useful when added to dentifrices. Strontium and Zinc peroxides are 
used locally as a dusting powder or in ointment. Zinc peroxide alone, or 
mixed with tannin, possesses definite astringent properties. Acetyl-benzoyl 
peroxide in i to iooo solution (i.e., a solution made by adding i Gm. to iooo 
mils, shaking vigorously, standing for several hours and decanting as re- 
quired) may be taken internally ad libitum as an intestinal antiseptic. It 
is also used as an antiseptic and deodorant wash in eye, ear, nose and throat 
conditions. 

PAREIRA, Pareira (Unofficial), — is the dried root of Chondrodendron tomentosum, a 
climbing, woody vine of the nat. ord. Menispermaceae, with very large leaves and a 
grape-like fruit, inhabiting Peru and Brazil. It contains Pelosine or Cissampeline, an 
alkaloid identical with the Berberine of Nectandra and the Buxine of Buxus sempervirens 
(boxwood). 

Fluidextractum Pareirae, Fluidextract cf Pareira (Unofficial), — Dose, ttj>x-x1v [av. ttjxxx.] 

Infusum Pareirae, Infusion of Pareira (Unofficial), — i in 17. Dose, 5j-ij. 

Pareira is diuretic and laxative, stimulating peristalsis and the action of the kidneys. 
It is eliminated by the kidneys, and passing over the mucous membrane of the genito- 
urinary tract it acts thereon in a tonic and soothing manner, especially on the bladder. 
It was formerly considered useful in chronic cystitis, gonorrhea and gleet, but must be used 
internally, as when injected locally for these affections it has not proved successful. For- 
merly official in the U. S. Pharmacopoeia it was omitted in the last revision. 

PEPO, Pepo, — is the ripe seed of Cucurbita Pepo the common Pumpkin, 
nat. ord. Cucurbitaceae. The active principle is a resin contained in the 
endopleuron or envelope immediately surrounding the embryo. It also 
contains an alkaloid Cucurbitine, a fixed oil, starch, sugar, etc. There are no 
official preparations. Dose, of the resin, gr. xv; of the seeds, §ss-jss [av. 
5 j], beaten up into an emulsion with sugar and water. 

Physiological Action and Therapeutics. 

Pumpkin-seed is an efficient agent for the removal of tapeworm, and its 
use is not followed by unpleasant symptoms. The outer coat of the seed 
should be removed, and an emulsion then made by trituration with sugar and 
water. This, if taken on an empty stomach and followed by a brisk cathartic, 
will generally prove effective. Dr. Squibb maintains that the seeds should 
not be decorticated, but that husks and all should be swallowed. According 
to some observers the expressed oil is equally efficient in doses of gss repeated 
two or three times and followed by a cathartic. 



pepsinum. 357 

PEPSINUM, Pepsin, — is the name of a hypothetical digestive principle 
in the gastric juice. As a definite body it is unknown, the various preparations 
being mere approximations and varying much from each other. It is officially 
described as a mixture containing a proteolytic ferment or enzyme, obtained 
from the glandular layer of the fresh stomach of the hog, and capable of 
digesting not less than 3000 times its own weight of freshly coagulated and 
disintegrated egg albumin, when tested by the official process. Dose, gr. 
iij-xv [av. gr. viij.] 

Pepsin is a fine, white, or yellowish-white, amorphous powder, or thin, pale-yellow, 
translucent grains or scales, free from any offensive odor; soluble in about 50 of water, more 
soluble in water acidulated with HC1, insoluble in alcohol, ether or chloroform. In aqueous 
solution it is acid to litmus. Commercial Pepsin is usually obtained from a solution pre- 
pared by digesting the mucous membrane scraped from the rennet-bags of sheep or the 
stomach of the pig in acidulated water for several days. It is then precipitated by sodium 
chloride (Scheffer), lead acetate (Boudault), or by drying the peptones on glass plates 
(Beale). It may also be precipitated by alcohol. By Scheffer's process it occurs as a 
tough, gray, leathery substance, partly soluble in water, one grain dissolving 3000 grains 
of albumin in a few days. Jensen's Crystal Pepsin, probably prepared after Beale's method, 
is in yellowish, translucent scales, soluble in water, and reputed to be many times stronger 
than any other preparation yet obtained. 

Official Analogue. 

Pancreatinum, Pancreatine — is officially described as a mixture of the 
enzymes naturally existing in the pancreas of warm-blooded animals, usually 
obtained from the fresh pancreas of the hog (Sus scrofa), or the ox (Bos taurus), 
and consisting principally of amylopsin, trypsin, and steapsin, and proved 
to be capable of converting not less than 25 times its own weight of starch 
into soluble carbohydrates when assayed by the official method. Pancreatin 
is a whitish or cream-colored, amorphous powder, slowly and incompletely 
soluble in water, insoluble in alcohol. Dose, gr. iij-xv [av. gr. viij.] 

Unofficial Preparations. 

Pepsinum Saccharatum, Saccharated Pepsin, — is Pepsin 1, triturated with 9 of Sugar of 
Milk. One part should digest at least- 300 parts of egg-albumin. Dose, gr. v-3j, shortly 
after meals. 

Liquor Pepsini, Liquid Pepsin, — contains of Saccharated Pepsin 40 parts, Hydrochloric 
Acid 12, Glycerin 400, Water q. s. ad 1000 parts. Dose, 3ij-iv. 

Liquor Pancreaticus, Pancreatic Solution, — prepared by digesting a finely-chopped pig's 
pancreas with 4 times its weight of dilute alcohol. It is a nearly clear alcoholic solution, with 
little taste or smell. Dose, 5 j-§ss. 

There are a large number of Pepsin and Pancreatic preparations on the market, some 
of which are of feeble activity or inert. The following have been accepted by the Council 
on Pharmacy and Chemistry of the American Medical Association and are described as 
below in New and Non-official Remedies, 1916. 

Peptic Ferments. 

Elixir of Enzymes, — a solution containing pepsin and rennet in a menstruum containing 
20 per cent, of alcohol. Dose, 5j~ij- 

Enzymol, — an extract prepared from the fresh animal stomach, stated to contain the 
activated gastric enzyme in association with the soluble constituents with which the pro- 



35 8 PEPSINUM. 

enzyme is naturally associated. It is free from alcohol, contains a trace of thymol, and 
has an acidity due to combined hydrochloric acid equivalent to 0.26 to 0.3 per cent, of 
actual hydrochloric acid. It is adjusted to a definite proteolytic power by the U. S. P. 
assay method for pepsin, and contains 25 per cent, of glycerin by weight. It is stated to 
be useful as an application to old sores, ulcers and slow-healing wounds. It is said to cor- 
rect offensive odors, to exert a solvent action on pus and sloughing and necrotic tissue, and 
to impart a healing stimulus. It is stated to have been effective in cases which have long 
remained unhealed and have resisted treatment. It is made ready for use by the addition 
of one-half to one or two volumes of water; for the solution of necrotic and carious bone, 
and in some large abscess cavities, it is advised that the preparation be diluted with two 
volumes of 0.2 per cent, solution of hydrochloric acid. A small vial, containing diluted 
hydrochloric acid and a pipette for measuring accompany the package. 

Essence of Pepsin-Fairchild, — an aromatized faintly acid liquid containing the entire 
soluble constituents of the fresh stomach glands — the proteolytic and milk-curdling en- 
zymes, coagulable nucleoproteids, organic and inorganic extractives — and 18.5 per cent, 
alcohol. Dose, 3j~iv. 

Pegnin, Milk-Sugar Rennet, — the milk-curdling enzyme of calf's rennet, diluted with 
sugar of milk and sodium chloride. By producing a finely divided coagulum, pegnin ob- 
viates the formation of the clotty curds which are liable to be produced when untreated 
cow's milk is taken as food. Cow's milk coagulated with pegnin has been used for infant 
feeding and as a food for adults in stomach affections and in disturbances of the digestion 
incident to infectious diseases, in hyperacidity, etc. From 8 to 10 Gm. (120 to 150 grains) 
of pegnin are required for 1 liter (34 fluidounces) of milk previously boiled and cooled to 
about 40 C. The mixture, after brief shaking, is allowed to stand from 2 to 3 minutes, 
or until it is completely coagulated, and then shaken vigorously during several minutes 
until the coagulum has been converted into a smooth, homogeneous mixture, and set aside 
in a cool place. For infants it is transferred to the nursing bottle as required and heated 
in warm water to the body temperature (37.5° C.) before feeding. 

Pancreatic Ferments. 

Diazyme Essence, — a liquid stated to contain the amylolytic enzyme of the pancreas, 
devoid of trypsin and lipase, in a menstruum containing 18.5 per cent, of alcohol by volume. 
Dose, 5j - i v - 

Diazyme Glycerole, — a liquid stated to contain the amylolytic enzyme of the pancreas, 
devoid of trypsin and lipase, in a menstruum containing about 60 per cent, of glycerin by 
volume. Dose, 5j~iv. 

Holadin, Extractum Pancreaticum Integrum, — an extract of the entire pancreas con- 
taining all the constituents of the gland and exhibiting great potency in respect to the sev- 
eral known enzymes, trypsin, amylopsin, lipase and the milk-curdling ferment. Holadin 
has power to digest starch and proteins and to split fats. It is claimed to be useful in va- 
rious diseases in which digestion of food is imperfect. 

Holadin is furnished only in capsules, each capsule containing approximately 3 grains- 
One capsule should be given about three hours after meals and one capsule at bedtime. 
The dose can be gradually increased to two or three capsules at a time. 

Panase, — a combination of the digestive enzymes of the pancreas derived from the 
pancreatic gland of the pig. Dose, gr. ij-x. 

Pankreon, — Tannin-Pancreatin Compound, — a mixture containing the active tryptic, 
diastatic and steatolytic ferments of the pancreas and about 8 per cent, of tannin. Pan- 
kreon has a proteolytic, amylolytic, emulsifying and mildly astringent action. This action 
it is claimed is developed in the alkaline intestinal fluids, although a portion of the ferments 
is likely to be destroyed by the gastric juice during its passage through the stomach. It 
is said to be useful in conditions of disturbed metabolism or anomalies of digestion due to 
functional inefficiency of the pancreas; in diarrhea, dysentery, dyspepsia, marasmus, etc. 
Dose, gr. iv-xv for adults and gr. j-iv for children. 

Trypsin, — the proteolytic enzyme of the pancreas, separated to a considerable extent 
from the other enzymes and constituents of the gland. Trypsin is applied locally by means 
of a brush or as a spray. About 6 grains are mixed with 2 grains sodium bicarbonate and 
triturated in a mortar while adding 1 or 2 drams of distilled water, then warmed to from 
38 to 40. 6° C. and applied immediately. 



pepsinum. 359 

Unofficial Vegetable Digestive. 

Papain, Papaiva, Papayotin, — is a vegetable ferment obtained from the milky juice of 
Carica Papaya, a S. American fruit-tree of the nat. ord. Papayaceae. It is soluble in water, but 
not in alcohol, and possesses the power of changing proteins into peptones in the presence 
of an acid, alkaline or neutral medium, but careful experimentation, according to Hare and 
other observers, renders it doubtful whether it can supplant Pepsin or Pancreatin. It is 
marketed under the name Papoid. Dose, gr. j-iij. Papaw Milk is the milky juice of the 
fruit, coagulating into two parts, a pulpy mass and a liquid serum. When mixed with 
alcohol an amorphous powder is precipitated, which when dried forms Papain. 

Taka-diastase, — -is a starch digesting enzyme obtained from Eurotium oryza, a mould of 
the aspergillus family growing upon hydrolyzed wheat bran. 

Incompatibles. 

Incompatible with Pepsin are: Alcohol, Alkalies, Tannic Acid, Vegetable decoctions and 
infusions; many mineral salts precipitate it from solution. With Pancreatin are: Acids, 
Alcohol, Sodium Chloride in excess. 



Physiological Action and Therapeutics. 

Pepsin is not a solvent but a mixture of ferments, and is a normal constituent 
of the gastric juice, converting proteins into peptones for assimilation, with 
the aid of the hydrochloric acids associated with it. This it will do out of the 
body or in cavities as the rectum, if warmth, acidity and moisture are present. 
Pancreatin, on the other hand, is destroyed by acids and requires an alkaline 
medium in which to exercise its powers. As the food passes out of the stom- 
ach in 2 or 3 hours, Pepsin should be administered within and Pancreatin 
after that period, to be effective. Pepsin and Pancreatin should not be 
prescribed together, because to be effective the first must have an acid medium 
in which Pancreatin is destroyed by Pepsin, and the second, to be effective, 
must have an alkaline medium in which Pepsin is destroyed by Pancreatin. 
Pancreatin contains Amylopsin, an amylolytic ferment, converting starch 
into glucose; Trypsin, a proteolytic ferment, converting proteins into peptones 
in an alkaline medium; Steapsin, which splits fats into glycerin and fatty 
acids; and a milk-cur dling ferment. 

Indigestion in its various forms is the malady for which Pepsin is chiefly 
employed, but it is to be recalled that a deficiency of pepsin only rarely 
occurs and that the hydrochloric acid (which converts the pepsinogen in the 
tissues into pepsin) is more often at fault and more often indicated in therapy. 
It is combined with hydrochloric acid in the treatment of Achy Ha Gastrica. 
It is added to nutritive enemata, the rectum not being a digestive organ, and 
has been injected into the bladder to break down a blood-clot, and has been 
suggested as a useful application to old sores, ulcers and foul smelling wounds 
to correct an offensive odor and stimulate healing. 

Pancreatin converts starch into sugar, proteins into peptones, and 
emulsifies fats in the presence of an alkaline solution (Pepsin requiring an 
acid one). Prolonged contact with mineral acids renders it inert. It is 



360 PETROLATUM. 

digested by Pepsin, and hence probably never passes into the duodenum in 
its own character. Pancreatin is used to partially digest (peptonize) milk, 
gruel, soups, and other foods, before their administration in cases of great 
digestive debility. These peptonized foods may be administered by the 
stomach or the rectum, and are valuable in intestinal dyspepsia, wasting 
diseases, and convalescence from acute affections. To prepare Peptonized 
Milk, Pancreatin gr. x, Sodium bicarbonate gr. xl, Water f§viij and milk 
1 quart are warmed for about 10 minutes by placing in a can of water, 
warmed to a temperature of about 115 F. or a temperature in which the 
hand can be immersed without discomfort. The milk thus prepared has a 
slightly bitter taste and to prevent further peptonizing it should be placed 
upon ice or rapidly brought to the boiling point and then placed in a cool 
place. For rectal feeding, milk should be fully peptonized by allowing the 
Pancreatin to act from 30 minutes to an hour. The resulting product has a 
decidedly bitter taste. A teaspoonful of Pancreatin solution taken after 
the administration of cod-liver oil will prevent the disagreeable eructations 
which are so offensive to some patients, and will aid the digestion of the oil. 
Pancreatin has been used with reputed success in certain types of infantilism 
dependent upon deficient Pancreatic secretion. 

Papain has the power of converting proteins into peptones, in either acid, 
alkaline or neutral media. It was at first thought that it would be useful in 
both gastric and intestinal indigestion, supplanting pepsin or pancreatin 
in cases of doubtful diagnosis, in which it is difficult to decide as to the 
location of the trouble. Increased clinical experience has failed to establish 
any distinct field of usefulness for this ferment. 

Taka-diastase is used with satisfaction in the so-called amylaceous dyspepsia, 
in chronic gastritis and gastro-enteritis when the patient is distressed by farina- 
ceous food, in the diarrhea and dysentery of infants, and in cases of diabetes 
due to pancreatic disease. 

PETROLATUM, Petrolatum, — is a mixture of hydrocarbons, chiefly of 
the methane series, obtained from Petroleum, by distilling off the lighter por- 
tions and purifying the residue. It is coloress or yellowish, and in the latter 
case is more or less fluorescent; amorphous, odorless and tasteless, of neutral 
reaction, insoluble in water, slightly soluble in absolute alcohol, readily soluble 
in ether, chloroform, petroleum benzin, benzene, carbon disulphide, oil of tur- 
pentine, and fixed or volatile oils. The soft variety is known commercially 
as Terr aline, Cosmoline, Vaseline, Petroleum Ointment, etc., and is largely pre- 
pared from residuums or sediments deposited in tanks containing crude petro- 
leum. Besides Petrolatum itself it is official in the following-named forms, — 

Petrolatum Album, White Petrolatum, — a white, unctuous mass, without odor or taste, 
of about the consistence of an ointment. 

Petrolatum Liquidum, Liquid Petrolatum, — a colorless, oily, transparent liquid, without 
odor or taste, but giving off, when heated, a faint odor of petroleum. It is a mixture of 



PETROLATUM. 36 I 

liquid hydrocarbons obtained from Petroleum. The heavy oil has a viscosity of not less 
than 3.1 and the light oil has a viscosity of not more than 3 when determined by the official 
test. Dose, 3j _ viij fav. 5iv.] 

Paraffinum, Paraffin, — a mixture of solid hydrocarbons, a colorless, translucent mass, 
odorless and tasteless, and slightly greasy to the touch. 

Official Analogues. 

Benzinum Purificatum, Purified Petroleum Benzin, — is a purified distillate from American 
petroleum consisting of hydrocarbons chiefly of the marsh gas series. It is a clear, color- 
less, highly inflammable, volatile liquid. Its vapor mixed with air and ignited explodes 
violently. It is a valuable solvent for oils, fats, resins, caoutchouc and some alkaloids. 

Benzenum, Benzene (B. P.), — is a liquid hydrocarbon obtained from light coal-tar oil. 

Physiological Action and Therapeutics. 

Petrolatum is a valuable protective dressing, and an excellent basis for oint- 
ments, having no acridity and no liability to become rancid. It is readily mis- 
cible with many active agents, as the alkaloids and phenol compounds, but 
it does not penetrate the skin so readily as animal fats and fixed oils. Un- 
combined, it forms an excellent bland application in all irritated conditions 
and injuries of the skin, and it has been used with benefit alone, or mixed with 
castor or olive oil, in chronic eczema accompanied by desquamation. Paraffin 
is employed by sub-cutaneous injection for cosmetic effects on saddle-shaped 
noses and other superficial deformities. 

Liquid Petrolatum is used as a laxative in doses of a teaspoonful to one 
ounce at bedtime or three times a day. Lane advises the heavy Russian 
mineral oil, but Bastedo's investigations indicate that there is no important 
difference between the actions of the heavy Russian and the heavy and light 
American oils. (Lightest specimen, sp. gr. 0.0857 at 22 ° C.) It is readily 
taken as it is almost tasteless, is unabsorbed and acts by softening and increas- 
ing the bulk of the feces. It is warmly recommended by Lane for chronic 
constipation and the autointoxication which -manifests itself in so many 
forms as a result of intestinal stasis. 

Benzin taken internally in overdose is known to produce gastro-enteritis, 
and such a case is reported which terminated fatally. In the ordinary medic- 
inal doses it does not produce either vomiting or diarrhea. Benzin-poisoning 
may be produced by its inhalation, which is becoming quite a practice among 
glove-cleaners, and alcoholics have been known to take to inhaling benzin in 
place of drinking spirits. It has been used with some success externally as a 
remedy for rheumatic pain, neuralgia, itch, and prurigo; and internally as a 
vermicide against tapeworm. In pharmacy it has many uses on account of 
its power as a solvent for oils, fats, resins, caoutchouc and some alkaloids. In 
the household it is used as a solvent application for removing grease from 
clothing. 

The light oils sold under a great variety of names, liquid albolene, 
liquid paraffine, etc., are widely used in the oily sprays for nose and throat 
conditions. 



362 PHENOL. 

Ambrine, Mulene, and Parresine, — are names applied to proprietary 
paraffin mixtures of secret composition which have recently come into 
prominence in the treatment of burns. The greatest notoriety surrounds 
the sensational reports concerning Ambrine which is the French prepara- 
tion; the other two are of American origin. The principle of the paraffin 
film method is supposed to be mainly mechanical, the film forming a pro- 
tective covering to the exposed tissues and perhaps forming a sort of 
scaffold for the feeble granulations. It is easily removable. Sollmann has 
prepared a series of paraffin combinations of simple type which surgeons 
are urged to use in preference to the secret ones in order to compare re- 
sults. Ordinary paraffin, melting between 48 and 53 C. (118-128 F.), 
preferably about 50 C. (122 F.) appears to possess practically the me- 
chanical properties of the French preparation, and is urged as to the 
standard of comparison. Paraffin- A sphaltum (1 to 3 per cent, of Trinidad 
or Bermudez Asphalt, or 1 per cent. Texas Asphalt) gives a preparation of 
superior pliability. The following additional formulas are suggested by 
Sollmann for clinical trial as preparations of increasing softness. Paraffin- 
Spermaceti, Paraffin 10 parts; spermaceti oil 1 part. Paraffin-Theobroma, 
Paraffin 10 parts; theobroma oil 1 part. Paraffin-Petrolatum, Paraffin 10 
parts; yellow petrolatum 1 part. For use these preparations are heated 
until liquid and applied to burns and wounds. 

PHENOL, Phenol {Carbolic Acid), C 6 H 5 OH, — is hydroxy-benzene, ob- 
tained either from coal tar by fractional distillation and subsequent purification, 
or made synthetically. It occurs in colorless, interlaced, needle-shaped crystals, 
of characteristic, aromatic odor, deliquescent on exposure to damp air, and 
acquiring a reddish tint with age and light* When copiously diluted with water 
it has a sweetish taste, and a slightly burning after-taste. It is soluble in about 
15 of water, very soluble in alcohol, ether, chloroform, benzene, glycerin, oils and 
carbon bisulphide; almost insoluble in benzin. It is melted by gentle heating, 
and is liquefied by the addition of about 8 per cent, of water. Dose, gr J-ij 
[av. gr. j], well diluted. 

Phenol occurs in castoreum, in the urine of man and herbivorous animals, and in the prod- 
ucts of the dry distillation of various organic substances, as resin, bones, wood, and coal. 
Peculiarities of it are that the addition of about 8 per cent, of water liquefies it, while a further 
addition of water produces a turbid mixture, until about 15 parts of water to 1 of phenol is 
reached, when a stable and clear solution is formed. One volume of the liquefied phenol, 
containing 8 per cent, of water, forms with one volume of Glycerin a clear mixture, which is not 
rendered turbid by the addition of 3 volumes of water (absence of Creosote and Cresol) . 

Hitherto described as neutral to litmus paper it may give a faintly acid reaction. Its 
claims to be considered an acid are, however, very feeble, as, though it combines with 
salifiable bases, it is incapable of neutralizing the alkalies, and its combinations are decom- 
posed by the feeblest acids (carbonic, etc.), sometimes, it is asserted, even by water. 
Chemically, it is considered to be the Hydroxyl (HO) derivative of Benzene (C 6 H 6 ), which 
would ally it to the alcohols; but as it does not yield the same products on oxidation (yielding 
finally oxalic instead of acetic acid), it is taken as the type of a class called phenols, which are 
simple HO derivatives of the aromatic hydrocarbons. 

Phenol is converted by concentrated sulphuric acid into Phenol-sulphonic Acid, 



PHENOL. 363 

C 6 H 5 H.S0 4 ; and by nitric acid into several substitution products, the most important of which 
is Picric Acid. The reddish tint which it acquires with age and light, does not impair its 
properties; but is not accounted for satisfactorily, though supposed to be due to the presence 
of Aurin and Rosolic Acid, impurities which form a red compound by the absorption of CO, 
and oxygen. 

Phenol coagulates albumin and collodion, Creosote does not. Impure Phenol contains 
several congeric bodies, particularly Xylic and Cresylic Acids. 

Official Preparations. 

Phenol Liquef actum, Liquefied Phenol, — is a liquid composed of not less than 8 7 per 
cent, by weight of absolute Phenol. Dose, Tn7ss— ij [av. tt#j.] 

Glyceritum Phenolis, Glycerite of Phenol, — has of Liquefied Phenol 20, Glycerin 80. 
Dose, TTjjiij-x [a v. ttjtv.] 

Unguentum Phenolis, Ointment of Phenol, — has of Phenol 2I, Ointment, 97I. For 
external use. 

Sodii Phenolsulphonas, Sodium Phenolsulphonate (Sodium Sulphocarbolate) , — occurs in 
transparent, rhombic prisms, soluble in 4.2 of water. Dose, gr. ij-x [av. gr. iv.] 

Zinci Phenolsulphonas, Zinc Phenolsulphonate, — occurs in transparent, rhombic prisms, 
soluble in 1.6 of water. Dose, gr. j-v [av. gr. ij.] 

Unofficial Preparations and Compounds. 

Aqua Phenolis, Water of Phenol, — has of the glycerite of Phenol 3x, to Water Oj. Dose, 
5j-iv. 

Phenol Iodatum, Iodized Phenol, — a mixture of Iodine and Phenol. (See page 303 .) 

Pheno-resorcin, — is a mixture of Phenol 67 with Resorcin 33 and Water 10, forming a 
liquid which mixes readily with water, and is supposed to combine the virtues of both its 
ingredients. Used locally. 

Phenol Solutions, for antiseptic surgery, are — 
5 per cent, in Water, (ttjxxv to the 5), as a wash. Is decidedly irritant. 
2\ per cent, in Water, (lrjjxij to the o), for sponges, hands, or as a lotion. 

Phenol Sodique, — is a proprietary preparation which has no particular advantage over 
phenol solutions of equal strength. 

Phenol-camphor, — has of Phenol and Camphor, equal parts. A colorless, refractive 
liquid; soluble in alcohol, ether, chloroform and oils; insoluble in water or glycerin. Used 
as a local anesthetic, chiefly for toothache; also in the proportion of Phenol i, Camphor 3, as 
an application to false membrane in diphtheria, and to the external ear in furunculosis. 
Campho-phenique is a similar preparation. (See under Camphora.) 

Phenosalyl, — is a clear, syrupy liquid, prepared by fusing together Phenol 9 parts, 
Salicylic Acid 1, Lactic Acid 2, and Menthol 0.1. It has a pleasant odor, is very soluble in 
water, and is used in a 1 per cent, solution as an antiseptic application, and in 10 to 30 per 
cent, solutions as a curative lotion for varicose ulcers. It is said to be superior as a ger- 
micide to any one of its ingredients, and to prove much less toxic than the agents usually 
so employed. 

Official Analogues and Derivatives. 

Phenolphthaleinum, Phenol phthalein, C20HUO4, — a dibasic phenol derivative, produced 
by the interaction of Phenol and Phthalic anhydride. It occurs as a white or faintly 
yellow, crystalline powder, odorless and tasteless, almost insoluble in water, soluble in 13 
of alcohol and 70 of ether. It is used as a laxative. Dose, gr. j-v [av. gr. ijss.] 

Trinitrophenol, Trinitro- phenol, Picric Acid, C 6 H 2 OH(N0 2 )3, — is obtained by the action 
of 'hot nitric acid on phenol-sulphonic acid, and occurs in yellow scales which are soluble 
in 78 of water and in 12 of alcohol. Externally it is antiseptic ?< analgesic, coagulant, and 
in solution is non-irritant to the tissues, but is too corrosive for internal use. Large doses 
cause vomiting, anuria, strangury, and yellow staining of the skin and mucous membranes. 
A saturated aqueous solution is highly recommended as a local application in erysipelas 
and burns, and is an efficient test for albumin in the urine. 

Creosotum, Creosote, — is a mixture of phenols and phenol derivatives, obtained during 
the distillation of wood-tar. It is described under its own title. 



364 PHENOL. 

Resorcinol, Resorcinol (Resorcin), — is a diatomic phenol, described on page 398. 

Cresol, Cresol, C7H7.OH, — is a mixture of isomeric cresols obtained from coal tar, freed 
from phenol, hydrocarbons, and water; a colorless or yellowish-brown refractive liquid, 
soluble in 50 of water, miscible in all proportions with petroleum benzin, benzene, alcohol, 
ether and glycerin. Dose, ttrss— ij [av. njrj.J # 

Liquor Cresolis Compositus, Compound Solution of Cresol, — has of Cresol 50, Linseed 
Oil 30, Potassium Hydroxide 8, Alcohol 3, Water to 100. Is similar to a proprietary known 
as Lysol, and is used locally in mixture with water, 1 to 5 per cent., as an antiseptic and 
disinfectant application, wash, gargle, etc. For mucous membranes the mixture should 
not be stronger than 2 per cent. 

A number of Cresol preparations are on the market under various trade names such as 
Trikresol, Krelos, Kresamine, Phenoco, Cresatin, etc. The cresols are phenols in which 
one or several of the hydrogen atoms have been replaced by alkyl groups, especially CH 3 
(N. N. R.). These preparations have a greater germicidal activity than phenol, are less 
toxic and less expensive. In stating their germicidal strength they are compared with 
phenol; the result of the comparison is called the phenol coefficient. The official compound 
cresol solution is three times as active as phenol or has a phenol coefficient of 3. The 
Council on Pharmacy and Chemistry of the American Medical Association has approved 
the phenol coefficient test as performed by the U. S. Hygienic Laboratory (Bulletin 82). 
The various preparations are now sold with a statement as to their phenol coefficient and 
the degree of dilution for disinfection is obtained by multiplying the coefficient by 50, for 
instance a disinfectant having a coefficient of 3 would be diluted 3X50 = 150 times (N. N. R.) . 

Incompatibles. 

Incompatible with Phenol are: Acetanilid, Acetphenetidin (Phenacetin), Antipyrine 
Albumin, Bromine water, Butyl-chloral Hydrate, Camphor, Chloralformamide, Chloral 
Hydrate, Collodion, Ethyl Carbamate (Urethane), Exalgin, Ferric salts, Gelatin in dilute 
solution, Hydrogen, Dioxide, Lead^ Acetate, Menthol, Naphthol, Nitric Acid, Phenyl 
Salicylate (Salol), Piperazin, Potassium Permanganate, Pyrocatechin, Pyrogallol, Resor- 
cinol, Sodium Phosphate, Thymol, Terpin Hydrate. 

Physiological Action. 

Phenol is antiseptic and disinfectant, somewhat antipyretic, also a local an- 
esthetic, and a depressant of the cardiac, respiratory, cerebral and spinal func- 
tions. In strong aqueous solutions it is destructive to low forms of life, rapidly 
destroying bacteria, protozoa, leucocytes, epithelial cells and spermatozoa, 
etc. In a weak solution (1-1000 to 1-500) it is a weak antiseptic ; in strengths 
of 1 to 5 per cent, it kills most bacteria but anthrax and tetanus spores are 
not killed by these solutions even after many hours (twenty-four). On un- 
organized ferments (enzymes), such as pepsin and ptyalin, it does not act 
so readily, but in large doses it destroys their activity, and it is an efficient 
parasiticide against certain vegetable parasites which infest the skin. The 
foregoing is true of the liquefied phenol and its aqueous and glycerin solu- 
tions, but not of its solutions in oils, which have no disinfectant properties. 

Applied to the skin in weak or moderately strong solutions, it produces local 
anesthesia with a sensation of numbness, which lasts for several hours. Ap- 
plied in concentrated form, it is irritant and superficially escharotic, with burn- 
ing pain of brief duration, and produces at the point of application a white spot, 
changing to red if the acid is soon removed. It does not vesicate, but if the 
application be prolonged, a white eschar or slough results, from coagulation of 
the albumin of the tissue, and this is bordered by a red zone of inflammation. 



PHENOL. 365 

Even a 3 per cent, aqueous solution, kept on a part for several days, has pro- 
duced dry gangrene of the tissues (Czerny). This is especially true of the fin- 
gers and toes, probably because the action of the drug on their blood-vessels 
arrests the circulation therein completely. A solution not stronger than 5 per 
cent, applied for 24 hours, caused gangrene of a finger necessitating amputation 
(Harrington). 

Taken internally, concentrated Phenolhas the same effect on the mu- 
cous membranes as on the skin, producing white, superficial eschars, after burn- 
ing pain of short duration, in the mouth, gullet and stomach. To the latter 
viscus it is a powerful irritant, and causes a violent gastritis. In medicinal 
doses it has no effect upon the circulation or respiration. Its antipyretic 
power is incapable of being utilized, requiring a dosage which would be 
dangerous. 

A toxic dose paralyzes the vaso-motor centre in the medulla before mark- 
edly affecting the heart. The blood-pressure and body-temperature fall; the 
respiration, at first accelerated by stimulation of the vagi, is quickly depressed 
and ultimately paralyzed; cardiac inhibition is stimulated, the heart being 
first slowed and then depressed. The anterior cornua of the spinal cord are 
first stimulated, producing convulsions; and subsequently depressed, causing 
suspension of reflexes, impaired motility and sensibility, and finally paralysis 
of both motion and sensation. The cerebrum is profoundly depressed, pro- 
ducing stupor deepening into coma, with contracted pupils. Death occurs, in 
most cases, by paralysis of respiration; in a few, by paralysis of the 
heart. 

Phenol is readily absorbed and rapidly diffused; many fatal cases having 
resulted from its external use in undiluted form. A single vaginal injection 
of a moderately weak solution has produced very severe constitutional results. 
It is partly oxidized in the blood, and partly eliminated by the lungs and kid- 
neys. It imparts to the urine a peculiar smoky or olive-green color, which is 
not due to blood, and may be seen after moderate doses, or even as a result of 
its absorption from dressings. When ingested in a large dose, phenol itself 
may appear in the urine; but the smoky color is due to the presence of its in- 
termediate oxidation products, viz., pyrocatechin (only in alkaline urine), and 
hydrochinone, also salts of phenol-sulphonic acid and glycuronic acid. In 
poisoning thereby the sulphates are absent from the urine. 

A case of poisoning by Phenol shows white, corrugated eschars in the mouth 
and fauces, if the drug has been swallowed in concentrated form. These eschars 
are also found on the mucous lining of the esophagus and stomach, at the au- 
topsy. The patient complains of an intense, burning sensation along the same 
tract, immediately after the ingestion of the poison, and soon passes into a state 
of collapse; the skin is cold and clammy, the pupils contracted, respiration 
becomes more and more feeble and shallow; the urine, if not entirely suppressed, 
is of a dark-green color; reflexes are then abolished, stupor and coma super- 



366 PHENOL. 

vene, and finally the breathing ceases. The blood, after death, is dark in color, 
and coagulates imperfectly; and fatty degeneration of the liver and kidneys 
may be found. When poisoning occurs by absorption, an early symptom is 
the peculiar, smoky color of the urine. There may be pain in the lumbar region, 
indicating renal irritation, and slight restlessness or cerebral disturbance; after 
which comes the impairment of respiration and stupor. 

A toxic dose of Phenol, taken internally, is one of the most rapidly acting 
poisons known, sometimes equalling Prussic Acid in this respect. The symp- 
toms develop almost immediately and death may occur in a very few minutes; 
but usually the patient lives from one to ten hours; rarely over two days. In 
some cases, a great amendment has occurred, with restoration of consciousness, 
but after some hours sudden and fatal collapse has supervened. The minimum 
fatal dose is not determined, but §ss has frequently caused death; and doses 
as small as tt|VJ have given rise to dangerous symptoms. Cases of suicidal 
and accidental poisoning by this drug are very frequent, by reason of the facility 
with which it may be obtained for use as a disinfectant. 

Therapeutics. 

Phenol owes much of its prominence to its having been the principal agent 
at first used in the antiseptic method of treating wounds; but its employment 
in that connection has become much restricted, and many of the most prom- 
inent surgeons have abandoned it altogether in favor of other germicides. Re- 
cent investigations have proved beyond doubt that this agent has a reputation 
as a disinfectant far above that which it deserves; that in the ordinary solutions 
it is almost useless as a germicide though actively antiseptic; and that very 
many hours of exposure to very strong solutions are required to kill pathogenic 
germs and their spores. In the estimation of many, however, it still retains 
high favor as a surgical antiseptic lotion; and it is in general use as a disin- 
fectant for surgical instruments, hospital apparatus, soiled linen, etc. The 
carbolic spray, formerly so commonly used during operations, has been en- 
tirely discarded. For disinfectant purposes about drains, privies, on floors, 
walls, etc., Cresol is to be preferred, having very high power as a disinfectant. 

As a local application, Phenol has extensive and varied uses. Unna calls 
it the opium of the skin, as it relieves pruritus of almost any form, if applied 
in 5 per cent, aqueous solution over the itching surface; and a lotion, com- 
posed of gr. xx to 3ss each of water and glycerin, makes a very efficient appli- 
cation for the itching of jaundice. The glycerite, diluted, effectively destroys 
the fungus of tinea tonsurans or tinea versicolor, and may be applied as a stimu- 
lant to indolent ulcers, or to patches of aphthous stomatitis. Its liability to 
cause gangrene, when applied continuously to a finger or toe (see page 365), 
should be remembered when using it on those members. A one per cent, solu- 
tion in water and glycerin makes an excellent analgesic and cleansing gargle 



PHENOL. 367 

for the painful sore throat of tonsillitis, pharyngitis, and diphtheria. Cotton 
soaked in strong phenol and applied to the cavity of a decayed tooth will stop 
the pain, but care must be taken, by covering it with dry cotton, to prevent 
its reaching the gum, or sloughing may result. For burns and scalds a good 
application is phenolized sweet oil of 3 per cent, phenol strength, and the strong 
phenol has been applied by a brush over burned surfaces with excellent results 
in many cases. In this form it is less dangerous than in solution, as it forms a 
protective combination with the exuded blood-serum, and prevents its own 
absorption. In granular conjunctivitis a 5 per cent, solution has been effi- 
ciently applied once a week in the angles of the upturned eyelid, and acute con- 
junctivitis is greatly relieved by holding the open eye in the spray of a steam 
atomizer, the cup of which contains a 5 per cent, solution. This measure may 
also be used for acute coryza with beneficial results; or a mixture of phenol 
and tincture of iodine may be dropped on to a sponge in a wide-mouthed bottle 
and volatilized for inhalation by being wrapped in a cloth wrung out of hot 
water, or by being held in the hand. In phthisis and other chronic pulmonary 
diseases, Phenol has been much employed as a spray by inhalation, and cer- 
tainly does good therein by relieving cough and irritation of the throat. In 
these affections, Creosote is preferred both for internal and local use. For local 
anesthesia in minor surgical operations, such as that for ingrowing toe-nail or 
opening a felon, pure phenol may be brushed over the line of incision. 

As a parenchymatous injection, which should be not over 5 SS of a 2 per cent, 
solution, Phenol has been employed with much success in combating deep- 
seated inflammations. The skin being first anesthetized by the local appli- 
cation of phenol, a hypodermic needle is introduced obliquely, to the centre of 
the inflamed tissue, but should not be connected with the syringe if any blood 
escapes through it, lest the injection be introduced into a vein. This method has 
been successfully used in glandular swellings, 5 to 10 minims of the solution for 
each gland being sufficient in phlegmons of every grade and character, ery- 
sipelas, poisoned wounds, inflamed bursae, chronic synovitis, buboes, and 
relapsing tonsillitis. It was formerly injected into the sac for the radical 
cure of hydrocele, but safer and more efficient operative methods are now 
employed. Hemorrhoids have been cured by Phenol, one or two minims in- 
jected into each tumor once a week, in 10 per cent, solution; but this measure 
may prove dangerous, and has never received general professional approval. 
Anthrax has been successfully combated by the local injection of the pure 
phenol, and in 3 per cent, solution it has been used subcutaneously in acute 
articular rheumatism and neuralgia with benefit in many cases. Tetanus 
has been successfully treated by subcutaneous injections of Phenol in \ to 
2 per cent, solutions, Bacelli and Ascoli reporting 73 cases thus treated with 
only two deaths. The quantity administered daily was usually from 5 to 
15 grains, but was as high as 60 to 80 grains in some cured cases, and a total 
administration of 500 grains in one, the organism proving very tolerant of 



368 PHOSPHORUS. 

the remedy in this disease. It has also been used intravenously in increasing 
doses of 5 to 20 grains in 2 per cent, solution and Bacelli reports a mortality 
of 17.4 per cent, among 190 reported cases in which it was so used. 

Internally, Phenol is not much employed. It has been given to relieve 
flatulence and dyspepsia, and is often an efficient remedy against vomiting 
Phenolphthalein is at present a popular laxative, and is the active ingredient 
of many proprietary preparations. It is used with advantage in combina- 
tion with agar-agar in those types of constipation due to deficient bulk of 
the intestinal contents. 

The Phenol-sulphonates of Sodium, Potassium, etc., have been em- 
ployed internally as intestinal antiseptics but their action is feeble. They 
may be used locally with good results in aphthae, tonsillitis, otorrhea, 
gonorrhea, and for inflamed mucous membranes generally. 

The Cresols (see page 364) are not unlike the phenol in their actions but 
are less poisonous and more actively germicidal. The official compound 
Cresol solution in 1 to 5 per cent, solution is widely used in obstetric work to 
cleanse the external parts before labor and as a hot douche after labor. It 
is also used to disinfect the hands and instruments, and as an irrigation in 
otorrhea, chronic abscesses, fetid ulcers, ethmoiditis, ozena, etc. 

A Cresol preparation named Creolinhas been highly praised by von Esmarch 
and others as the ideal antiseptic for external use, but it has given rise to serious 
symptoms when excessively employed. As a vaginal wash in puerperal cases 
the 2 per cent, solution has given general satisfaction, and weaker ones were 
recommended by Parvin as a vesical wash in female cystitis. Solutions of 1 
in 1000 are employed locally in otorrhea, rhinitis, blepharitis, keratitis, and 
nasal ulcers. 

PHOSPHORUS. This element, its Acids and their salts, the Phosphates 
and Phosphites, are properly studied together, as the chief aim of their medic- 
inal use is to supply phosphorus to the organism. 

Phosphorus, P, — is a non-metallic element obtained from bones, and oc- 
curs as a translucent, nearly colorless solid, of waxy lustre, and the consistence 
of beeswax, insoluble in water, to which, however, it imparts its characteristic 
odor and taste. It is soluble in 102 of absolute ether, 400 of dehydrated 
alcohol, and freely in chloroform and in carbon disulphide. It has a disagree- 
able odor and taste, melts at 44 C, and in the air it emits white fumes which 
are luminous in the dark. On longer exposure to the air it ignites, and should 
be kept under water in a cool place, protected from light. It usually con- 
tains Arsenic and sometimes Sulphur, the limits of which are fixed by the 
official tests. Dose, gr. T 51j-to [ av - § r - t£if-] 

Acidum Phosphoricum, Phosphoric A cid t —i& a liquid composed of 85 to 88 
per cent, of Ortho phosphoric Acid, H 3 P0 4 , and 15 per cent, of water, and is 



PHOSPHORUS. 369 

obtained by oxidizing phosphorus with nitric acid. It is strongly acid, odorless, 
colorless, and miscible in all proportions with water or alcohol. 

Acidum Phosphoricum Dilutum, Diluted Phosphoric Acid, — has of Phosphoric Acid 10 
parts in 76.5 Distilled Water, and contains 9.5 to 10.5 per cent, of Orthophosphoric Acid. 
Dose, njrv-xlv [av. ngxxx.] 

Acidum Hypophosphorosum, Hypophosphorous Acid, — is an aqueous 
solution containing 30 to 32 per cent, of Hypophosphorous Acid, H 3 P0 2 . 

Acidum Hypophosphorosum Dilutum, Diluted Hypo phosphorus Acid, — an aqueous solu- 
tion containing 9.5 to 10.5 per cent, of H 3 P0 2 . Dose, tijjv-x [av. irjjviij.] 

Preparations of Phosphorus. 

Pilulae Phosphori, Pills of Phosphorus, — each contains gr. T £o of Phosphorus, dissolved 
in Chloroform, mixed with Althaea and Acacia in Glycerin and Water, and coated by shaking 
with a solution of Balsam of Tolu in Ether. Dose, j-ij [av. j.] 

Tinctura Phosphori, Thompson's, (Unofficial), — Phosphorus gr. j, Absolute Alcohol 5v, 
Glycerin § jss, Alcohol 3ij, Spt. Menthae Piperitae ngxl. Of this oj contains gr. ^3 of Phos- 
phorus. Dose, ttjjx-xI. 

Tinctura Phosphori, Bellevue Hospital, (Unofficial), — Phosphorus gr. xxxij, Absolute 
Alcohol, §xlvj, Essence of Vanilla 5 j, Oil of Orange 3iij, Alcohol q. s. ad Sxlviij. Of this 5j 
contains gr. ■£% of Phosphorus. Dose, njjv-xx. 

Phosphites and their Preparations. 

Calcii Hypophosphis, Calcium Hypophosphite, Ca(PH 2 2 ) 2 , — colorless prisms, or thin, 
pearly scales, of nauseous taste, soluble in 6.5 of water, insoluble in alcohol. Is an ingredient 
of the Syrupus Hypophosphitum. Dose, gr. v-xv [av. gr. viij.] 

Potassii Hypophosphis, Potassium Hypophosphite, KH 2 P0 2 , — white masses, or a white 
granular powder, deliquescent, odorless, of saline taste and neutral reaction. Soluble in 0.6 
of water and in 9 of alcohol. Dose, gr. v-x [av. gr. viij.] 

Sodii Hypophosphis, Sodium Hypophosphite, NaPH 2 2 +H 2 0, — small plates, or a 
white, granular powder, deliquescent, odorless, of sweetish, saline taste, and neutral reaction. 
Soluble in 1 of water and in alcohol. Dose, gr. v-xxx [av. gr. xv.] 

Syrupus Hypophosphitum, Syrup of Hypophosphites, — has of Calcium Hypophosphite 
4I, of Potassium and Sodium Hypophosphites i| each, per cent. Dose, 5 j~5ss [av. Sijss.j 

Ammonii Hypophosphis, Ammonium Hypophosphite (Unofficial), — occurs as irregular 
crystalline plates, soluble in > water, very soluble in dehydrated alcohol. Dose, gr. j-iv 
[av. gr. ij.] 

Phosphates and their Preparations. 

Syrupus Calcii Lactophosphatis, Syrup of Calcium Lactophosphate, — has of Calcium 
Carbonate 2\, Lactic Acid 6, Phosphoric Acid 3.6 per cent. Dose, 5j-iv [av. 3ijss.] 

Sodii Phosphas, Sodium Phosphate, Na 2 HP0 4 +i2H 2 0, — large, colorless, monoclinic 
prisms, efflorescent, of saline taste and alkaline reaction; soluble in 2.7 of water, insoluble 
in alcohol. Its solubility in water is much increased by the addition of citric acid. Dose, 
gr. xx-5ij [av. 5j.] 

Sodii Phosphas Exsiccatus, Exsiccated Sodium Phosphate, — is the crystallized phosphate 
allowed to effloresce, and then gradually heated to ioo° C. until the salt ceases to lose weight. 
Dose, gr. x-xl [av. gr. xxx.] 

Sodii Phosphas Effervescens, Effervescent Sodium Phosphate, — has of the exsiccated 
salt. 20, Sodium Bicarbonate 47!, Tartaric Acid 25I, Citric Acid i6\. Dose, 5j-iij [av. 
5ijss.] 

Elixir Ferri, Quininae et Strychninae Phosphatum, Elixir of Iron, Quinine and Strychnine 
Phosphates (Unofficial), — has in each dose of 3j the ^ of a grain of Strychnine. Dose, 
3ss-ij [av. 5j-] 
24 



I 



$70 PHOSPHORUS. 

Glyceritum Ferri, Quininae et Strychninae Phosphatum, Glycerite of the Phosphates of 
Iron. Quinine and Strychnine (Unofficial), — has of Strychnine gr. -fa in each dose of ttj^xv. 
Dose, agx—xx [av. ttjxv.] 

Syrupus Ferri, Quininae et Strychninae Phosphatum; Syrup of the Phosphates of Iron, 
Quinine and Strychnine (Unofficial), — has of Strychnine gr. -§l in each dose of 5j, and is 
prepared by mixing the Glycerite 25 with Syrup to 100. Dose, 5 ss— i j [av. 5J-] 

Ferri Phosphas, Ferric Phosphate, — is described under Ferrum. 

Syrupus Phosphatum Compositus, Compound Syrup of Phosphates, Parrish's Chemical 
Food (Unofficial), — has in each 3, of Ferric Phosphate gr. ijss, Calcium Phosphate gr. j. 
Dose, 5j-iij- 

Calcii Glycerophosphas, Calcium Glycerophosphate, — a fine, white, odorless and almost 
tasteless powder, somewhat hygroscopic, soluble in 50 of water and insoluble in alcohol. 
Dose, gr. ij-vj [av. gr. iv.] 

Sodii Glycerophosphas, Sodium Glycerophosphate, — white plates or scales or powder, 
odorless, saline in taste, very soluble in water, nearly insoluble in alcohol. Dose, gr. ij-vj 
[av. gr. iv.] 

Liquor Sodii Glycerophosphatis, Solution of Sodium Glycerophosphate, — a 50 per cent, 
aqueous solution of the anhydrous salt. Dose, ttjjij— viij [av. TTjrvj.] 

Melachol (Unofficial), — is a proprietary preparation, advertised to contain in each f5 
eighty-five grains of Sodium Phosphate with Citric Acid and Sodium Nitrate. Dose, 3ss-5 j f 
in water. 

Incompatibles. 

Incompatible with Phosphorus are all oxidizers. With Phosphoric Acid and the Phosphate, 
are: the Chlorides of Barium, Calcium and Magnesium in ammoniacal solutions; Lead Acetates 
Silver Nitrate and Iron Phosphate. With Sodium Phosphate are: Alkaloids, Antipyrine, 
Chloral Hydrate, Lead Acetate, Phenol, Pyrocatechin, Pyrogallol, Resorcinol, Salicylic 
Acid, Sodium Salicylate, also those under Phosphoric Acid above. With Dilute Hypophos- 
phorus Acid and the Hypo phosphites are: Arsenic salts, Bromine and Bromates, Chlorine 
and Chlorates, Chromates, Cupric salts, Ferric salts, Iodine and Iodates, Nitric Acid, 
Permanganates, Sulphuric Acid, Sulphurous Acid. 

Physiological Action. 

Phosphorus in small doses stimulates metabolism and growth of bones. 
When administered to young animals it stimulates osseous growth increasing 
the size and density of the bones; but in full-grown animals there is no change. 
The red blood cells are increased in number, although in toxic doses there is 
extensive destruction with liberation of large amounts of bile pigments. In 
poisonous doses it is a powerful irritant of the gastro-intestinal tract, causing 
vomiting and purging with great depression of the vital forces. It causes 
acute hemorrhages by producing fatty degeneration of the arterial walls; 
also fatty degeneration of the stomach, liver and heart, accompanied by deep 
jaundice; then delirium, convulsions, coma and death, the latter usually from 
gradual failure of the respiration and circulation. Acute yellow atrophy of 
the liver resembles phosphorus poisoning so much that it is very difficult to 
distinguish between them. Its fumes cause necrosis of the upper or lower 
maxillae, especially in those whose teeth are decayed. This effect is seen par- 
ticularly among workers with phosphorus such as match makers, but is less 
commonly seen since the sesquisulphide of Phosphorus has replaced the other 
forms in the manufacture of matches. The effect of Phosphorus on metab- 
olism is to increase the nitrogenous products, to diminish the excretion of 



PHOSPHORUS. 371 

carbon dioxide, to reduce the glycogen of the liver to almost nothing, and to 
raise the temperature. While generally increasing metabolism it so influences 
that process as to arrest it before completion with the result that various 
intermediate products accumulate in the blood (amino acids, peptones, lactic 
acid, etc.). The diminished oxidation induces fatty degeneration of epi- 
thelial, glandular and muscular protoplasm throughout the body. 

Phosphoric Acid is a weak mineral acid, being much less corrosive and irri- 
tant than the others (see page 368), but in large and concentrated dose it may 
cause gastro-enteritis. It contains no free phosphorus and does not produce 
the effects of that substance, but is believed to act in the dilute form as a 
gastric tonic and a refrigerant. 

Sodium Phosphate is a member of the group known as the saline cathartics. 
In small doses, it is laxative and in large doses purgative. It acts by increas- 
ing the fluids in the intestine, and is unirritating unless taken in too great 
concentration producing nausea and vomiting. It was formerly thought to 
increase the flow of bile but this is now disputed. The monosodium salt 
(NaH 2 PC>4) or acid phosphate is preferred to the official disodium or alkaline 
phosphate when it is desired to acidify the urine. 

The Hypophosphites are absorbed and excreted unchanged and, although 
originally introduced by Churchill because it was thought that they possessed 
a distinctly favorable influence upon nutrition, especially in tuberculosis, 
they have since been found to be physiologically inert. They are probably 
converted into phosphates in the stomach. 

The Glycerophosphates were introduced on the theory that they were 
superior to the inorganic salts and were more readily assimilated. The 
exact value of these preparations remains to be determined, although 
accumulating evidence would seem to indicate that they possess no great 
advantage. 

Therapeutics. 

Phosphorus is chiefly used to promote the nutrition of osseous and nervous 
tissue. It is useful in nervous exhaustion due to overwork, also in osteo- 
malacia and rachitis. Progressive pernicious anemia has sometimes been 
arrested by Phosphorus in very small doses, while in impotence of functional 
character there is no remedy so effective. In wakefulness of the aged and 
that due to cerebral anemia small doses of the pill or tincture are sometimes 
remarkably beneficial. In certain skin diseases (acne, psoriasis, lupus), it is 
an excellent substitute for arsenic. Neuralgia is often cured by Phosphorus, 
but large doses are necessary, at least gr. xV every four hours. 

Phosphoric Acid in the dilute form is employed as a refrigerant in fevers, 
and as a gastric tonic to weak anemic children with the view of improving 
the appetite and nutrition. It has been considered of value in strumous 
affections, but is of little real benefit, except as a feeble digestive stimulant. 



37 2 PHYSOSTIGMA. 

The Hypophosphites are gradually falling into disuse since it has been 
shown that not only are many of the claims of their beneficial action false 
but that they also pass through the body and are excreted in the urine 
unchanged. 

Sodium Phosphate in doses of 3 J — ij thrice daily for adults (gr. x-xxx for chil- 
dren) is extremely useful as a laxative in conditions depending on catarrh of 
the bile-ducts and duodenum, as headache, jaundice, and chalky stools. It 
is an efficient agent in obesity, incipient hepatic sclerosis, chronic infantile 
diarrhea, bilious sick-headache, and the pasty, white stools of ill-conditioned 
children. Vichy-water contains this salt in the proportion of gr. f to the 
pint, and is considered a valuable water in hepatic and kindred conditions. 

The Acid Sodium Phosphate may be used to acidify the urine, especially 
when it is alkaline and loaded with phosphates. It is a useful drug to acidify 
the urine prior to the administration of Hexamethylenamine which it will 
be recalled is active only in the presence of an acid urine in which it liberates 
formaldelryde and thus exerts its antiseptic action. 

Glycero-phosphoric Acid and its salts are said to accelerate metabolism and the nitrog- 
enous exchanges, to promote the assimilation of albuminoids, and to increase the excretion of 
nitrogen, the oxidation of broken-up sulphur compounds and the elimination of sodium chlo- 
ride. They may favor the assimilation of the phosphates of the food and so protect the com- 
bined phosphorus of the nervous system from waste (Robin). The acid is highly valued as a 
nervine remedy and has been used with benefit in neurasthenia, locomotor ataxia, phosphaturia, 
lithemia and muscular atrophy. The Iron salt is praised in anemia and chlorosis. 

PHYSOSTIGMA, Physostigma, {Calabar Bean)— -is the ripe seed of 
Physostigma venenosum, nat. ord. Leguminosae, a woody creeper of Calabar, 
West Africa, where it is used by the natives as an ordeal for witches, vomiting 
after its ingestion being held to establish the innocence of the accused. It con- 
tains the alkaloids, Physostigmine {Eserine), C 15 H 21 N 3 2 ; Calabarine, a tetan- 
izer like strychnine; and Eseridine, which acts like physostigmine but is less 
powerful. The two latter may be decomposition products of physostigmine, 
which is a very unstable body. Dose, gr. j-iij [av. gr. jss.] Physostigma should 
contain not less than 0.15 per cent, of alkaloids soluble in ether. 

Preparations. 

Extractum Physostigmatis, Extract of Physostigma, — an alcoholic extract, of which the 
usual dose is from gr. ^^g— | [av. gr. $.] 

Tinctura Physostigmatis, Tincture of Physostigma, — 10 per cent. Dose, ttjjv-xx [av. 

TTRXV.] 

Physostigminae Salicylas, Physostigmine Salicylate {Eserine Salicylate), — colorless, 
columnar crystals, of bitter taste and neutral reaction, soluble in 75 of water and in 16 of 
alcohol. Dose, gr. -^Q-fa [av. gr. -fa.] 

Physostigminae Sulphas, Physostigmine Sulphate {Eserine Sulphate) (Unofficial), — a 
white, microcrystalline powder, of bitter taste, very deliquescent in moist air, very soluble 
in water and in alcohol. Dose, gr. -rbo~zo [av. gr. -fa.] 

Incompatibles. 

Incompatible with Physostigma preparations are: Caustic Alkalies, Tannic Acid and 
other alkaloidal precipitants (see page 6). 



physostigma. 373 

Physiological Action and Therapeutics. 

Physostigma depresses the spinal motor centres and the respiratory centres 
in the medulla, producing loss of reflex action and increasing motor paralysis, 
but not directly affecting sensation or the cerebral functions. It stimulates 
secretion, excites nausea and vomiting, salivation and diaphoresis. It 
stimulates involuntary muscular fibre, especially that of the intestines, 
stomach and bronchial tubes, and is laxative by increasing intestinal peris- 
talsis and the intestinal secretions. Large doses produce tonic contractions 
which may interfere with the forward movement of the intestinal contents. 
It slows the heart by stimulating the peripheral terminations of the vagus, 
and increases the peripheral resistance by contracting the arterioles, raising 
the blood pressure. It contracts the pupils and causes spasm of accommoda- 
tion, by direct stimulation of the oculo-motor nerve endings, and diminishes 
intraocular tension. In its physiological action it is antagonistic to atropine 
upon secretion, the eye and smooth muscle fibre. Death occurs by paralysis 
of the respiratory centres in the medulla. It is rapidly absorbed, and is 
eliminated chiefly by the kidneys. 

The alkaloid Physostigmine represents the action of the drug in its effects 
on the spinal centres, the eyes, and the involuntary muscles. Calabarine stimu- 
lates the spinal cord like strychnine, and interferes with the action of physostig- 
mine when present in quantity, as it may be in old specimens of the bean. 
Eseridine acts similarly to physostigmine, but is much less poisonous. 

The applications of Physostigma are not many. It is efficient in consti- 
pation due to torpor of the bowels, in which condition it is usually combined 
with belladonna and nux vomica. It ought not to be used when inflamma- 
tion or obstruction is present. It is recommended by some surgeons for 
postoperative tympanites and the writer has seen several instances in which 
it seemed to do good when given in fairly large doses after all other methods 
had failed. It has not met with much success in the tympanites associated 
with the severe toxemia of acute infectious diseases as typhoid fever and may 
do harm by the depression induced by large and frequently repeated doses 
with which some are wont to use it. It is used with gratifying results in 
atony of the bladder and in some cases of emphysema and bronchial asthma. 
While theoretically antagonistic in poisoning by atropine or strychnine, 
practically, it is not of much value. 

Physostigmine (Eserine) is used locally by ophthalmologists for many pur- 
poses in affections of the eye. In a solution of gr. ij to the 5 of water dropped 
into the eye it is efficient in breaking up or preventing adhesions of the iris, 
diminishes intraocular tension, prevents suppuration after operations, contracts 
the pupil, diminishing the entrance of light in photophobia, and empties the 
vessels of the eye. It is very useful in keratitis, glaucoma, strumous ophthal- 
mia, and neuralgia of the eyeball. The salts of Physostigmine in neutral solu- 



374 PHYTOLACCA PICROTOXINUM. 

tion may be used for these purposes, as well as to counteract the effects of atropine 
on the pupil. Gelatin disks medicated therewith may be obtained in the shops, 
and are a convenient form in which to use the drug for ophthalmic purposes. 

PHYTOLACCA, Phytolacca (Unofficial),— is the dried root {Poke-root) of Phytolacca 
decandra, a plant of the nat. ord. Phytolaccacese, found in all parts of the United States. 
It contains a neutral principle Phytolaccin, and in acid Phytolaccic Acid, also tannin, starch, 
fixed oil, etc. Dose, as an alterative gr. j-v [av. gr. ij]; as an emetic gr. x-xxx [av. gr. xv.] 

Fluidextractum Phytolaccae, Fluidextract of Phytolacca (Unofficial), — Dose, as an alter- 
ative njfj-iv [av. ttjjjss]; as an emetic ttjx-xxx [av. tuxv.j 

Physiological Action and Therapeutics. 

Phytolacca is emeto-cathartic, acting slowly but persistently, with great nausea and 
considerable depression. It lowers the rate of respiration and of cardiac action, and is a 
motor depressant, paralyzing the spinal cord and the medulla, death occurring from paralysis 
of respiration preceded by tetanic convulsions. Several cases of poisoning by this plant 
have occurred. 

Phytolacca has long been known and used in a wide variety of conditions. It was 
suggested as a remedy for obesity as early as 1858 and a resinoid preparation of the berries 
is on the market as an "anti-fat" remedy, under the name Phytoline, the dose of which is 
ttjx six times a day, before and after each meal. The crude drug and its preparation, the 
fluidextract, were dropped from the last Pharmacopoeia and in therapeutics it has been re- 
placed by more efficient remedies. 

PICHI (Unofficial), — is the shrub Fabiana imbricata, a member of the nat. ord. Sola- 
naceae, and a native of S. America. Among the Chilians it is prized as a remedy in cystitis 
with calculi and gravel, and in chronic catarrh of the bladder. It is highly praised in dys- 
peptic disorders. Its medicinal virtues reside in oleoresinous constituents which are in- 
soluble in water. An extract is prepared from the leaves, of which the dcse is gr. v-x in 
capsules. Dose of the fluidextract, 3jj but it should not be added to water. 

PICROTOXINUM, Picrotoxin, Picrotoxic Acid, C 30 H 34 O 13 (Unofficial), 
— is a poisonous, neutral principle obtained from the seeds contained in the ber- 
ries {Cocculus Indicus, fish-berries), of Anamirta paniculata (Anamirta cocculus, 
Menispermum cocculus), a climbing shrub of the nat. ord. Menispermaceae, a 
native of the East Indies. The berries contain, besides Picrotoxin, a large 
quantity of fixed oil and other substances of less interest. In the shell are found 
Menispermin an alkaline principle, Paramenispermin which is neutral and crys- 
talline, and Hypopicrotoxic Acid. 

Picrotoxin occurs in colorless, flexible crystals, of bitter taste and neutral reaction, soluble 
in 240 of water and in 9 of alcohol, also in acids and in alkaline solutions. Dose by the stomach 
gr. -fto~i~oi cautiously. For hypodermic administration, a solution in water of gr. ij in 5j 
may be used, in doses of gr. ■^o~¥ 1 o °f tne principle, TTjjiv equalling gr. gV- 

Unofficial Preparations of Cocculus. 

Tinctura Cocculi, Tincture of Cocculus, — 1 in 8. Dose, nj>ij-xv. 
Fluidextractum Cocculi, Fluidextract of Cocculus. — Dose, igrj-iij. 
Planat's Tincture of Cocculus, — 1 in 4. Dose, njrj-v. 

Incompatibles. 

Acids are chemically incompatible. Chloral Hydrate, Morphine, and general Anesthetics 
are physiologically incompatible except to its depressant action on the heart and respiration. 



pilocarpus. 375 

Physiological Action. 

Picrotoxin at first stimulates and finally paralyzes the centres in the medulla 
oblongata, and somewhat excites the spinal cord. It stimulates the para- 
sympathetic system (i.e., cranio-sacral nerves — the oculomotor, chorda 
tympani, vagus and pelvic) centrally (Grunwald). The first symptoms of a 
physiological dose are vomiting, salivation, sweating, rapid respiration, mus- 
cular twitching, slowed pulse, and palpitation of the heart, followed by a period 
of stupor and unconsciousness. Then occurs a series of powerful convulsions, 
commencing in tonic spasms and quickly changing to clonic contractions of 
the jaws and limbs, during which respiration is interrupted and may cease al- 
together. The body temperature is raised, the reflexes are exalted, the heart 
is slowed, the arterial tension is increased, and the respiration, at first quick- 
ened, finally becomes slow and labored. Under a toxic dose the stimulant 
effects are rapidly followed by paralysis. Death occurs usually from asphyxia, 
due partly to the convulsions and partly to the final paralysis of the respiratory 
centres; in some cases from paralysis of the heart, which is arrested in diastole. 
The order, succession and character of the phenomena produced by Picrotoxin 
resemble in marked degree those of the epileptic paroxysm. Picrotoxin is 
poisonous to the lower forms of life, and is therefore powerfully antipara- 
sitic. 

Therapeutics. 

Picrotoxin is not used internally at the present time although formerly 
advocated in various nervous disorders, such as epilepsy, chorea, etc., and in 
the night sweats of phthisis and in dysmenorrhea. It has been replaced 
by more efficient remedies. Remedies for local use are sometimes ingested 
by mistake and serious poisoning results. Parasitic skin diseases are well 
treated by an ointment of Picrotoxin (gr. x to the 5) which will also kill 
pediculi, but it must be used cautiously and with special care to avoid an 
abraded surface. The tincture may be used undiluted as a wash to kill body- 
lice. Cocculus berries are used to stupefy fish, being thrown into ponds con- 
taining them. They are also employed to adulterate beer and porter in order 
to make these drinks more intoxicating. A decoction of the berries or Picro- 
toxin itself, is used for "knock-out" purposes by criminals, administered in 
beer or other intoxicating beverages. 

PILOCARPUS, Pilocarpus (Jaborandi), — the dried leaflets of Pilocarpus 
Jaborandi or of Pilocarpus micro phyllus, Brazilian plants of the nat. ord. 
Rutaceae, yielding on assay not less than 0.6 per cent, of total alkaloids. 
These include Pilocarpine, C11H16N2O2, a syrupy fluid, slightly soluble in 
water and forming salts, and I so pilocarpine, isomeric with pilocarpine, and 
Jaborine with an atropine action but present in too small amounts to exert 



376 PILOCARPUS. 

much influence. Pilocarpus also contains a volatile oil (Pilocarpene doH 16 ), 
a little resin, tannin, etc. Dose, gr. x-xlv [av. gr. xxx.] 

Preparation and Salts. 

Fluidextractum Pilocarpi, Fluidextract of Pilocarpus, — Dose, Ti£x-xlv [av. ttjjxxx.] 
Pilocarpinae Hydrochloridum,Pi/oca^we Hydrochloride, — colorless, translucent crystals, 

deliquescent in the air, very soluble in water or alcohol. Dose, gr. -^-\ [av. gr. \ by mouth, 

jfe by hypo.] 

Pilocarpinae Nitras, Pilocarpine Nitrate, — white, shining crystals, permanent in the air; 

soluble in 4 of water and in 75 of alcohol. Dose, gr. ^-f [av. gr. | by mouth, -^ by 

hypo.] 

Incompatibles. 

Incompatible with Pilocarpus are: Alkaloidal precipitants (see page 6), Calomel, Potassium 
Permanganate. Atropine is physiologically incompatible with pilocarpine. 

Physiological Action. 

Pilocarpus is a direct antagonist to atropine in its effects. It is a stimu- 
lant of the peripheral terminations of nerves supplying glands and involun- 
tary muscular fibre, subsequently paralyzing the latter. It is therefore a 
powerful diaphoretic and sialogogue, a cardiac depressant by stimulation of 
the vagus ends, also myotic, emetic, and under some circumstances aborti- 
facient. Its taste is hot and pungent. It causes prompt and profuse per- 
spiration (gix-xv in quantity) and salivation (5x-xxvij) after a preliminary 
flushing of the skin. The nasal, bronchial and lachrymal secretions are 
much increased, sometimes watery diarrhea occurs; the action of the heart 
at first increased is afterwards lowered, the arterial tension is reduced, and 
the temperature falls from i° to 4 F. Drowsiness, pallor, chilliness and 
debility succeed, and last several hours; the pupils are contracted and accom- 
modation is impaired; elimination of urea is greatly increased, but not the 
quantity of urine; the respiratory power is lowered and apnea may occur from 
increase of the bronchial mucus. Its active principle is rapidly absorbed, 
and is eliminated by the skin, the salivary glands and the kidneys, the 
effects passing off usually in from three to six hours. Children are less 
affected than adults by proportionate doses. It causes contraction of the 
bladder, uterus and spleen, in the latter case whether the organ is enlarged 
or of normal size. The desire to urinate, which is experienced after a full dose, 
is due to the drug causing contraction of the bladder. Pilocarpus is not a diu- 
retic, but tends rather to diminish the quantity of urine as a result of its power- 
ful diaphoretic action. 

Therapeutics. 

Pilocarpus is used with benefit in dropsies, especially the renal form, also 
in eclampsia of renal origin, in uremia, meningiti s and other inflammations 
of serous membranes, but is contraindicated when from any cause there is a 



PIMENTA PIPER . 377 

weak heart. In the acute and chronic forms of Bright's disease it has been 
used with advantage, but being very depressant it must be employed with 
great caution in this disorder. For alopecia it is the most efficient remedy 
known, stimulating the skin and improving the color and condition of the 
hair. In small non-diaphoretic doses it will sometimes relieve the almost 
intolerable itching which attends acute eczema and urticaria of generalized 
types. In agalactia it stimulates the secretion of milk, and it often gives 
prompt relief in parotitis. Ptyalism is frequently relieved by minute doses 
of Pilocarpine (gr. -g-$), which, acting specifically on the same gland, may 
correct its morbid action. Similar doses used thrice daily will check profuse 
perspiration, and are much more effective than Atropine or Potassium 
Chlorate in the mercurial salivation of syphilis, acting as a powerful glandular 
eliminant to remove the excess of mercury. The hypodermic use of Pilo- 
carpine will sometimes arrest a paroxysm of spasmodic asthma and is equally 
efficient in hiccough. Atropine-poisoning is best combated by the use of 
Pilocarpine hypodermically. 

In erysipelas it is often highly efficient, and for the purpose of breaking up 
a common cold it is one of the best agents at our command; For the latter 
purpose the fluidextract of Pilocarpus may be used in doses of TTLx— 3 j 
according to age, given at bed-time and repeated once or twice during the 
night if necessary. Children bear it well in all its physiological actions. 
Otologists resort to its use in chronic catarrhal otitis media and in labyrin- 
thine disease. 

Ophthalmologists employ Pilocarpine with most excellent results in the 
amblyopia of alcoholism and that from the abuse of tobacco, in detachment of 
the retina, chronic iritis, keratitis, glaucoma, hemorrhage into the vitreous, 
atrophic choroiditis, white atrophy, to promote resolution and absorption in 
inflammatory conditions with exudation, and instead of physostigmine as a 
myotic. Pilocarpine is highly efficient as an aid to sorbefacient remedies in 
removing inflammatory exudations and promoting the absorption of effusions. 
When iodides and mercurials are being used for these purposes their action is 
greatly aided by this drug administered occasionally for a few days at a time. 

PIMENTA, Allspice (Unofficial), — is the dried, nearly ripe fruit of Pimento, officinalis, 
a West Indian tree of the nat. ord. Myrtacese. The berries contain a Volatile Oil which is 
official, a green fixed oil, fat, tannin, gum, resin, etc. Dose, gr. x-xl [av. gr. xv.] 

Oleum Pimentae, Oil of Pimenta, — the volatile oil, colorless or pale yellow, of aromatic 
odor, pungent taste and slightly acid reaction. It contains Eugenol 65 per cent, (see under 
Caryophyllus, page 205); and is a constituent of Bay Rum. Dose, TTjjij— v [av. itjnij.] 

Allspice is a warm, aromatic stimulant, very useful as a condiment, improving digestion 
by increasing the vascularity of the gastric mucous membrane and by stimulating the salivary 
secretion. The oil is an agreeable remedy for flatulence, nausea, and intestinal colic, and is 
used to prevent the griping of purgatives and to cover the taste of nauseous medicines. 

PIPER, Pepper, (Black Pepper), — is the dried, unripe fruit of Piper nigrum, or Pepper- 
vine, a perennial plant of the nat. ord. Piperaceae, growing in India, Siam, Java, and Borneo. 
It contains Piperine, also a green, acrid, concrete oil, a balsamic volatile oil, starch, lignin, 
gum, extractive, etc. Dose, gr. v-xx [av. gr. vijss.] 



37^ PIPERAZINUM. 

Oleoresina Piperis, Oleoresin of Pepper, — contains almost all the volatile oil and acrid 
resin extracted by ether, with but little of the Pipeline. Dose, gr. J-j [aw gr. ss.] 

Piperina, Piperine, Ci 7 H 19 N0 3 , — a feeble base obtained from Pepper, and other plants 
of the Piperaceae. Occurs in colorless or pale-yellowish prisms, of neutral reaction, almost in- 
soluble in water, slightly so in ether, but soluble in 30 of alcohol. Dose, gr. j-x [av. gr. iij.] 

Piperidinum, Piper idin (Unofficial), — is produced by the hydrolysis of Piperine, or 
synthetically by reducing pyridine by nascent hydrogen. It occurs as a colorless, limpid liquid, 
and is a powerful base. The Acid Tartrate is a white, crystalline powder, readily soluble in 
water, the dose of which is gr. x-xv. 

Pepper when applied to the skin acts as an irritant, internally its effects are similar to those 
of other aromatics, being a warm carminative and stimulant, increasing slightly the action of 
the heart, stimulating the kidneys somewhat, and toning up the mucous membrane of the 
urinary and intestinal passages, by which channels it is eliminated. It has been thought to 
possess antiperiodic power, and was formerly much employed in intermittents. Its chief 
medicinal use is to correct flatulence, and to excite action of the stomach, being very commonly 
taken as a condiment with food. It is occasionally employed in gleet, but more extensively in 
hemorrhoids and other diseases of the rectum. Its active constituents are the concrete oil or 
resin and the volatile oil, Piperine having very slight action on the system except as an anti- 
periodic and antipyretic, qualities which it certainly possesses. 

Piperidin Tartrate increases the solvent power of serum for sodium biurate to a much 
greater extent than Piperazine, and has been employed as a solvent for gouty deposits, 
uric acid gravel and calculi. 

PIPERAZINUM, Piperazine, Diethylene diamine, C 4 HjoN 2 (Unofficial), — 
is a synthetical basic compound formed by the action of ammonia upon 
ethylene chloride; and occurs as a white, crystalline powder, soluble in water 
and liquefying when exposed to the air, from which it absorbs water and 
carbon dioxide. Dose of the base or its hydrochloride, gr. v-x. 

Incompatibles. 

Incompatible with Piperazine are Acetanilid, Acetphenetidin (Phenacetin), Alkaloidal 
salts, Alum, Butyl-chloral Hydrate, Chloral Hydrate, Copper Sulphate, Ferric Chloride, 
Ferrous Sulphate, Mercuric Chloride, Phenol, Phenocoll, Picric Acid, Potassium Perman- 
ganate, Quinine, Silver Nitrate, Solution of Arsenic and Mercury Iodide, Sodium Salicylate, 
Spirit of Nitrous Ether, Tannic Acid. 

Analogues. 

Lycetol, Dimethyl piperazine Tartrate (Unofficial), — is a uric acid solvent, which is said 
to combine the solvent properties of Piperazine with the alkalinizing and diuretic effects of a 
tartrate. The dose is gr. xv-xxx daily, administered in carbonated water or in the form of 
lemonade. 

Lysidin (Unofficial), — is a base obtained by the action of sodium acetate upon ethylene- 
diamine hydrochloride, and said to possess a solvent power on uric acid five times greater than 
that of Piperazine. It has been tried in cases of chronic gout with excellent results. The 
stiffness of the joints was lessened, and a conspicuous reduction occurred in the tophi around 
the joints, and on the epiglottis in one case. The dose is oss-3ijss of the 50 per cent, alkaline 
solution in a glassful of carbonated water. 

Sidonal, Piperazinae Quinas, Piperazine Quinate, — is prepared by heating Piperazin 
with quinic acid. It is a white, crystalline powder, very soluble in water and is said to be 
useful as a uric acid solvent. Dose, gr. xv-xx, five or six times daily, dissolved in water. 

Piperidin Tartrate, — a powerful solvent of sodium biurate, is described above, under 
the title Piper. 

Piperazine possesses the property of forming with uric acid in the test- 
tube a very soluble compound, piperazine urate being seven times more 
soluble in water than is lithium urate, the former requiring but 50 parts and 
the latter 368 parts of water for solution. It is non- toxic, and devoid of 



piscidia — pix. 379 

powerful physiological effects, being well borne without ill results, even when 
administered for prolonged periods. It is non-irritant to mucous membranes, 
is readily absorbed from the stomach, and circulates in the blood unchanged, 
reaching the parts affected by gouty deposits in a condition in which it is 
supposed to neutralize and dissolve the latter thus facilitating their removal 
from the body. 

The administration of Piperazine in gout promptly reduces the redness 
and swelling of the affected joints. The minimum daily dosage for this pur- 
pose is about 15 grains, which should be dissolved in half a pint of water, 
and the solution should be added to a pint or more of any convenient car- 
bonated water, and taken in divided doses through the day. It gives marked 
relief in the pruritus of the uric acid diathesis due to the irritation of imper- 
fect nitrogenous elimination. In solution it may be introduced into the 
bladder to relieve the vesical irritation due to an excess of uric acid in the 
urine. It may be locally employed by hypodermic injection, but this pro- 
cedure has not been found of value in the writer's practice and at times gives 
rise to considerable pain. A 1 per cent, solution, applied locally to open 
gouty sores, sometimes relieves the pain and reduces the inflammation. As 
a solvent for uric acid and urate concretions Piperazine has been highly 
praised by many observers and its efficacy disputed by many others. In 
practice it has not sustained the claims made for it, and being a proprietary 
preparation and high in price, it has fallen into disrepute. 

PISCIDIA, Jamaica Dogwood (Unofficial), — is the bark of the root of Piscidia erythrina, 
a tree of the nat. ord. Leguminosae, growing in the West Indies. It occurs as a tough, fibrous 
bark, of heavy, narcotic odor, and contains a yellowish, resinoid substance named Piscidin. 
Its active principle has not been isolated. A fluidextract is on the market, of which the dose 
is 5ss-j, carefully increased. 

Piscidia has a narcotic effect on many animals, and has been used in Jamaica for many 
years to stupefy fish, so that they may be easily taken. It produces muscular relaxation, inco- 
ordination of movement, lowered sensibility, increased action of the heart and increase of the 
arterial tension by stimulation of the vaso-motor centre. Soon however the heart is weakened, 
vascular tension falls, and a tetanoid state results from stimulation of the spinal cord, with 
reduced reflex action. On the brain its effects resemble those of Opium, but is causes deep 
sleep without any unpleasant after results. It relieves pain in less degree however than 
Opium does, but its hypnotic action is greater. It also relieves cough and spasm, produces 
diaphoresis and salivation and dilates the pupil. From toxic doses death occurs by asphyxia 
in animals. In man its action is probably the same, but in decidedly less marked degree. 

Piscidia is used chiefly as a general nervous sedative. Its hypnotic and anodyne powers 
are somewhat uncertain, but have in many cases been very decided. It is useful in whooping- 
cough and spasm, and has proved almost specific in many cases of neuralgia, while in others it 
has caused great gastric distress without the least anodyne effect. 

PIX, Pitch, — is a resinous exudation from the stems of certain trees of the 
genera Pinus (pines) and Abies (firs and spruces), and may also be obtained 
as a residue of the distillation of tar. Its chief constituents are Resin and a 
Volatile Oil which is a mixture of several isomeric terpenes in varying propor- 
tions. The only official form is — 

Pix Liquida, Tar {Pine Tar), — a product obtained by the destructive dis- 
tillation of the wood of Pinus palustris and other species of Pinus, nat. ord. 



380 PIX. 

Pinacea?. It is thick, viscid, semi-fluid, blackish-brown, of acid reaction, 
terebinthinate odor, and sharp, empyreumatic taste; slightly soluble in water, 
soluble in alcohol, in oils and in a solution of potassa or of soda. Its princi- 
pal constituents, are Oil of Turpentine, Creosote, Phenols, Pyrocatechin, 
Acetic Acid, Acetone, Xylol, Toluol, Methylic Alcohol, and Resins. By dis- 
tillation it yields an acid liquor, Pyroligneous Acid, and an empyreumatic oil 
(see Oleum Picis Liquidae below), the residue being pitch. Dose, gr. v-xx 
[av. gr. viij], in pill, up to 5ij daily. 

Pix Burgundica, Burgundy Pitch (Unofficial), — the prepared resinous exudation of 
Abies excelsa, the Norway Spruce, a native of Europe and Northern Asia. It occurs in 
hard, brittle, opaque or translucent mass, with a shining, conchoidal fracture, almost 
entirely soluble in glacial acetic acid; is very fusible, and at the body-heat it softens and 
becomes adhesive. It is mildly stimulant to the skin, and is used as a basis for plasters. 

Pix Canadensis, Canada or Hemlock Pitch (Unofficial), — is the prepared resinous exu- 
dation of Abies canadensis, the Hemlock spruce of the U. S. and Canada. Its properties are 
much the same as those of Burgundy Pitch. 

Preparations. 

Oleum Picis Liquidae Rectificatum, Rectified Oil of Tar, — a rectified volatile oil distilled 
from Tar. Dark, reddish-brown (almost colorless when fresh), of tarry odor and taste and 
acid reaction, readily soluble in alcohol. Dose, irgj-v [av. TTjjiij.] 

Syrupus Picis Liquidae, Syrup of Tar, — has of Tar £ per cent.; and is a sweetened Tar- 
water. Dose, 5ss-ij [av. 5j.] 

TJnguentum Picis Liquidae, Tar Ointment, contains of Tar 50 Parts, Yellow Wax 15, 
Lard 35. Is irritating unless mixed with finely levigated chalk. 

Oleum Pini Pumilionis, Oil of Dwarf Pine Needles, — a volatile oil distilled from the 
fresh leaves of Pinus montana, nat. ord. Pinacea. It is a colorless, or faintly yellow oil, of 
pleasant, aromatic odor and bitter, pungent taste. Dose, T&j-v [av. TTjuij.] 

Infusum Picis Liquidae, Tar Water (Unofficial), — made by shaking Tar 1 with Water 4 
frequently during 24 hours, decanting and filtering. Dose, Oss-j daily. 

Vinum Picis Liquidae, Wine of Tar (Unofficial), — Tar §xvj, Glycerin, White Wine, 
Honey, aa § viij, Acetic Acid o j, Boiling Water Ovj, shaken together and digested in a closed 
vessel for two hours at 150 to 160 F., then macerated for a few days, frequently shaken, 
strained and filtered. Dose, 3j-iv. 

Oleum Pini Sylvestris, Oil of Scotch Fir (Unofficial), — a colorless, fragrant oil, distilled 
from the leaves of Pinus Sylvestris, resembling Turpentine in action. Used by inhalation 
(3ss to Oj of boiling water), or locally. 

Apinol, Apinolum (Unofficial), — a clear, amber colored oil, with a pine odor obtained 
from the wood of Pinus palustris and Pinus australis by destructive distillation. It con- 
sists mainly of laevomenthone, CioHi 8 0. It is antiseptic, local anesthetic and expectorant. 
Dose, tt£v-xv with cane sugar as a menstruum. 

Physiological Action and Therapeutics. 

Tar is a complex mixture of resins and hydrocarbons, containing creosote 
and phenol, which give it irritant qualities. Internally it is expectorant, and 
produces gastro-intestinal irritation, sometimes severe headache, giddiness and 
febrile phenomena. It is eliminated chiefly by the kidneys, which it stimulates 
and may congest, causing increased diuresis. Externally it is a decided stimu- 
lant to the skin, often giving rise to considerable irritation and pain. It is anti- 
septic and in most of its effects it resembles the turpentines. Tar is used as 



PLANTAGO PLUMBUM. 381 

a local application in chronic scaly skin diseases, especially psoriasis and chronic 
eczema. As an atomized inhalation it is of decided benefit in bronchitis, pharyn- 
gitis, laryngitis and winter cough. Internally it may be employed with advan- 
tage in these affections; the best preparation for this purpose is the syrup, 
which is a sweetened tar- water, the sugar forming with the tar a soluble 
compound. 

Burgundy Pitch has been dismissed from the pharmacopoeia, its place as 
a basis for plasters being now taken by Lead Plaster. It is a gentle rubefacient 
when applied to the skin, but in some persons if used extensively it causes a 
vesicular and pustular inflammation. Locally as a plaster it is beneficial in lum- 
bago, chronic rheumatism, chronic pleurisy, painful joints, and superficial 
neuralgia, protecting the part from variations of temperature, and perhaps by 
gentle pressure stimulating the lymphatics and promoting absorption. A vol- 
atile oil from the Hemlock Spruce has been used as an abortifacient, with dan- 
ger to the life of the subject. Oil of Pine is frequently added to the oily 
sprays prescribed in rhinitis and pharyngitis and is useful as an inhalant with 
hot water to allay the irritation in laryngitis and bronchitis of a subacute or 
chronic nature. A few drops upon the "ether cone" will lessen the irrita- 
tion and amount of mucus during anesthesia. It is also used internally 
as an expectorant and locally to the back in lumbago and joints of chronic 
rheumatism. 

PLANTAGO, Plantain (Unofficial), — is the leaf of Plantago major and Plantago lanceo- 
lata, nat. ord. Plantaginaceae, the common ribbed grass. The pounded leaves applied as a 
paste or the dry leaf powdered, are actively hemostatic, stopping hemorrhages speedily. 
Among the ancients it had a good reputation as a remedy for toothache and earache, which still 
adheres to it in Switzerland and other parts of Europe. In many other painful affections 
it was formerly much used, especially in mastitis, rhus-poisoning, erysipelas, burns, scalds, 
wounds and bruises. A poultice of the leaves may be applied to the affected part, and an 
infusion administered internally. A fluidextract is sold in the shops, of which the dose is 
ngv-xv. 

PLUMBUM, Lead, Pb, — is a soft solid metal, which occurs in nature chiefly 
as a sulphide (galena), also as carbonate, phosphate and sulphate, and as an 
oxide rarely. It resists the action of air, some strong acids, and pure water 
free from air, but aerated water oxidizes and dissolves it in small quantity. 
Its official salts are as follows: — 

Plumbi Acet8LS,Lead Acetate, (Sugar of Lead), — Pb(C 2 H 3 2 ) 2 4- 3H 2 0, — colorless, shining, 
prismatic crystals or scales, efflorescent, of faintly acetous odor and acid reaction, and a sweet- 
ish, astringent and metallic taste. Soluble in 1.4 of water and in 38 of alcohol, in 0.5 of 
boiling water and in 1 of boiling alcohol Dose, gr. ss-ij [av. gr. j.] 

Plumbi Oxidum, Lead Oxide, (Litharge), PbO, — a heavy, yellowish, or reddish-yellow 
powder, odorless and tasteless; insoluble in water or alcohol, almost but wholly soluble with 
slight effervescence in dilute nitric acid. When heated in contact with charcoal it is reduced 
to metallic lead. Used as Plaster and sometimes with oil as an external application. 

Preparations. 

Liquor Plumbi Subacetatis, Solution of Lead Subacetate (Goulard's Extract), — an 
aqueous solution containing lead subacetate corresponding to not less than 18 per cent. 



3S2 PLUMBUM. 

of Pb, prepared from Acetate of Lead 18, Oxide of Lead 11, and Distilled Water to 100. 
It is a clear, colorless liquid, of sweetish, astringent taste and alkaline reaction, and when 
added to a solution of acacia it produces a dense, white precipitate (distinctive from normal 
lead acetate). Used locally as an astringent and cooling lotion, diluted usually with an 
equal quantity of water. 

Liquor Plumbi Subacetatis Dilutus, Diluted Solution of Lead Sub acetate, (Lead Water), — 
has of the preceding 4, in Distilled Water to 100. Used locally as a mildly astringent and cool- 
ing lotion. 

Emplastrum Plumbi, Lead Plaster, — has of Lead Oxide 100, Olive Oil 100, Lard 100 and 
water q. s. It is used in the preparation of the official Emplastrum Resinse and Unguen- 
tum Diachylon. 

Emplastrum Resinae, Rosin Plaster, (Rosin Adhesive Plaster), — consists of Powdered 
Rosin 14, Lead Plaster 80 and Yellow Wax 6. 

Unguentum Diachylon, Diachylon Ointment, — has of Lead Plaster 50, White Petrolatum 
49, Oil of Lavender 1. Used locally in eczema and other cutaneous disorders. 

Unguentum Plumbi Carbonatis, Ointment of Lead Carbonate (Unofficial), — has of the 
Carbonate in very fine powder 10, Benzoinated Lard 90. Used as a dressing for burns. 

Incompatible with Lead Salts are: Alkalies, Mineral Acids and their salts, Albuminous 
solutions, Opium, Potassium Iodide, Vegetable Acids, Vegetable Astringents, Waters con- 
taining lime, sulphates, carbonates, and carbonic acid gas. With Lead Acetate are: Acids, 
Alkalies, Bromides, Carbonates, Chloral Hydrate, Chlorides, Chromates, Cyanides, Glu- 
cosides, Gums, Hydrochloric Acid, Iodides, Opium, Phenol, Pyrocatechin, Pyrogallol, 
Resorcinol, Salicylic Acid, Sodium Phosphate, Sodium Salicylate, Sulphates, Sulphides, 
Sulphites, Tannic Acid, Urea, Urethane, Vegetable decoctions, infusions and tinctures. With 
Solution of Lead Subacetate are: Acacia, Acids (organic), Albumin, Alkaloids, Antipyrine, 
Glucosides, and otherwise like Lead Acetate. 



Physiological Action and Therapeutics. 

Lead salts are all more or less poisonous, but metallic Lead is inert until 
converted into a soluble salt by the acids of the stomach. The Acetate in large 
doses is emetic, so that acute lead-poisoning therefrom is rare. Its chief 
phenomena are intense gastro-intestinal irritation, vomiting, paralysis, coma and 
collapse. Chronic lead-poisoning, Plumbism, is the commonest of all forms 
of metallic poisoning and has its source in many trades notably painters and 
workers in white lead, plumbers, potters and those engaged in the handling 
of printing-type, and working in the smelting of lead ores. It has also re- 
sulted from the use of hair dyes, cosmetics, canned foods and many almost 
inconceivable ways. It produces loss of appetite, emaciation, pallor and 
constipation, followed by slowing of the heart's action, and accompanied by 
violent colic, muscular impairment evinced by paralysis of the extensor mus- 
cles of the forearm (drop-wrist), impaired sensibility and albuminuria. Oc- 
casionally aphonia, vertigo, gastralgia, headache, stupor and convulsions are 
manifested. Arthritis without fever or tenderness in the joints, which, how- 
ever, are red and swollen, is a frequent symptom. A blue line (sulphide) is 
seen along the margins of the gums in those who do not clean their teeth. 
Neuralgic troubles may arise and amblyopia often occurs from impairment 
of the optic nerve. The metal becomes deposited in the affected muscles 
and other tissues, and probably acts by impairing the isolating power of the 
nerve-fibres, thus enfeebling the nerve-currents. It also produces contrac- 



PLUMBUM. 383 

tion of the smaller vessels, and may affect any muscles of the body, also the 
brain, producing delirium, coma, and convulsions. Abortion is a frequent 
result, either through an influence on the muscular tissue of the uterus, or from 
a toxic action on the fetus. Death may occur from extension of the paresis 
to the muscles of respiration, from gradual impairment of nutrition, or from 
convulsions and coma, a form of disease known as Lead-encephalopathy. 

Astringency is the chief quality of the lead salts; they lessen secretion, con- 
tract muscular tissue and then destroy its contractile power, slow both the 
heart and the respiration, and in time destroy the red blood-corpuscles. The 
red cells contain granules which stain with the basic dyes, a condition which 
although present in other diseases is a rather constant feature in Chronic 
Plumbism, persisting throughout the whole course of the poisoning and dis- 
appearing with recovery. Lead enters the blood as an albuminate, in which 
form it is retained by the tissues. It is slowly excreted by the liver, kidneys, 
skin and mammary glands. That which escapes by the bile is reabsorbed 
by the bowel, and is again excreted by the intestinal glands, escaping with 
the feces as a sulphide. It lessens the excretion of uric acid. 

Lead salts are chiefly used as astringents and hemostatics. The solution 
of the Subacetate diluted with 4 parts of glycerin and water is locally employed 
in many skin-diseases, especially in eczema, lichen, impetigo, and erythema; 
also in catarrhal discharges of muco-purulent character from the ear, vagina, 
and urethra, particularly gonorrhea and leucorrhea. Inflammations of ex- 
ternal parts are constantly treated by the lotion of Leadwater and Laudanum 
("L andL") (liquor plumbi subacetatis dilutus 7 parts to 1 of tinctura opii). 
The undiluted solution is more efficient in the strength of 4 parts to pint of 
water with 1 part of Laudanum. Though the constituents of this lotion are 
chemically incompatible it is a valuable sedative. It should not be used if 
the skin is broken as absorption may occur and healing of the wound is 
hampered by reason of its constringent action (Hare). The Acetate, in 
2-grain doses every three hours, is an efficient internal styptic in various 
hemorrhages, particularly in hematemesis and gastric ulcer. Its astringent 
action is well manifested in diarrheas, gr. ij with gr. j of powdered opium in 
choleraic diarrhea, and smaller doses for the summer complaint of children. 

The Carbonate is used only externally to protect irritated surfaces, as ery- 
thema, erysipelas, and intertrigo, in which it may be dusted over the surface 
if unbroken. The unofficial ointment, or white paint mixed with linseed oil, is 
an excellent application to burns or scalds, but if applied on the broken cuticle 
it may prove rapidly poisonous. The Iodide is employed externally as an oint- 
ment to enlarged lymphatic glands and enlarged spleen, also for chronic eczema 
and psoriasis. 

The Nitrate is an efficient application to fissured nipples, gr. x to 5 j of glyc- 
erin. In powder, dusted over unhealthy granulations, and sanious ulcers 
resulting from onychia, it gives prompt relief after a brief period of pain. In 



3 $4 PODOPHYLLUM POLYGONUM. 

solution (gr. x to the 5) it is a most efficient deodorizer against the fetor 
from gangrenous sores, ozena and other offensive discharges. The Oxide is 
employed in the manufacture of plasters and most of the other salts of lead. 
It may be used as an external application mixed with sweet oil in superficial 
burns, but care should be taken that it is applied only to the unbroken 
cuticle. It is not employed internally. 

PODOPHYLLUM, Podophyllum (May Apple),— -is the dried rhizome and 
roots of Podophyllum peltatum, the Mandrake, an herbaceous perennial of 
the nat. ord. Berberidaceae, growing in the woodlands of Canada and the 
United States, having a pale-green stem, with a single white flower at its 
summit. Its active principle is a Resin named Podophyllin, which is official 
and contains two isomeric glucosides, Podophyllotoxin and Picro podophyllin; 
also podophyllinic acid and protocatechuic acid. Podophyllum should con- 
tain not less than 3 per cent, of Resin when assayed by the official process. 
Dose, gr. v-xx [av. gr. vijss.] 

Preparations. 
Fluidextractuin Podophylli, Fluidextract of Podophyllum, — Dose, ttjj-xx [av. irjrvaij.] 

Resina Podophylli, Resin of Podophyllum (Podophyllin), — is prepared by maceration and 
percolation in alcohol, and precipitation by acidulated water. It is an amorphoric powder. 
Soluble in alcohol, ether, chloroform, and solutions of soda or potassa. Dose, as a laxative ; 
gr- :fV-i [av. gr. f]; as a purgative, gr. |-j [av. gr. £.] 

Pilulae Podophylli, Belladonna et Capsici, Pills of Podophyllum, Belladonna and 
Capsicum (Unofficial), — have in each pill gr. \ of the resin, with Extract of Belladonna gr. 
i, and Capsicum gr. £. Dose, j-ij pills [av. j.] 

Podophyllum is a tonic-astringent and resin-bearing purgative, having action 
similar to that of jalap but slower, like calomel taking 6 to 10 hours to produce 
its cathartic effect. It is said to be useful when the stools are dark in color 
and calomel when they are light colored. It increases the intestinal secre- 
tions and the flow of bile, causing copious watery stools, with considerable 
griping pain and some nausea. The powder is irritant to the respiratory 
passages and to the skin. The Resin is an excellent purgative in cases of 
habitual constipation or portal congestion and a useful cholagogue. Laxa- 
tive effects are produced by small doses but grain-doses are necessary for its 
full action. It should be combined with hyoscyamus or belladonna, in order 
to counteract its griping tendency. It is an efficient derivative in cases of 
catarrhal or malarial jaundice, and is recommended in very small doses for 
bilious vomiting and headache, and in the vomiting and diarrhea of gastro- 
enteritis. In children with summer diarrhea associated with watery, foul- 
smelling, musty stools and in adults with chronic diarrhea of the same type 
small doses (gr. -fa—M every two hours will be found beneficial when other 
remedies have failed. 

POLYGOOTM, Smart-weed, Water-pepper (Unofficial),— is the plant Polygonum Hydro 
ipperoides, nat. ord. Polygonaceae, indigenous to the United States, having narrow lanceolated, 



PONGAMIA — POTASSIUM. 385 

leaves and slender spikes of whitish flowers. It contains Tannin and an active principle, 
Polygonic Acid, which is green, crystallizable, insoluble in water, but soluble in alcohol, ether, 
and chloroform. Dose, of the Extract, gr. j-v; of the Fluidextract, tt^x-xxx or more. 

Smart-weed has a pungent, acrid taste, producing a sensation of heat in the stomach, and 
a peculiar tingling throughout the system. It stimulates the action of the heart, raises the 
arterial tension, increases the warmth of the surface, promotes the cutaneous, bronchial and 
renal secretions and the menstrual flow. It is diuretic, emmenagogue and aphrodisiac. 
The juice applied to the skin excites inflammation and vesication. 

Amenorrhea from functional inactivity of the uterine system is benefited by this 
remedy in 5ss doses of the fluidextract four times daily for a week before the expected 
period. It has considerable influence over functional impotence, but produces aching pains 
in the hips and loins, and a sense of weight and fullness within the pelvis. It has been used 
with benefit in diarrhea, dysentery and gravel, also locally in mercurial salivation and the sore 
mouth of nursing women. 

PONGAMIA, Kurung Oil (Unofficial), — is a yellow oil expressed from the seeds of 
Pongamia glabra, an Indian tree of the nat. ord. Leguminosae. It has been used for many 
years in India for skin affections, and in professional hands has proven an excellent application 
in pityriasis versicolor, rubbed in twice daily. It promises to be a valuable remedy in parasitic 
diseases of the skin, is not irritating and does not discolor the surface to which it is applied. 

POTASSIUM, Kalium, K, — is represented by a number of official salts, 
which are colorless or white, sometimes anhydrous, and generally soluble in 
water. The metal itself is not official. The chief source of its salts is the ash 
remaining after the combustion of plants or trees, which contains the Carbonate, 
from which most of the other salts are prepared. There are also two subsidiary 
sources, — the Nitrate, found native, and the Bitartrate, which under the name 
of Crude Tartar or Argol is deposited during the fermentation of wine. It is 
distinguished from all other bases (except magnesium, sodium and ammonium) 
by not being precipitated by ammonium sulphide or ammonium carbonate. 
It is positively known by the violet color it imparts to flame, by its very sparing 
solubility when converted into the bitartrate, and by its precipitation by platinum 
perchloride. 

Potassium Salts and their Preparations. 

Potassii Hydroxidum, Potassium Hydroxide, Potassa, KOH, — a very deliquescent, 
' white, hard and dry solid, of very acrid and caustic taste and strongly alkaline reaction, soluble 
in 0.9 of water and in 3 of alcohol. It is a powerful and deeply-acting escharotic, and should 
be kept in well-stoppered bottles made of hard glass. 

Potassa cum Calce, Potash with Lime (Vienna Paste), — is an unofficial preparation, made 
by rubbing together equal parts of the preceding and unslaked lime. Used as a caustic. 

Liquor Potassii Hydroxidi, Solution of Potassium Hydroxide, Liquor Potasses, — is an 
aqueous solution, containing not less than 4.5 per cent, of the hydroxide, and prepared by 
dissolving 6 of the latter in 95 parts of distilled water. It is a clear, colorless, odorless 
liquid, of acrid and caustic taste, and strongly alkaline reaction. Dose, njjv-oss [av. 
ttjjxv], well diluted with water. 

Potassii Acetas, Potassium Acetate, KC 2 H 3 2 , — a white, satiny, crystalline mass, very 
deliquescent, odorless, of pungent, saline taste, and alkaline reaction, soluble in 2.9 of water 
and in 0.5 of alcohol. Dose, gr. v-5 j [av. gr. xv.] 

Potassii Carbonas, Potassium Carbonate, K 2 C0 3 , — a white, crystalline or granular pow- 
der, very deliquescent, odorless, of alkaline taste and reaction, soluble in 0.9 of water, in- 
soluble in alcohol. Dose, gr. ij-xx [av. gr. xv.] 

Potassii Bicarbonas, Potassium Bicarbonate, — KHC0 3 , — colorless prisms of saline and 
alkaline taste and alkaline reaction, soluble in 2.8 of water, decomposed by boiling water, 
almost insoluble in alcohol. Dose, gr. v-xlv [av. gr. xv.] 

Potassii Chloras, Potassium Chlorate, KCIO3, — colorless prisms or plates, of pearly 
lustre, of cooling, saline taste and neutral reaction, soluble in 11.5 of water and in 1.8 of 

25 



386 POTASSIUM. 

boiling water; slightly soluble in mixtures of alcohol and water, insoluble in absolute alcohol. 
Dose, gr. j-x [av. gr. iv.] 

Potassium Chlorate should be kept in glass-stoppered bottles, and great caution should 
be observed in handling the salt, as dangerous explosions are liable to occur when it is mixed 
with organic matters (cork, tannic acid, sugar, etc.), or with sulphur, antimonium sulphide, 
phosphorus, or other easily oxidizable substances, and either heated directly or subjected to 
trituration or concussion. It should not be mixed with glycerin in the presence of a free acid. 

Gargarysma Potassii Chloratis, Potassium Chlorate Gargle (Unofficial), — has of the 
salt 5j, in Glycerin 3iv and Water to §vj. 

Trochisci Potassii Chloratis, Troches of Potassium Chlorate, — each troche contains about 
2J grains of the salt, with sugar and tragacanth. Dose, j-iij, slowly dissolved in the mouth. 

Potassii Citras, Potassium Citrate, K 3 C 6 H 5 7 + H 2 0, — transparent, prismatic crystals, 
odorless, of cooling, saline taste, and alkaline to litmus in reaction soluble in 0.6 of water, 
very soluble in boiling water, sparingly soluble in alcohol. Dose, gr. x-xxx [av. gr. xv.] 

Potassii Citras Effervescens, Effervescent Potassium Citrate, — consists of the Citrate 20, 
Sodium Bicarbonate 47.7, Tartaric Acid 25.2, and Citric Acid 16.2. Dose, 5j-ij [av. 5j], in 
a glass of water, as an effervescing drink. 

Liquor Potassii Citratis, Solution of Potassium Citrate {Neutral Mixture), — contains 
about 8 per cent, of the anhydrous salt, together with small amounts of citric and carbonic 
acids. Prepared by dissolving Citric Acid 6, and Pot. Bicarb. 8, each in water 40, filtering the 
solutions separately, and adding in each case enough water to bring to 50 parts, then mixing 
the two together. Dose, §ss-S j or more [av. 3iv]. 

Potassii Nitras, Potassium Nitrate {Saltpetre, Nitre), KN0 3 , — colorless, transparent 
prisms or a crystalline powder, of pungent, cooling and saline taste and neutral reaction; 
soluble in 2.8 of water and in 0.5 of boiling water; almost insoluble in alcohol. Dose, gr. 
v-xx [av. gr. viij.], well diluted. 

Potassii Silicas, Potassium Silicate, Soluble Glass, K 2 Si0 3 (Unofficial), — is used in solution 
of a syrupy consistence for the preparation of immovable dressings for fractured limbs, etc. 
[See under Silicates.] 

Potassii Bitartras, Potassium Bitartrate {Acid Tartrate of Potash, Cream of Tartar), 
KHC 4 H 4 6 , — colorless rhombic crystals, or a white, gritty powder, of acidulous taste and acid 
reaction; soluble in about 155 of water, and in about 16 of boiling water, very slightly 
soluble in alcohol. Is a constituent of Pulvis Jalapae Compositus. Dose, as a diuretic, 
gr. xx-3j [av. gr. xxx]; as a purgative Bss-j. 

Potassii et Sodii Tartras, Potassium and Sodium Tartrate {RochelleSalt), KNaC 4 H 4 6 - 
+ 4H 2 0, — colorless, rhombic crystals, or a white powder, of cooling and slightly saline and 
bitter taste, and alkaline to litmus in reaction; soluble in 0.9 of water, very soluble in boil- 
ing water, almost insoluble in alcohol. Is a constituent of the following preparation. Dose, 
5j-iv [av. 5ijss.] 

Pulvis Effervescens Compositus, Compound Effervescing Powder, Seidlitz Powder, — 
each powder has of the preceding salt about 120 grains, of Sodium Bicarbonate 40 grains, 
mixed in blue paper; and of Tartaric Acid 35 grains in white paper. Dose, 1 to 2 pair, 
dissolved separately in water and the solutions poured together. 

The Arsenite is described under Arsenum, — the Bromide under Bromum, — the Iodide 
under Iodum, — the Hypophosphite under Phosphorus, — the Permanganate under 
Manganum. 

Incompatibles. 

Incompatible vnihLiquor Potassii Hydroxidi are: Acids, Acid salts, Metallic salts; _ Prepa- 
rations of Ammonia, Belladonna, Hyoscyamus, and Stramonium. With Potassium and 
Sodium Tartrate are: Acids, Ammonium Chloride, Barium salts, Calcium salts, Lead salts, 
Magnesium Sulphate, Potassium Sulphate, Silver Nitrate, Sodium Sulphate. With the 
Acetate are: Mineral Acids. With the Carbonate and Bicarbonate, see page 201. With the 
Chlorate, see above Potassium Chlorate, also under Chlortjm. With the Citrate, see under 
Limon. With the Nitrate see under Ac. Nitricum. With the Sulphate see under Ac. Sul- 

PHTJRICUM. 

Physiological Action. 

Potassium Hydroxide, like other caustic alkalies, destroys the tissues by 
combining with their water, dissolving the albumin and saponifying the fats, and 



POTASSIUM. 387 

converting the tissue to which it is applied into a moist, gray slough, with con- 
siderable surrounding inflammation. Internally it acts as a powerful corrosive 
poison, destroying the mucous membrane of the parts with which it comes in 
contact, and giving rise to intense pain, diarrhea, convulsions and delirium. 
Unless speedily rejected or neutralized it causes death from inflammation of 
the larynx, from the gastro-intestinal lesions, or after some time from stricture 
of the esophagus. Liquor Potassii Hydroxidi, containing over 5 per cent, of 
the hydroxide, possesses in a degree the same caustic properties, and should 
never be administered undiluted. It neutralizes the acids in the stomach, 
and in the blood exists chiefly as the carbonate, being eliminated with the urine 
which it renders alkaline. If its use be continued too long it impairs the blood, 
and renders the subject anemic. 

Potassium Salts in medicinal doses act chemically on the contents of the 
stomach, neutralizing its free acids, and disordering digestion if long admin- 
istered. They increase the saliva, promote oxidation, and stimulate the retro- 
grade metamorphosis of the body, and are therefore waste-producers. In large 
dose they are cardiac depressants, paralyzant to muscular tissue, poisonous 
to protoplasm especially nerve tissue, and injurious to the ozonizing function 
of the blood. The Bicarbonate, taken on an empty stomach, enters the blood 
unchanged, meets the neutral phosphate of sodium and is decomposed, acid 
phosphate of sodium being formed which renders the urine more acid. On a 
full stomach it is decomposed by the acids of the gastric juice, increases the 
alkalinity of the blood and makes the urine less acid. The salts of potassium 
with vegetable acids enter the blood in their own form, are there decomposed, 
forming free C0 2 , and are converted into alkaline carbonates, in which form 
they are eliminated, alkalinizing the blood and the urine. They are diuretics 
also, increasing the urinary water and solids, but decreasing the uric acid by 
causing increased oxidation. The mineral salts are not decomposed in the 
blood, but are eliminated in their own form, the Nitrate being a most active 
diuretic, the Chlorate often irritating the kidneys, depressing the heart, caus- 
ing albuminuria, and impairing the ozonizing function of the blood. In large 
doses these salts decompose the red blood-corpuscles and paralyze the motor 
ganglia of the heart. The Chlorate does not part with its oxygen in the system, 
as formerly believed. The Sulphate is chiefly purgative in its action, but acts 
harshly, and in overdoses has caused death. 

The action of the remaining Potassium salts is described under the titles 
of their acid and other constituents, to which their effects are chiefly 
referable. 

Therapeutics. 

Potassium Hydroxide is used locally to destroy morbid or cicatricial tissue, 
to cauterize the wounds resulting from bites of animals or stings of insects to 
form issues or to open deep-seated abscesses, or to destroy chancres, malignant 
pustules, nevi, and warts. • 



388 POTASSIUM. 

Liquor Potassii Hydroxidi is used internally as a free alkali to neutralize 
excess of acid in the stomach, blood and secretions, and as an antilithic in the 
uric acid diathesis, also for acne, boils, and obesity. Locally it is employed 
to soften the nail in in-growing toe-nail, and diluted to relieve pruritus and to 
remove scales in various skin-diseases. The Carbonate is diuretic, antacid 
and antilithic, but is seldom used internally being too irritant, and the Bicar- 
bonate having all its virtues without its objectionable qualities. Locally a 
solution (3j to the 5) is said to be effectual as a remedy for pruritus vulvae, 
and one of half the above strength is used in freckles, sunburn and tan of the 
epidermis, in moist eczema and the itching of urticaria. 

The Bicarbonate is the most frequently used alkaline carbonate. It is 
employed internally and well diluted for its sedative effect on the stomach to 
relieve the pain and eructations of gastric dyspepsia, to correct hyperacidity, 
and in gastric catarrh to render the mucus less viscid and more easily expelled. 
For its effects after absorption it is used in diabetes, gout and rheumatism, 
to neutralize free acid in the tissues and thereby economize the alkalies of the 
blood; in cystitis and gonorrhea, to correct excessive acidity of the urine and 
soothe the inflamed surfaces; in gall-stones and jaundice, to lessen duodenal 
irritation; and in bronchitis and bronchial catarrh, to promote expectoration. 
Some practitioners rely on it as a febrifuge, and commend it highly in fevers. 
Locally it is employed as a lotion for acne, acute eczema, and fetid perspir- 
ation of the feet and axillae. 

The Acetate and Citrate are good purgatives in doses of 5ij to 5i y > and in 
smaller doses are employed as alkalinizers of the blood and urine and as diu- 
retics. Of the vegetable potassium salts the Acetate is the most certain diu- 
retic, and also promotes the flow of bile, the Bitartrate is the most active ca- 
thartic, while the Citrate is the most reliable diaphoretic and the best to alkalin- 
ize the urine, it having the least injurious effect on the blood and on the diges- 
tion. In lithemia the first and last of these salts are given to promote oxida- 
tion, and by keeping the urine alkaline they may reduce small calculi of the 
uric acid variety. In acute rheumatism and fevers they act as antacids in the 
blood, as febrifuges by promoting diaphoresis, and as sedatives to the general 
nervous system. As an agreeable laxative no preparation surpasses the Bi- 
tartrate in 2 to 4 drachm doses made into a paste with orange marmalade or 
any other conserve. It is used as a diuretic in general cardiac dropsy and in 
acute desquamative nephritis. In cases of acute dysentery with scorbutic 
symptoms, as seen among miners and sailors, a full purgative dose of this salt 
(§ss or more) has acted most beneficially as a preliminary to other treatment, 
and in many cases has proven to be the only remedy required. In the acute 
diarrhea of soldiers it is usually promptly curative. Being an acid salt its 
internal administration will in many cases acidify an alkaline urine. Locally 
in powder as a dressing it is an efficient antiseptic and absorbent, especially 
useful in the treatment of carbuncle. 



POTASSIUM. 389 

Potassium Chlorate is employed locally in solution (3ss to the 5) as a deo- 
dorant and detergent wash in inflamed, ulcerated and aphthous conditions of 
the mouth. On unhealthy mucous membranes it exercises an alterative action 
for the better, but if long used it will keep up a state of chronic irritation. In 
mercurial salivation it is of benefit, and in dilute solution (gr. x to the 5 ) is an 
efficient application to unhealthy sores and ulcers, as a wash for foul sinuses 
or cavities, and as an injection in chronic affections of the bladder. The pow- 
dered salt may be applied to aphthae, and dusted over epithelioma will alter the 
action, diminish the pain, check the growth and promote cicatrization. In- 
ternally this salt has been administered with the idea that it parts with its oxygen 
in the system, but it is now acknowledged that it is excreted unchanged. As 
it may set up congestion and irritation of the kidneys it is highly dangerous in 
large doses or if used for any length of time, but is constantly administered 
with benefit in acute tonsillitis, diphtheria, chronic bronchitis, purpura, hem- 
aturia, ovarian tumor, pseudo-membranous laryngitis scarlatina, typhoid fever 
and chronic cystitis. It is believed to have an almost specific power to limit 
the pharyngeal inflammations of childhood, and the formation of pus in cer- 
vical adenitis of infancy. Advocated half a century ago by Simpson for the 
treatment of habitual miscarriage, its use for this condition has been revived 
by Jardine and Remy, who find that it exercises a beneficial influence on the 
endometrium, and has the power of preserving the life of the fetus and bring- 
ing about normal parturition, if its administration is commenced in the third 
month of pregnancy and continued without interruption until full term. When 
used internally it should be given in small doses, gr. iij-x, up to gr. xx in 24 hours 
for an infant, gr. xxx in 24 hours for a child of 2 to 4 years, and 5issfor an adult 
in the same time, and the action of the heart and the kidneys should be care- 
fully watched. It should never be prescribed with potassium iodide lest the 
poisonous iodate be formed, nor with the syrup of the iodide of iron, lest it 
liberate iodine and cause severe gastritis. Strong acids and acid sulphates de- 
compose it, and it forms explosive compounds with easily oxidizable substances, 
as sugar, sulphur, tannin, sodium or potassium hypophosphites, catechu, gly- 
cerin, etc. For the combination of Potassium Chlorate with the tincture of the 
chloride of iron, as a gargle, see under Chlorum, page 219. 

The Nitrate has been much employed as a refrigerant diaphoretic and diu- 
retic in febrile and inflammatory affections, especially in inflammation of the 
trachea and bronchi, pneumonia and rheumatism, but its action is uncertain, 
and it is now giving place in these disorders to more efficient agents. The 
Sulphate is used in teaspoonful doses in water as an hepatic stimulant and a 
mild cathartic, increasing the secretions of the intestinal glandular apparatus. 
Its action is sometimes harsh, and death has resulted from overdoses. Potas- 
sium and Sodium Tartrate is the aperient agent in Seidlitz Powders. In doses 
of § ss-j it is a gentle and cooling laxative, and in drachm doses frequently re- 
peated it is used to render the urine alkaline and as an antilithic. 



390 PRUNUM PRUNTJS VIRGINIANA. 

The therapeutics of the other Potassium Salts are described under the re- 
pective titles of their more active bases. 

PRUNUM, Prune (Unofficial), — is the partly dried, ripe fruit of Primus domestica, the 
Plum tree, nat. ord. Rosaceae, indigenous to Western Asia, but cultivated in most countries 
of temperate climate. Prunes contain sugar, pectin, albumin, malic acid and salts. The 
root-bark contains a glucoside Phloridzin, which causes glycosuria in animals (see below, 
under Prunus Virginiana). 

Prunes are laxative and nutritious, and are freely used as a food and sweetmeat, but in 
excess may give rise to flatulent colic from the indigestibility of their skins. Stewed prunes is 
an excellent dish for constipation in children, and may be made more effective by the addition 
of a little Senna. 

PRUNUS VIRGINIANA, Wild Cherry,— is the bark of Prunus serotina, 
a small forest tree of the nat. ord. Rosaceae, growing in Canada and the United 
States. On maceration in water it develops a distinct odor of bitter almonds. 
It contains tannin, gallic acid, resin, starch, etc., also Amygdalin and Emulsin, 
which by their mutual reaction in the presence of water, produce Hydrocyanic 
Acid and a Volatile Oil resembling that of Bitter Almond. The root-bark con- 
tains a glucoside, Phloridzin, found also in the same part of the apple, pear and 
plum trees. Dose of the powdered bark, gr. xx-xlv [av. gr. xxx.] 

Preparations. 
Syrupus Pruni Virginian®, Syrup of Wild Cherry, — 1 5 per cent. Dose, 3 ss-jss [a v. 3 j •] 

Incompatibles. 

Incompatibles are as for Tannic Acid and Hydrocyanic Acid (see pages 65 and 69). Hot 
Water is incompatible in making the preparations, as it destroys the ferment emulsin. 

Physiological Action and Therapeutics. 

Wild Cherry is an aromatic bitter tonic, increasing appetite, aiding diges- 
tion, and thus promoting the constructive metamorphosis. The presence of 
a volatile oil gives it a local stimulating action on the alimentary canal in com- 
mon with serpentaria, cascarilla and other members of the same class. Hydro- 
cyanic Acid, being yielded by it in the presence of cold water, imparts a seda- 
tive action to its preparations, calming irritation and diminishing nervous ex- 
citability. Very large doses reduce the action of the heart. 

Phloridzin administered by the mouth or hypodermically causes glycosuria, 
acetonuria, and a great increase in the nitrogen metabolism. The glycosuria 
differs from that of true diabetes in the fact that the sugar of the blood is not 
increased, this agent affecting not the general metabolism of the body, but only 
*he renal epithelium, which it renders more permeable to sugar. It is employed 
as a test for renal sufficiency. 

Wild Cherry preparations are used with benefit in catarrhal conditions of 
the bronchial mucous membrane, also in the hectic of phthisis and scrofula, 
with palpitation of the heart and a debilitated stomach; a collection of symp- 
toms often observed in consumptive subjects, for whom it is a very useful pal- 



PULSATILLA. 39 1 

liative. Cough is supposed to be especially amenable to its influence, and hence 
it has become a matter of daily routine to prescribe the syrup as an ingredient 
of cough-mixtures. The infusion is an excellent stomachic tonic, and may 
be administered with benefit in dyspepsia and in convalescence from acute 
disease. 

PULSATILLA (Unofficial), — is the herb, collected soon after flowering, of 
Anemone Pulsatilla and Anemone pratensis {Pulsatilla nigricans), the Pasque- 
flower or Meadow Anemone, small herbal plants of the Ranunculaceae, to which 
order Aconite also belongs. They inhabit Europe and Siberia, and have large, 
purple flowers, which are inodorous and very acrid. Pulsatilla contains an acrid 
yellow oil, which in the presence of water is gradually changed into Anemonin, 
C 10 H 8 O 4 , or Pulsatilla camphor, the active principle, and Anemonic Acid, a 
white, crystalline, tasteless and apparently inert substance, which is formed 
also by the action of alkalies on Anemonin. The herb should be carefully 
preserved and not kept longer than one year. Dose, gr. j-v. 

Anemone patens or Pulsatilla nuttaliana, is an inhabitant of the United States, sometimes 
has whitish-colored flowers, and was formerly one of the official sources of the drug. 

Preparations. 

A tincture may be prepared according to the pharmacopceial directions for Tincturse 
Herbarum Recentium (i part in 2 of alcohol), the dose of which is ttj^-tjex, several times a 
day. The imported German homeopathic tincture contains equal parts of the expressed juice 
and alcohol, and is an efficient preparation; but tinctures or fluidextracts made from the 
imported dried plant are not trustworthy. 

Anemoninum, Anemonin, C 10 H 8 O 4 , (Unofficial), — a volatile, unstable, camphoraceous 
principle, crystallizable, soluble in chloroform and in hot alcohol, almost insoluble in water 
and in ether. Dose, gr. |-£ in pill; but much larger doses may be taken without inconvenience, 
as much as two grains having produced no physiological symptoms in man (Schroff). 

Incompatibles. 

Incompatible with Pulsatilla and Anemonin are: Alkalies (caustic), Metallic Salts, Tannic 
Acid. 

Physiological Action. 

Pulsatilla is an active irritant when locally used; the oil vesicates the skin, 
and the fresh juice produces tingling and burning sensations in a part to which 
it is applied. It may excite a violent dermatitis, with a vesicular or pustular 
eruption, and inflammation and even gangrene of the entire limb has followed 
the application of the bruised root to the calf of the leg for rheumatism. In- 
halation of its dust has produced itching of the eyes, colic, vomiting and diar- 
rhea; and swallowing the fresh herb may cause severe irritation of the gastro- 
intestinal mucous membrane. The fresh juice applied to the tongue gives 
rise to tingling and burning sensations followed by numbness, symptoms very 
like those caused by Aconite. Internally administered Pulsatilla is diuretic, 
diaphoretic and emmenagogue, and also acts as a cardiac and vascular sedative, 
lowering the action of the heart, the arterial tension and the body-temperature. 



39 2 PULSATILLA. 

In overdoses it strongly affects the mucous membranes, and produces nausea 
and vomiting, slimy diarrhea, bloody urine, profuse and offensive sweats, coryza 
and cough; also vesicular and pustular eruptions on the skin, peculiar pains 
in the eyes and dimness of vision. Its primary action is that of a spinal irri- 
tant, secondarily it produces exhaustion and paralysis of both motion and 
sensation. Stupor, coma and convulsions may be caused by a toxic dose, also 
paralysis of the cord and medulla. Most of these effects have been observed 
on rabbits, and the pharmacology of the drug is not yet accurately worked out. 
The homeopathic writers credit it with specific influence on the synovial mem- 
branes, the veins, the ears, and the generative apparatus of both sexes. 

Anemonin was discovered in 177 1 by Storck, and its effects have been studied 
to some extent on animals. Applied to the conjunctiva it caused slight inflam- 
mation, and placed on the human tongue it left slight burning sensation. When 
melted, its vapor produced intense inflammation of the eyes and pricking sen- 
sations in the tongue followed by numbness and white patches. The symptoms 
following its internal administration in fatal doses were a slow and feeble pulse, 
slow respiration, lowered body-temperature, frequent diarrhea, paralysis of 
first the hind- and then the fore-legs, dyspnea, mydriasis followed by myosis, 
stupor and death without convulsions. The absence of the latter is thought 
to be due to a paralyzing action of this principle on the cerebral motor centres, 
as in poisoning by extract of Pulsatilla convulsions are always present. The 
autopsies showed congestion and edema of the lungs, also marked hyperemia 
of the cerebral and spinal membranes, especially in the vicinity of the medulla. 
The heart walls were relaxed, and its cavities and the great vessels filled with 
dark and clotted blood, while the blood elsewhere was fluid. The liver, spleen, 
kidneys and abdominal viscera were found to be healthy. 

Therapeutics. 

The ancient writers credited different species of Anemone with many medic- 
inal virtues, but the modern use of this drug dates from the time of Baron 
Storck and his contemporaries (1770-1800) who highly praised the Pulsatilla 
nigricans as a remedy for corneal opacities, cataract, paralysis, rheumatism, 
amenorrhea, melancholia, secondary syphilis, old ulcers and scaly skin diseases. 
Later therapeutists differ widely as to the medicinal value of this drug, recent 
observers finding no efficacy in it. 

In acute and chronic dyspepsia, characterized by gastric catarrh or sub- 
acute gastritis with a white-coated tongue, no taste or a greasy sensation in the 
mouth, nausea, flatulence, heart-burn, sick headache, anorexia, depression, 
and diarrhea, Pulsatilla is a very efficient remedy, given in medium doses, Tflv 
of the tincture every four hours. It does good service in intestinal catarrhs, 
shown by passive, mucous diarrhea with little pain, which are frequently seen 
in the febrile affections of childhood, especially measles, mumps, chicken-pox 
and remittent fever. 



PYRETHRUM — QUASSIA. 393 

PYRETHRUM, Pellitory, — is the root of Anacyclus Pyrethrum. a plant of the nat. ord- 
Composite, native of Northern Africa, but cultivated in Europe. It contains an alkaloid 
Pyrethrine, also inulin, tannin, mucilage, etc., with a brown Resin and two fixed oils. Dose, 
as a masticatory, gr. x-xlv [av. gr. xxx.] 

Pyrethrum Roseum, Persian Pellitory (Unofficial), — is indigenous to Western Asia, and 
resembles Chamomile in appearance. The flower-heads are used in powder to kill insects, 
4 grains killing a fly in a vial in 2 or 3 minutes. 

Tinctura Pyrethri, Tincture of Pyrethrum, — 20 per cent. Not used internally. 

Pellitory is an irritant sialogogue. When chewed it causes a pricking sensation in the 
tongue and fauces, with heat, acridity, pungency and a copious flow of saliva and buccal mucus. 
Large doses may cause bloody diarrhea, tetanoid spasms, accelerated pulse, and profound 
stupor. Applied to the skin it acts as a rubefacient, the powder inhaled as a sternutatory. 
It stimulates the local nerves and vessels of the mouth and salivary glands by direct irritant 
action, but soon depresses the nerves and blunts their sensibility. 

Pellitory is chewed as a masticatory and sialogogue in paralysis of the tongue, rheumatic 
and neuralgic affections of the head and face, and pain from carious teeth. Its powder has 
been recommended as a sternutatory in chronic catarrh of the frontal sinuses. As a gargle or 
lotion (3iij to Oj) it is very useful for relaxed uvula and as a mouth-wash. When used for 
toothache a few drops of the tincture should be inserted into the cavity on cotton or wool. 
Used as a sialogogue it is an efficient agent to secure the rapid elimination of Iodine from the 
system in chronic poisoning thereby. 

QUASSIA, — is the wood of Picrasma excelsa, or of Quassia amara, trees of 
the nat. ord. Simarubaceae. The former is known commercially as Jamaica 
quassia, and the latter as Surinam quassia. The wood is turned into cups, 
which are sold under the name of quassia- or bitter-cups. It contains a bitter 
principle, Quassin, C 31 H 42 9 , which is crystalline, soluble in hot alcohol and 
in chloroform, slowly in cold water, faster in alkaline or acidulated water. Dose 
of the powdered wood, gr. v-xv [av. gr. viij .] 

Tinctura Quassiae, Tincture of Quassia, — 20 per cent. Dose, ttjjv-5j [av. irgxxx.] 
Infusum Quassiae, Infusion of Quassia (Unofficial), — made with cold water 5x, Quassia 

chips 3j, macerated for \ hour and strained. Or water poured into a quassia-cup and left 

standing will give a good infusion. Dose, 5j-iij. 

Physiological Action and Therapeutics. 

Quassia is a simple bitter, having no flavor, but is intensely bitter and less 
agreeable than either gentian or chiretta. It is fatal to flies and fish, and makes 
an excellent anthelmintic enema against the thread-worm. A concentrated 
preparation is poisonous to rabbits and dogs, and has produced very alarming 
narcotic symptoms in a four-years-old child. Its action is that of a bitter stom- 
achic tonic, as described under Calumba. 

The preparations of Quassia contain no tannin and hence may be prescribed 
with salts of Iron. It is employed in atonic dyspepsia with pain after eating, 
and vomiting or regurgitation of food, also in atonic diarrhea depending on 
indigestion or an irritable condition of the intestinal mucous membrane. It 
is useful in convalescence to promote the appetite and digestion, and with sod- 
ium bicarbonate in gastric vertigo. It has been used as a feeble antiperiodic. 
and in hysteria its repulsiveness is an aid to its medicinal action. The strong 
infusion as an enema is an effective remedy against the thread-worm (oxyuris 
vermicularis). 



394 



QUILL A J A — RADIUM . 



QUILLA JA, Soap Bark, — is the inner bark of Quillaja Saponaria, a tree of the nat. ord. 
Rosaceas, indigenous to Peru and Chili. It contains calcium sulphate crystals, also starch and 
the glucoside Saponin, C 32 H 54 1? , a white, amorphous, sternutatory powder, soluble in water 
and in dilute alcohol. The official preparations are — 

Fluidextractum Quillajae, Fluidextract of Quillaja, — Dose, ngj-v [av. njjiij.] 

Tinctura Quillajae, Tincture of Quillaja, — 20 per cent. Dose, tt^v-xxx. 

Quillaja in powder is sternutatory and causes the water in which it is macerated to froth, 
making emulsions of oils, and being used instead of soap for washing purposes in various 
affections of the skin, also to stimulate the growth of the hair in alopecia. Its properties are 
due to the glucoside Saponin, which is found also in Senega and a number of other plants, and 
is a violent irritant of the respiratory passages, a local anesthetic, an antipyretic, a powerful 
paralyzant of the heart and respiration, and a poison to the voluntary muscles. It has not 
been made use of in practical medicine. 

A decoction of the bark (5 in 200) has been employed in doses of 5 j-ij according to age, as 
a substitute for Senega in the treatment of diseases of the respiratory organs where a pleasant 
expectorant is indicated. Its expectorant properties are well established, and children take it 
readily. It does not provoke diarrhea or vomiting, and has a sweetish, agreeable taste. 

RADIUM. — By the inter-atomic change of the elements, uranium, 
radium, thorium and actinium, as is shown by the table, certain so- 







Table 


OF 


Radio-active 


Elements. 








Uranium 1. 








Thorium 






5-10 9 yrs. VI 
Uranium X 


238— a 

1 1 








13X10 10 yrs. 


232 — a 

i 




1 








24.6 days IV 


234—0 

1 








Mesothorium I 
5-5 yrs. 


232 

I 




Uranium X 2 


1 












1. 1 5 minutes V 


234—187 


Actinium 


230 


Mesothorium II 


228-/87 






I 




I 


6.2 hours 


1 




Uranium Z 








io 6 yrs. VI 


O — > a 


Radio Actinium 


O 


Radio Thorium 


228 — a 






I 


19 days 


1 


2 yrs. 


i 




Ionium 


230— >a 


Actinium X 


O 


Thorium X 


224 — a 




io 5 yrs. IV 


1 

1 


1 1.4 days 


1 

1 


3.64 days 


I 




Radium 1 


226— »a 


Emanation 


O 


Emanation 


230— a 




1680 yrs. 


I 

224— »a 


3.9 seconds 


i 

O 


54 seconds 


1 




Emanation 1 


Actinium A 


Thorium A 


4- 
216 — a 






3.85 days 


1 


0.002 seconds 


1 


0.14 seconds 


1 






(Niton) 










Radium A 


220— *a 


Actinium B 


O 


Thorium B 


212 — fiy 







3 minutes VI 


1 


36 minutes 


1 

O 


15.3 hours 


1 






Radium B IV 


216— »07 


Actinium C & C'/\ 


Thorium f C 


212 




<u 






2.15 minutes O O 


i 




. 


Radium C & C 


' 214 — a 




1 


208 







19.5 minutes 


/\ 07 








1 






10 seconds 


D O 
1 




End 




208 — £7 






Radium D 


1 
210 — 






4. 
End probably 




16 yrs. 


I 

2IO — 07 








Bismuth 




Radium E 












5 days 


1 












Radium F 


206 — a 












Polonium 


1 












136 days 


End probab 


yi 


ead 











1 Elements used for therapeutic purposes. 



RADIUM 395 

called rays are emitted, first, the alpha particle or positive ray, second, the 
beta, or negative ray, and third, the gamma, a ray analogous to the Roentgen 
ray. These rays give rise to distinct physiologic and therapeutic reactions. 
The most common of the radio-active elements are uranium and thorium, 
but the inter-atomic change is so slow that their radio-activity is extremely 
weak and practically worthless. The claim made for their therapeutic 
activity is, no doubt, due to the association with the more active elements 
which are derived from them, and on account of the very small quantity, 
require careful and extensive chemical manipulation for their separation. 

It will be necessary to consult the table to understand the various changes 
which take place by the disintegration of these elements. 

The same process can be followed in all these elements, modified only 
by their natural physical characteristics. When these elements are freshly 
prepared they require a certain time to reach their equilibrium, that is, 
when the rate of formation equals the rate of decay or dissipation. This 
occurs with radium in about thirty days. They all possess the property 
of ionization, and by this their activity is calculated, and with proper 
apparatus it is possible to detect the roirVorro of a milligram of radium 
element. About 90 per cent, of the radiation is alpha, 9 per cent, is beta 
and 1 per cent, gamma. The active deposit of rapid decay is chiefly re- 
sponsible for the strong beta and gamma radiation; the other elements give 
off the alpha particle. 

Physiologic Action. 

If a given amount of one of these radio-active elements is placed upon 
the skin a local reaction follows, which may vary from a slight erythema from 
stimulation, to extensive ulceration and local gangrene from overstimulation, 
the amount and character of reaction depending entirely upon the amount 
of element, its activity, filtration and the time of exposure. An excessive 
reaction has been termed a "burn." The depth of this reaction depends 
more or less upon the filtering out of the low radiation with such metals as 
aluminium, silver, platinum or lead. The reaction of these elements simu- 
lates that produced by the Roentgen rays. The general symptoms that 
follow are, no doubt, a result of local conditions. 

When one of these elements is introduced into the system, the result de- 
pends largely upon its physical character. If administered in the gaseous 
state it differs in action from that of the salt, while the latter varies according 
to its solubility. There are, however, certain reactions which seem to be 
common to all. The blood shows changes and the blood pressure is altered. 
The respirations are reduced in rate and depth, while large doses may produce 
dyspnea. The gaseous elements are eliminated by the lungs and do not ap- 
pear to cause any irritation, while the solids may be found in all secretions, 



39 6 RADIUM 

even in the breast milk of mothers. Administration by the mouth will be 
followed at times by gastro-intestinal disturbance, which is especially notice- 
able in solutions containing the emanation. The insoluble salts simply pass 
through the intestinal canal and are eliminated, but the elements formed 
within the body may be absorbed into the circulation and eliminated accord- 
ing to their physical properties. 

The radio-active elements may be used externally, using the alpha, beta 
and gamma rays, in the same manner as the Roentgen rays. Internally, by 
introduction into the system where the radio-activity is carried through the 
body in the same manner as other medicinal agents. 

Therapeutics (Radiotherapy). 

External applications are made by many different kinds of applicators, 
depending upon the nature of the affection to be treated. They may be 
divided into two groups. 

First, where application is to be made to the surface a flat plaque is used 
with the radio-active material incorporated in a varnish and spread usually 
upon a flat piece of metal, or other material. Where flexibility is desired, 
heavy silk may be used. By means of such an applicator a small or large 
surface receives a given amount of low radiation uniformly distributed. In 
this way it will be found of value in the treatment of certain forms of skin 
disease, such as eczema, psoriasis, lupus and kindred affections. 

Second, where the application is to extend below the surface of the skin 
the radio-active elements are contained in small tubes. By this means the 
alpha ray is practically eliminated and only the more penetrating beta and 
gamma rays are employed, or where the gamma ray alone is desired, a jacket 
of 3 mm. of lead or its equivalent is employed to surround the active tube. 
Where a large supply of radium can be obtained, it is usual to employ the 
emanation or the active deposit; this method, however, requires extensive 
apparatus and skilled manipulation; it eliminates the danger of loss of radium 
and offers a far wider range of usefulness. The methods of application vary 
widely, depending upon the nature, extent, location and character of the dis- 
ease. The active tubes must be protected by various metal filters, and they 
in turn protected so as to eliminate the secondary radiation given off by the 
metal. They should be frequently moved upon the part so as to change the 
surface while keeping the diseased portion in line. This is done to lessen 
the chance of destruction of the tissues in direct contact with the active tube. 

The dosage is usually recorded in " milligram-hours " (mgh.), thus 10 
milligrams applied for 5 hours, would equal 50 mgh., or 50 milligrams ap- 
plied for 1 hour would equal 50 mgh., and while the amount in each instance 
would be the same, the time and method of application must be stated, as 
the result would be quite different under the two conditions. 






RADIUM 397 

The radio-active elements have been employed in the treatment of various 
tumors, both malignant and non-malignant, and are especially useful when 
the disease is, contained within a cavity, where it is impossible to apply the 
Roentgen rays without doing injury to surrounding parts. It is to be used 
in conjunction with operative procedures and in those cases where surgery 
is not advisable. 

Internally. — The radio-active elements may be administered by mouth, 
by rectum or hypodermatically. They may be used in a bath, or may be 
absorbed from air charged with the emanation of either radium or thorium. 
When they are used internally the physical characteristics of the particular 
salt must be considered. The common salts of radium are the sulphate, car- 
bonate, bromide or chloride, contaminated usually with barium, which, how- 
ever, from the small quantity, may be disregarded. The first two are in- 
soluble and are of little value internally, and usually pass through the ali- 
mentary canal unchanged. The last two are soluble and are absorbed and 
to a great extent eliminated by the kidneys and alimentary canal like other 
soluble inorganic salts. While these salts are within the body the emanation 
and "active deposit" are produced, and while very small, are responsible for 
considerable activity, due to a great extent, to the alpha radiation. Some 
authorities prefer to use the emanation instead of the salts of radium, and 
have devised an apparatus consisting of a jar containing water in which is 
placed a given amount of radium sulphate; this apparatus has been called 
an emanator. The water is charged with the emanation, and is administered 
according to the needs of the- individual. It must be remembered that when 
this method is employed the emanation is a gas and is rapidly eliminated by 
the lungs, therefore, it must be administered in small and frequent doses. 
During the short cycle of time that it is contained within the body an in- 
finitesimal amount of the "active deposit" is formed. By the use of a rather 
complicated apparatus it is possible to separate the "active deposit," and 
introduce it into the system, either upon common salt charged with it, or a 
solution made from the salt. 



Administration and Dosage. 

The dosage for the internal administration of these radio-active elements 
is usually estimated by the microgram, microcurie, or the mache unit; the 
latter, while in general use, is by no means as accurate as the others. A 
great number of the springs of the world contain the emanation of radium 
and in some instances they appear to be of therapeutic value, but it must 
be remembered that this radio-activity is transient and the water which is so 
charged must be taken immediately, as it loses its strength rapidly, therefore, 
it will not stand transportation. Artifically this water may be prepared by 



39 8 RESORCINOL 

an emanator as described above and the water thus prepared will be many 
times stronger than the natural supply; usually an emanator will supply 
from 5000 to 500,000 mache units daily. The water must # be taken at 
frequent intervals and sipped slowly, the solutions must be cool, and not 
agitated. 

A salt of radium may be employed in solution and administered by the 
mouth, or as is usual, hypodermatically, either directly under the skin or into 
the deeper tissues, or it may be introduced directly into a vein. The salts 
employed are either the bromide or chloride. The dosage depends upon the 
condition, and varies from one micro curie to ten microcuries, or larger where 
the occasion demands. The injections may be given daily, weekly, or at 
greater intervals, as the system remains charged for a longer time than 
when the emanation is used. 

In the more chronic forms of disease where these active products are used, 
the method usually adopted is to treat vigorously for a month or two, then 
to rest for the same interval, being governed by the symptoms. Results 
have been reported from the administration of these elements in diseases 
resulting from malnutrition, the various forms of anemias with or without 
splenic involvement. It has been claimed that it will lower the blood 
pressure for a considerable period in cases with old arterial changes and with 
abnormally high pressures, and will modify the process involved in arthritis 
of various types, and to some extent, in gout. 

RESORCINOL, Resorcinol, Metadihydroxybenzene, C 6 H 4 (OH) 2 , — is a dia- 
tomic phenol, isomeric with Pyrocatechin and Hydroquinone, obtained usu- 
ally by the reaction of fused sodium hydroxide upon sodium metabenzene- 
disulphonate. It occurs in colorless, needle-shaped crystals, very soluble in 
water, alcohol, ether, or glycerin. It is 99.5 per cent, pure when assayed by 
the official process. Dose, gr. j-x [av,. gr. ij]; as an antipyretic gr. v every 
2 hours, or gr. xv-xxx, not repeated. 

Unofficial Analogues. 

Hydroquinone, Para-dihydroxy-benzene, C 6 H 4 (OH) 2 , — isomeric with Resorcinol, crys- 
tallizes in rhombic, colorless prisms which are slightly soluble in water, readily so in alcohol and 
in ether. It is obtained from Arbutin, a glucoside constituent of Uva Ursi and other Ericaceae, 
also from Aniline. It is an efficient antipyretic, without injurious effects so far as observed, 
but its influence is only temporary. Dose, as an antipyretic, gr. xv-xx, best given in alcohol. 
Gr. xl have been given without disagreeable effects. 

Pyrocatechin, Catechol (Ortho-dihydroxy-benzene) , — also isomeric with Resorcinol, is one 
of the acid constituents of coal tar, and is obtained also from wood tar and from kinic acid. 
It is a fair antipyretic, but its use has been abandoned on account of its by-effects. 

Incompatible with Resorcinol are: Acetanilid, Albumin, Alkalies, Antipyrine, Camphor, 
Ferric Chloride, Menthol, Potassium Iodide in alkaline solution, Spirit of Nitrous Ether. 
With Hydroquinone are: Chlorine-water, Chromic Trioxide, Ferric Chloride, Nitric Acid. 

Physiological Action. 

Resorcinol resembles Phenol in action, but is less toxic. Locally it is irri- 
tant and mildly escharotic, and is vesicant to mucous membranes. Like 



RESORCINOL 399 

phenol it is a universal poison, and is antiseptic, disinfectant, and parasiticide. 
Internally it is diaphoretic, antipyretic, depressant to the heart and respira- 
tion, and a narcotic poison in sufficient quantity. In doses of 20 to 40 grains 
it causes sensations of heat, discomfort and oppression, followed by profuse 
prespiration and languor; if fever be present the temperature of the body is 
lowered several degrees but rises again after a rigor in from 2 to 4 hours. 
A dose of 60 grains produced giddiness and violent perspiration, with marked 
anxiety, and finally collapse and unconsciousness. Larger doses (150 grains) 
have produced deafness, dizziness, salivation, confused vision, vertigo, uncon- 
sciousness, general clonic convulsions and tetanic rigidity of the muscles of 
the neck, with no decline of temperature in feverless subjects. Toxic doses 
(gr. xv to each 35 ozs. of weight) in animals cause trembling succeeded by epi- 
leptiform convulsions, which increase in severity and then decline; the respira- 
tion is quickened and enfeebled, the heart's action becomes rapid, weak, and 
irregular, and death results from paralysis of respiration, the drug paralyzing the 
motor tracts in the spinal cord but not affecting the general sensibility. It is 
eliminated chiefly by the urine which it colors a bluish-violet hue, and with great 
rapidity, about one hour serving for its excretion. 

Therapeutics. 

Resorcinol has been employed internally as an antiseptic and an antipy- 
retic, but being unreliable in the latter respect and highly dangerous it is now 
discredited as an internal remedy, though it has been commended in various 
gastric and intestinal inflammations. It is a valuable local application in many 
affections of the skin and mucous membranes. As an application to rodent 
ulcer, tuberculous and other ulcerations of the larynx, in diphtheria, tonsillitis, 
pharyngitis, and chronic rhinitis, strong even supersatured solutions are em- 
ployed with increasing satisfaction, being highly efficient and quite painless. 
Applied to the peri-laryngeal mucous membrane, in 0.33 per cent, solution, 
with an acidulated solution of quinine given internally, it has been very useful 
in the treatment and prophylaxis of pertussis. A 2 per cent, solution has given 
satisfaction as a local antiseptic application to wounds, parasitic skin diseases, 
cystitis, gonorrhea, anthrax, and syphilitic sores of unhealthy character. As 
a spray a similar solution is well applied to catarrhal or ulcerative affections 
of the respiratory passages. It may be applied in undiluted form to chancres, 
papillomata and carbuncles. A saturated ethereal solution is a good applica- 
tion where the caustic action of the drug is required. 

A paste consisting of equal parts of Resorcinol and Zinc Oxide has been 
applied to the face to promote peeling of the skin in the treatment of acne ros- 
acea. In three or four days the skin becomes like parchment, when the ap- 
plication must be stopped, in order to avoid the cracking of the skin which be- 
gins at that stage. A dressing of gelatin, glycerin, zinc oxide and hot water 



400 RHAMNUS PURSHIANA RHEUM. 

is then applied, covered with cotton wool. In a few more days the dressing 
comes off, bringing the epidermis with it. Some few dangerous and unfavorable 
results have followed this method, but a number of very satisfactory cases are 
reported. Freckles and other superficial spots on the skin may be removed 
by the same treatment. 

Resorcinol exercises a powerful influence on recent cell infiltration, and 
is very successful in subacute and chronic eczema with much thickening from 
exudation, also in seborrhea, psoriasis and pityriasis. It is an efficient applica- 
tion in the parasitic skin diseases, as scabies and tinea. 

CASCARA SAGRADA, Rhamnus Purshiana (Chittem Bark, Sacred 
Bark), — is the bark of Rhamnus Purshiana, the California Buckthorn, a 
small tree of the nat. ord. Rhamnaceae, growing on the Pacific Coast of the 
United States. In the previous Pharmacopoeia Cascara Sagrada and its 
preparations were designated as Rhamnus Purshiana. Dose, gr. x-xxx 
[av. gr. xv.] 

Another species of the same order, Rhamnus Frangula, is official under the 
title Frangula, which see. 

Preparations. 

Extractum Cascarae Sagradae, Extract of Rhamnus Purshiana, — Dose, gr. j-vj [av. gr. 
iv.] 

Fluid extractum Cascarae Sagradae, Fluidextract of Rhamnus Purshiana, — Dose, ttj>x-x 

[av. TTgXV.] 

Fluidextractum Cascarae Sagradae Aromaticum, Aromatic Fluidextract of Rhamnus 
Purshiana, — Dose, i^x-5j [av. ttj^xxx.] 

Cascara Cordial, — is a trade preparation, intended as a remedy for constipation and 
dyspepsia, and as a pleasant excipient for nauseous and bitter drugs. A similar prepara- 
tion may be made by combining the fluidextract with the official Elixir Aromaticum in the 
proportion of 5j to Bij> of which the dose is 5j or more. 

Physiological Action and Therapeutics. 

Cascara Sagrada is a member of the class called the Anthracene derivates 
of which the other members are the phthaleins (phenolphthalein) and the 
vegetable drugs, aloes, frangula, rhubarb and senna. These drugs stimulate 
peristalsis, acting principally upon the large intestine, and produce large, 
soft and painless evacuations unless the dose be excessive when griping re- 
sults. The active principles of Cascara Sagrada are derivates of anthra- 
quinone, the most important of which is Emodin (dihydroxyanthraquinone) . 
It also contains a bitter principle which imparts to it a rather disagreeable 
taste. Cascara Sagrada is used in chronic constipation and the bowels are 
not habituated to it but are said to act naturally and regularly after its use. 
It requires 8 to 12 hours for its action and ought never to be used when a 
rapid, purgative action is required. 

RHEUM, Rhubarb, — is the dried rhizome and root of Rheum officinale, 
Rheum palmatum, or probably other species of Rheum, nat. ord. Polygonaceae, 






RHEUM 40I 

grown in China and Thibet, where records of its medicinal use date from 2700 
b. c. It contains three closely related anthracene derivatives, Chrysophan, 
yielding Chrysophanic Acid, Emodin, and Rhein, which are the cathartic 
principles; also several bitter resins, a variety of tannic acid, calcium oxalate, 
starch, sugar, pectin, and other plant constituents. The species of rhubarb 
cultivated in the United States are devoid* of cathartic power, but their leaf- 
stalks are used as a fruit. Dose of the powdered root, as a stomachic gr. 
j-v; as a purgative, gr. x-xxx [av. gr. xv.] 

Preparations. 

Extractum Rhei, Extract of Rhubarb. — Dose, gr. j-x [a v. gr. iv.] 
Fluidextractum Rhei, Fluidextract of Rhubarb. — Dose, ttjjx-xxx [av.TTjxv.] 
Pilulse Rhei Compositae, Compound Pills of Rhubarb, — each pill contains of Rhubarb 
about 2 grains, Aloes i£, Myrrh 1, Oil of Peppermint ^ grain. Dose, j-v pills [av. ij.] 

Tinctura Rhei, Tincture of Rhubarb, — has of Rhubarb 20, Cardamom 3, Glycerin 10, 
Alcohol and Water to 100. Dose, 5 ss— ii j [a v. 3 j.] 

Tinctura Rhei Aromatica, Aromatic Tincture of Rhubarb, — has of Rhubarb 20, Cin- 
namon 4, Cloves 4, Nutmeg 2, Glycerin 10, Alcohol and Water to 100. Dose, ttjtx-Sj [a v. 

TTJJXXX.] 

Syrupus Rhei, Syrup of Rhubarb, — has of the Fluidextract 10, Spirit of Cinnamon 0.4, 
Potassium Carbonate 1, Water 5, Syrup to 100. Dose, for an infant, 5j; f° r older chil- 
dren, 5ij - iv [av. 5ijss.] 

Syrupus Rhei Aromaticus, Aromatic Syrup of Rhubarb, — has of the Aromatic Tincture 
15, Potassium Carbonate 1, Syrup 85. Dose, as the Syrup. 

Pulvis Rhei Compositus, Compound Powder of Rhubarb, — has of Rhubarb 25, Magnesia 
65, Ginger 10. Dose, a teaspoonful [av. gr. xxx.] 

Mistura Rhei et Sodae, Mixture -of Rhubarb and Soda (Unofficial), — has of Sodium Bi- 
carb. 3 1, Fluidextract of Rhubarb if, Fluidextract of Ipecac £, Glycerin 35, Spirit of Pep- 
permint 3I, Water to 100. Dose, 3ss-iv [av. 3J-] 

Incompatibles. 

Incompatible with Rhubarb preparations are: Mineral Acids, Catechu infusion, Cin- 
chona infusion, Galls infusion, Lead Acetate, Lime-water, Mercuric Chloride, Silver Nitrate, 
Tartar Emetic, Zinc Sulphate. 

Physiological Action and Therapeutics. 

Rhubarb is classed among the tonic-astringent and resin-bearing purgatives, 
agents which stimulate the muscular layer of the bowel. It is also classified as 
one of the "Anthracene derivates" of which other members are Aloes, Cascara 
Sagrada, Frangula, Phenolphthalein and Senna (see Cascara Sagrada). 
These drugs depend for their action upon the hydroxyanthraquinones 
which they contain, especially Emodin, which act principally upon the large 
bowel when given in laxative doses. In small doses (gr. j-v) its action is 
that of a gastric tonic and an intestinal astringent, the influence of the bitter 
principle and the rheo-tannic acid probably predominating. In larger doses 
(gr. xxx-lx) its cathartic action prevails, producing in 6 to 8 hours copious 
yellow, pultaceous stools, with some griping and considerable hepatic stimu- 
lation. After the cathartic principle is expelled, the astringent quality of 
26 



402 RHUS AROMATICA — RHUS TOXICODENDRON. 

its tannin asserts itself and constipation is likely to result. The yellow color 
of the stools is partly due to the rhubarb pigment and partly to excess of 
bile, the drug, according to Rutherford and Vignol, having marked chola- 
gogue properties. Its pigment stains the milk, urine and sweat, the milk 
acquiring a bitter taste and purgative properties. 

Rhubarb is highly esteemed as a cathartic for children, from the mildness 
of its action; though occasionally producing quite severe griping, it never in- 
flames the gastro-enteric mucous membrane. The tonic and astringent action 
following its catharsis makes it a valuable agent in diarrheas due to the pres- 
ence of irritating matter in the bowel, and to correct atonic indigestion accom- 
panied by diarrhea. For hemorrhoids with constipation its gentle action makes 
it peculiarly suitable, its astrigent after-effect being entirely overcome by 2- 
to 4-drachm doses of olive oil nightly. It may be combined with a mercurial 
or with sodium bicarbonate, the latter being supposed to overcome its astrin- 
gent action and to disguise its taste in some degree. In small doses the tinc- 
ture is a very efficient stomachic tonic, improving appetite, assisting diges- 
tion, and promoting the action of the liver without producing cathartic 
results. The preparations most in use for children are the Aromatic Syrup 
and the Mistura Rhei et Sodse. 

RHUS AROMATICA, Sweet Sumach (Unofficial),— is an indigenous shrub of the nat. 
ord. Terebinthaceae, growing about 5 feet high, and having yellow flowers in spikes. The 
root-bark contains a volatile oil, several resins, fat, tannin, etc. A fluidextract is prepared 
from the bark of the root according to the general pharmacopceial rule, and may be given 
in doses of njx-xxx, every 2 or 3 hours. 

Rhus Aromatica has astringent properties, and seems to possess a selective action upon the 
urinary tract. Its action is not yet clearly made out. Therapeutically it has been used with 
advantage in cystitis, night-sweats, hematuria, menorrhagia, diabetes insipidus, diarrhea and 
dysentery. As a remedy for incontinence of urine in children it has attracted considerable 
attention, having been extremely efficient in doses of ttjxv of a good fluidextract four times 
daily, administered in glycerin and water, or any other suitable excipient. It is reported to be 
equally effective in hysterical enuresis of adults, but larger doses (ttjjxx-xxx several times a 
day) are required. 

RHUS GLABRA {Smooth Sumach) (Unofficial), — is the dried fruit of Rhus glabra, an 
indigenous shrub of the nat. ord. Anacardiacece, growing in rocky and barren soil to a height 
of 8 to 1 2 feet. The leaves and bark have an astringent and bitter taste, and are also used 
medicinally. It contains tannin, coloring matter, also potassium and calcium malates. 

Fluidextractum Rhois Glabrae, Fluidextract of Rhus Glabra (Unofficial). — Dose, ngv-xxx 
[av. ttjjxv.] 

The fluidextract diluted with water to which Potassium Chlorate has been added makes 
a useful astringent gargle in catarrhal pharyngitis, stomatitis, and aphthae. An infusion 
( o j to the pint) or the official fluidextract may be used as a wash and dressing for ulcers 
and wounds. It is seldom used internally although occasionally advised in mild catarrhal 
affections of the stomach and bowels. 

RHUS TOXICODENDRON, Poison Ivy (Unofficial) —is the fresh leaf 
of Rhus radicans, a plant of the nat. ord. AnacardiacecE, indigenous to Canada 
and the greater part of the eastern United States. This climbing plant is not 
by itself a distinct species, but a variety of the erect shrub, Rhus Toxicodendron, 
the poison oak, formerly official as a source of the drug; both of which when 
wounded exuding a poisonous, acrid, milky juice, which turns dark on expos- 






RHUS TOXICODENDRON. 403 

ure. The poisonous principle of the plant is Toxicodendric Acid, which is vol- 
atile, and also exists in Rhus venenata the swamp sumach, Rhus pumila, and 
Rhus diversiloba, the first of which is probably the most poisonous of the four. 
The dose of the leaves is generally placed at gr. j-iv, but if old and dry they will 
generally prove to be inert. 

Tinctura Rhois Toxicodendri, Tincture of Rhus Toxicodendron (Unofficial), — may 
be prepared according to the formula of the Pharmacopoeia for Tincturae, one part of the 
fresh leaves to two of Alcohol. Dose, tt^x 1 ^— TT^ij. 

Physiological Action and Therapeutics. 

The effects of Rhus Toxicodendron upon the skin are familiar to all who 
have suffered from contact with poison-oak or ivy. Some persons are so sus- 
ceptible to this poison that the exhalations from the plant will produce on them 
its characteristic action. Others are apparently insusceptible to its influence, 
and can with impunity rub the juice into their skin, or even chew its leaves. 
The action of the plant when locally applied is that of a cutaneous irritant, 
causing redness and swelling of the affected parts, with a vesicular eruption 
and intolerable itching, which may spread rapidly over the surface of the body 
and extend to the mucous membranes, producing conjunctivitis, redness and 
tumefaction of the mouth and throat, thirst, cough, nausea and vomiting, vertigo 
and stupefaction. Colicky pains are experienced in the abdomen, are worse 
at night and are aggravated by food and drink. Diarrhea may occur, with 
tenesmus and bloody stools, also diuresis, bloody urine, or even complete re- 
tention. Fever with delirium is frequently present, and may be like typhoid 
in character, or intermittent with profuse perspiration. Pains are experi- 
enced throughout the body, but particularly in the joints and lumbar 
region, apparently intensified by rest and heat. Similar phenomena attend 
its internal administration, but fatal results have not followed in any case of 
poisoning recorded. The effects of the poison usually last from ten to fifteen 
days, and are then followed by desquamation of the epidermis. 

Rhus Toxicodendron was used medicinally by Dufresnoy in France and by 
Alderson in England about the close of the eighteenth century. The attention 
of the former was attracted to it by the accidental poisoning of a student who 
was afflicted with chronic eczema, which disappeared on the subsidence of 
the Rhus symptoms. It is a favorite remedy with the so-called homeopathists, 
who ascribe to it extraordinary virtues in acute cutaneous affections of vesicular 
type, subacute and chronic rheumatism, vesicular erysipelas and typhoid fever. 
Among regular authorities it has met with very little favor as a remedial agent, 
though Phillips recommends it strongly in rheumatic affections of the fibrous 
tissues, erythema and erysipelas, eczema, herpes zoster and pemphigus. Pif- 
fard corroborates these opinions of its therapeutical value, and states that when 
rheumatic pain is worse at night prompt relief may be expected from Rhus. 



404 RICINI OLEUM. 

RICINI OLEUM, Castor Oil,— is a fixed oil expressed from the seeds 
of Ricinus communis, a tree of the nat. ord. Euphorbiaceae, indigenous to India, 
but extensively cultivated in the United States. The oil is an almost color- 
less, transparent, viscid liquid, of faint odor, bland or slightly acrid taste, neu- 
tral reaction, soluble in an equal weight of alcohol. It consists mainly of Ric- 
inolein, the glyceride of ricinoleic acid, also palmitin, stearin and myristin in 
small quantities, and an acrid principle. The seeds contain a highly toxic 
substance named Ricin, and an alkaloid, Ricinine, which seems to be inert. 
Dose, 5ij-Sj [av. Siv.j 

Administration. 

The nauseous smell is best concealed by the Essential Oil of Bitter Almonds. Emulsions 
are not a success. Capsules containing the requisite dose are easily obtained. In the absence 
of these the best way to administer a dose of oil is to smear the sides of a clean wineglass with 
very thick cream, then pour in the oil, covering it with a little more cream. A teaspoonful 
of cream being then taken into the patient's mouth, he is directed to bolt the dose at one gulp. 
Some prefer it floated on orange-juice, strong coffee, gruel or wine. One of the best vehicles 
for it is foaming beer. Glycerin increases its purgative power, when given conjointly. If the 
mouth be chilled by broken ice immediately before taking the oil, the taste of the latter will be 
imperceptible. 

Physiological Action and Therapeutics. 

Used externally pure Castor Oil is perfectly bland. Internally administered 
it is non-irritant until it reaches the small intestine, where it is saponified, the 
resulting soap producing purgation by a mildly irritant action on the bowel, 
stimulating the intestinal glands and muscular coat, but not the liver. It 
is a simple purgative, acting in four to six hours, producing one or more liquid 
stools without pain or tenesmus, and followed by a sedative effect on the 
intestines. Ricinoleic Acid enters the blood and the tissues, and is excreted 
with the various secretions of the body, imparting its purgative qualities to 
the milk of the nursing mother. Ricin, given either hypodermically or by 
the mouth, produces violent gastro-enteritis, nephritis and cystitis, also 
inflammation of the mucous lining of the biliary duct. To it are ascribed 
the jaundice and anuria observed in some cases of poisoning by castor-oil 
seeds. 

Castor Oil is one of the best of the simple purgatives, and is used when a 
free evacuation of the bowels is alone indicated, or when only a laxative action 
is desired, as in the constipation of pregnancy and post-partum conditions, 
diarrhea from the presence of irritating matter in the bowels, and after 
operations on the abdominal or pelvic organs. It is often used as a purgative 
for children, also for the aged and infirm. Infants bear a larger relative 
dose than adults, probably from their ability to digest a greater quantity of 
what is taken. It is employed with great benefit as a laxative in irritation or 
inflammation of the bowels, in hemorrhoids, inflammatory or spasmodic 
affections of the genito-urinary organs, nephritis or cystitis, gonorrhea, 
calculi, and stricture of the urethra and rectum. In cases of dysentery 10 to 



ROSA — ROSMARINUS 4©5 

20 drops of laudanum may be added to each dose to counteract the pain, 
tenesmus and exhaustion resulting from the frequency of the passages. If 
much depression exists, as shown by lowered arterial tension and a dry, 
glazed tongue, 5 drops of oil of turpentine should also be added. 

Castor Oil is much used in the puerperal state and greatly abused. There 
is considerable evidence in support of the charge that it induces hemorrhoids 
by congesting the rectal vessels. Its purgative action is milder in proportion 
to the purity of the sample employed. Externally, the pure oil is employed 
as a local sedative and protective, as in neutralizing the effects of lime upon 
the conjunctiva. 

ROSA, Rose, — is represented in official pharmacy by: — 

Rosa Gallica, Red Rose, — is the petals of Rosa gallica, collected before 

expanding. They contain an aromatic oil, tannic and gallic acids, Quercitrin, 

coloring matter, salts, etc. 

Preparations. 

Aqua Rosae Fortior, Stronger Rose Water (Triple Rose Water), — is a saturated aqueous 
distillate prepared from the fresh flowers of Rosa centifola, nat. ord. Rosaceae. An agree- 
able excipient and flavoring agent. Dose, 5ss-iv [av. 5ij-] 

Aqua Rosae, Rose Water, — consists of equal volumes of the preceding and distilled water, 
mixed together immediately before use. Dose, 3j-§j [av. 5iv.] 

Unguentum Aqua Rosae, Ointment of Rose Water, (Cold Cream), — has of Stronger 
Rose Water 19, Expressed Oil of Almond 56, Spermaceti 12^ White Wax 12, and Sodium 
Borate \. 

Fluidextractum Rosae, Fluidextract of Rose, — prepared from Red Rose with glycerin 
and diluted alcohol. Dose, ttb.v-3J [av. tt^xxx.] 

Mel Rosae, Honey of Rose, — has of the Fluidextract 12, and Clarified Honey to 100. 
Dose, 5j-ij [av. 5j.] . 

Oleum Rosae, Oil of Rose, Attar of Rose (Unofficial), — is a volatile oil distilled from the 
fresh flowers of Rosa damascena. It is a pale-yellowish, transparent liquid, having a strong 
odor of rose, a sweetish taste and a slightly acid reaction, but slightly soluble in alcohol. 
It consists of an aromatic oxygenated elaeopten and an odorless solid stearopten (rose- 
camphor). Being very expensive it is much adulterated with other volatile oils. It is 
used chiefly for perfuming cosmetic preparations, ointments and lotions. 

Rose Water has no strictly medicinal properties, but is an agreeable excip- 
ient for lotions, collyria and urethral injections. The ointment, commonly 
termed cold cream, is a pleasant emollient and protective agent, generally used 
for chapped hands and other superficial skin affections. Red Rose is classed 
among the astringents, as it contains an appreciable amount of tannic and gallic 
acids. A compound infusion, containing sugar and dilute sulphuric acid, was 
formerly official, and is used as an agreeable gargle for the throat and mouth 
in inflamed and ulcerated conditions. The chief uses of the rose preparations 
are as vehicles for other agents, or to impart flavor and odor to extemporaneous 
prescriptions. 

ROSMARIMJS, Rosemary, — the source of the official oil of Rosemary, is the fresh 
flowering tops of Rosmarinus officinalis, a shrub of the nat. ord. Labiatae, cultivated for the sake 



406 RUB US RUTA. 

of its large, pale-blue flowers. They are pungently aromatic and somewhat camphoraceous, 
and contain the volatile oil, a little tannin, some resin and a bitter principle. 

Oleum Rosmarini, Oil of Rosemary, — is the volatile oil distilled from Rosemary, a col- 
orless or yellowish liquid, having the characteristic odor of the plant and a camphoraceous 
taste; readily soluble* in alcohol. It should yield, on assay, not less than 2.5 per cent, of 
ester, and not less than 10 per cent, of total Borneol. Dose, n^j-v [av. njuij.] 

Rosemary was formerly considered emmenagogue, galactagogue and diuretic, but is now 
never employed in substance. Its oil is somewhat stimulant and carminative, and in excessive 
quantity has caused death. It is chiefly used as an external stimulant in liniments and lotions, 
especially to the scalp in alopecia, where it is supposed to increase the blood-supply to the 
hair bulbs and is usually combined with cantharides. 

RUBUS, Rubus (Unofficial), — is the dried bark of the rhizome of Rubus villosus, the 
common Blackberry, Rubus nigrobaccus, or Rubus cuneifolius, nat. ord. Rosaceae. It con- 
tains more than 10 per cent, of Tannic Acid. Dose, gr. x-xxx [av. gr. xv.] 

Syrupus Rubi Aromaticus, Aromatic Syrup of Rubus (Unofficial), — contains Rubus, 
Cinnamon, Cloves and Mace. Each fl5 has 30 grains of the drug. Dose, 5j-iv. 

Blackberry-bark derives its virtues from its tannin. It is strongly astringent, and may be 
used in decoction, wine or the above-named preparation. It is highly esteemed in summer 
and infantile diarrheas. 

RUBUS ID^US, Raspberry, (Unofficial)— is the fruit of Rubus Idasus the Raspberry 
bush, nat. ord. Rosaceae. It contains sugar, malic and citric acids, proteins, pectin, etc., also 
a Volatile Oil consisting of compound ethers, to which the odor is due. Its sole use in medi- 
cine is to prepare a pleasantly flavored syrup. The closely allied, light-red fruit of Rubus 
strigosus, the wild Red Raspberry, and the purplish-black fruit of Rubus occidentalism the 
Thrmble-berry, may be employed in place of the raspberry. 

Syrupus Rubi Idaei, Raspberry Syrup, (Unofficial), — has of Raspberries and Sugar any 
convenient quantity, boiled (but not in tinned vessels) and strained. Dose, ad libitum. It 
has a bright-red color, a fruity, agreeable odor, a pleasant, acidulous taste and an acid reaction. 
It has no special medicinal virtues, but forms an agreeable flavoring for mixtures, and mixed 
with water a pleasant drink in febrile conditions. 

The leaves of the wild Red Raspberry (Rubus strigosus) are considerably astringent, and in 
infusion, § j to the pint, are a popular domestic remedy for diarrheas. 

RUMEX, Yellow Dock (Unofficial), — is the root of Rumex crispus, and of some other 
species of Rumex, plants of the nat. ord. Polygonaceae, growing as common weeds along road- 
sides. Several species of Rumex have sour leaves, and are popularly called Sorrel to distinguish 
them from the others which are called Dock. The official root contains tannin, mucilage, starch, 
calcium oxalate, and two principles named Rumicin and Lapathin, which are shown to be 
identical with Chrysophanic Acid. Its constituents are nearly identical with those of Rhubarb. 
Dose, gr. xv-5ij- 

Fluidextractum Rumicis, Fluidextract of Rumex (Unofficial), — Dose, nj7xv-5j. 

Rumex was employed formerly in chronic cutaneous disorders, glandular swellings, and 
other symptoms of the so-called strumous diathesis. It is rarely used at the present time, 
having been replaced by more efficient remedies. 

RUTA, Rue (Unofficial), — the leaf of Ruta graveolens, an herbaceous 
perennial of the nat. ord. Rutaceae, growing wild throughout Southern Europe, 
and frequently cultivated in gardens for its yellowish flowers. 

Oleum Rutae, Oil of Rue (Unofficial), — the volatile oil distilled from Ruta graveolens; a 
colorless, or greenish-yellow liquid, of disagreeable but aromatic odor, pungent acrid taste 
and neutral reaction, soluble in an equal weight of alcohol. Dose, TTjrj-ij. 

Rue is an active irritant, the oil applied locally producing heat, inflamma- 
tion and vesication. Administered in full medicinal dose it causes a sensation 
of heat in the stomach and skin, increases the action of the heart, and stimu- 
lates the bronchial, cutaneous and renal secretions. The odor of the oil is dis- 
tinctly perceptible in the breath, sweat and urine. After a toxic dose of the 



SABAL SABINA. 407 

oil violent gastro-enterftis results, with extreme prostration, convulsions, stran- 
gury and suppression of the urine, and the symptoms of a narcotic poison ensue 
if the dose is large enough. Abortion may be produced by large doses, but 
with great danger to life. 

The Oil of Rue is employed internally in amenorrhea, menorrhagia, and 
metrorrhagia, hysteria, convulsions and flatulence. As an emmenagogue it is 
efficient when the condition is one of functional inactivity of the uterus and 
ovaries. Used as an abortifacient it has frequently caused death, preceded 
by symptoms of irritant and narcotic poisoning. Even in poisonous doses 
its abortifacient action is very uncertain, so that only the most ignorant 
criminals employ it with such purpose. It was formerly official but has been 
dismissed from the pharmacopoeia. 

SABAL, Sabal, — is the partially dried ripe fruit of Serenoa serrulata, the 
Saw Palmetto, nat. ord. Palmae. Dose, gr. x-5 j [av. gr. xv.] 

Preparations. 

Fluidextractum Sabal Fluidextract of Sabal. Dose/ngx-xxx [av. tjjxv.] 

Elixir Saw Palmetto and Santal Compound (Unofficial), — each fiuidounce represents 

Saw Palmetto berries 5ij, Corn-silk 5ij, Sandal-wood gr. xxx. Dose, 5j-iv, three to six 

times a day. 

Sabal is sedative, nutritive and tonic. It seems to have some specific action 
on the prostate gland, and has been used with much benefit in the enuresis 
of old men. It is highly praised in the late stage of gonorrhea, in prostatic 
enlargement, incontinence of urine, vesical catarrh, irritable bladder, and 
urethritis. 

SABINA, Savin (Unofficial), — the tops of Juniperus Sabina, a small ever- 
green shrub of the nat. ord. Conifers, growing in Northern Europe, Asia and 
America. It closely resembles Red Cedar (Juniperus virginiana), but is 
distinguished from the latter by its smaller size and by its larger fruit. It 
contains a volatile Oil, tannin, resin, extractive matters, chlorophyll, etc. 
Dose, gr. v-x [av. gr. vijss.] 

Preparations. 

Oleum Sabinae, Oil of Savin, Ci Hi 6 (Unofficial), — a volatile oil distilled from the fresh 
tops of Savin; existing in the fresh tops in the proportion of 2§ per cent, and in the berries 
10 per cent. It is a colorless or yellowish liquid, isomeric with oil of turpentine, having a 
peculiar, terebinthinate odor, a pungent camphoraceous taste and neutral reaction; soluble 
in an equal volume of alcohol. Dose, ttuj— ij [av. itjjj.] 

Physiological Action and Therapeutics. 

Externally the action of Savin resembles that of Turpentine, except that 
it is more irritant, the oil producing vesication if applied sufficiently long. In- 
ternally a full medicinal dose causes heat sensations, nauseous eructations, 



408 SACCHARUM. 

flatulence, increased cardiac action, stimulation of tlfe cutaneous, bronchial 
and renal secretions, irritation of the kidneys, hyperemia of the ovaries and 
uterus, and increased menstrual activity. In large doses it produces hem- 
aturia, dysuria, and intense gastro-enteritis, with violent vomiting and purg- 
ing. Toxic doses produce the symptoms of an irritant and narcotic poison. 
It may originate uterine contractions in the pregnant female, but its abortifa- 
cient effect can only be produced by a quantity sufficient to endanger life. 

As an emmenagogue Savin is highly esteemed by many authorities. So 
irritant an agent, however, requires the exercise of great caution in its use. 
It has been found extremely efficient in dysmenorrhea when not due to 
mechanical causes; also in menorrhagia and hemorrhage after abortion. As a 
caustic it is efficient for the destruction of warts and other excrescences, and 
the moistened powder is used as a paste on venereal condylomata, in combina- 
tion with burnt alum or cupric subacetate. 

SACCHARUM, Sugar (Sucrose), Ci 2 H 22 0ii, — is the refined sugar obtained 
from Saccharum officinarum, the sugar-cane, a perennial plant of the nat. ord. 
Gramineas, indigenous to India and adjoining countries but cultivated in trop- 
ical regions throughout the world. It is also obtained from various species 
or varieties of Sorghum, nat. order Gramineae, and from one or more varieties 
of Beta vulgaris, the sugar-beet, nat. ord. Chenopodiaceae. It is present in sev- 
eral other grasses, as Zea Mays (maize), also in the juice of various trees (maple, 
birch, palm, etc.), and in many roots. 

Sugar occurs in white, dry, hard, crystalline granules, permanent in the air, odorless, of 
purely sweet taste and neutral reaction, soluble in 0.5 of water and in 170 of alcohol, in 0.2 of 
boiling water and in 28 of boiling alcohol, insoluble in ether. The saturated aqueous solu- 
tion is miscible with water in all proportions. It is dextrorotary. 

Other Sugars. 

Saccharum Lactis, Sugar of Milk (Lactose), C^H^Oh+HjjO, — is one of the constituents 
of the milk of mammals, and is officially described as a white crystalline sugar obtained 
from the whey of cow's milk. Occurs in white, hard, crystalline masses, yielding a grkty, 
white powder, odorless, permanent in the air, of faintly sweet taste and neutral reaction, 
soluble in about 4.9 of water and in 2.6 of boiling water, insoluble in alcohol, ether or 
chloroform. 

Glucosum, Glucose (Liquid Glucose), C 6 Hi 2 6 , — a syrupy liquid, colorless or slightly 
colored, odorless, of sweetish taste, and obtained by the incomplete hydrolysis of starch 
and consisting chiefly of dextrose and dextrins. It is very soluble in water, sparingly sol- 
uble in alcohol. 

Levulose, Fruit-sugar, C 6 H 12 6 (Unofficial), — frequently found with grape-sugar in 
fruits, also in honey. 

Allied Substances. 

Theriaca, Treacle, Sugar-house Molasses (Unofficial), — is the uncrystallizable residue of 
the process for refining sugar, a thick, brown, fermentable syrup, very sweet and of sp. gr. about 
1.40. 

Amylum, Starch, C 6 H 10 O 5 , — when boiled with dilute mineral acids or when subjected to 
the action of diastase, ptyalin, or pancreatin, is converted into glucose. 

Benzosulphinidum, Benzosulphinide, Saccharin (Glusidutn, B. P.), the anhydride of 
ortho-sulphamide-benzoic acid, — occurs as a white, crystalline powder, having an intensely 



SACCHARUM. 409 

sweet taste, even in dilute solutions; soluble in 290 of water, and in 30 of alcohol, in 25 of 
boiling water, readily soluble in ammonia water, in alkali hydroxide solutions, and in a 
solution of sodium bicarbonate with evolution of C0 2 . Dose, gr. ss-v [av. gr. iij.] 

Sodium Benzosulphinidum, Sodium Benzosulphinide {Sodium Saccharin or Soluble Sac- 
charin), — occurs as colorless prisms or white, crystalline powder, intensely sweet, soluble 
in 1.2 of water and 50 of alcohol. Dose, gr. ss-iv [av. gr. iij.] 

Preparations. 

Syrupus, Syrup, — has of Sugar 85, Distilled Water to 100. 

Sugar is an ingredient of Pil. Ferri Carbonatis, Pil. Ferri Iodidi, Ferri Carbonas Saccharatus, 
Pulvis Crete Compositus, Pulvis Glycyrrhizae Compositus, also the Troches, Syrups, Com- 
pound Syrups, etc. 

Physiological Action and Therapeutics. 

Sugar is employed in pharmacy and therapeutics chiefly as a vehicle, a 
corrigent and a preservative to protect the active ingredients against putre- 
faction, but not always against fermentation. They also protect certain 
ferruginous preparations against oxidation. As an ingredient in troches, 
powders and extemporaneous mixtures sugar is used to cover the taste or to 
make insoluble substances more easily miscible with water. It increases the 
solubility of lime in water. As a food it possesses well-known properties, 
supplying heat and energy to the body and sparing the proteins for tissue 
building and repair. It is decidedly diuretic in its action upon healthy 
kidneys. Sugar and sugar-forming food constitute more than one-half of 
the nourishment needed by a healthy person, and when withheld or diverted 
as in diabetes, the patient is actually starved and undergoes progressive and 
rapid emaciation. Levulose is found to be more easily consumed in the 
system than cane-sugar, and in the treatment of diabetic patients may be 
used with benefit for some time. Heretofore its cost has been very great, 
but it is now being manufactured in large quantities and sold at a reasonable 
price, under the trade-name Diabetin. 

Sugar of Milk is obtained from the whey of cow's milk. It enters into 
alcoholic fermentation with difficulty. In the presence of decomposing 
albuminous matter and under certain other influences, it undergoes the lactic 
fermentation, which results in the formation of lactic acid, carbon dioxide and 
alcohol. It readily reacts with the reduction tests. 

Sugar of Milk is a powerful diuretic, especially in cardiac dropsy, in which 
See considers it "the best and most certain diuretic we possess, the excretion 
of urine caused by it being greater than that due to any other drug." He found 
that it acts similarly to Caffeine though more powerfully, while possessing none 
of the disadvantages of the latter. Its diuretic action is but slight in cases where 
extensive renal disease exists, and it has no power over dyspnea. 

Sugar of Milk is used in the triturations, also in Dover's powder, as a diluent. 
Being much harder than sugar it is considered a valuable excipient for powders 
requiring the minute subdivision of their medicinal constituent. It is less 



4IO SALICINUM. 

sweet than sugar, and being less apt to ferment in the stomach and bowels, is 
better than the latter for use with infants' food. 

Benzosulphinide (Saccharin), when pure is about 500 times sweeter than 
sugar, and imparts a distinctly sweet taste to 70,000 times its weight of water; 
but the commercial article is standardized to about 300 times the sweetening 
power of sugar. It is not a food, but has no injurious action on man, and is 
eliminated in the urine and the saliva without change. It is used as a substitute 
for sugar in the food of diabetics and subjects of hepatic disease and corpulence; 
also to cover the taste of nauseous drugs. A grain of Saccharin sweetens 6 
to 8 fluidounces of liquid. The Sodium Saccharin or Soluble Saccharin 
is, as its name implies, more readily soluble than Saccharin and serves the 
same purposes. It may be used to a maximum quantity of 30 grains per 
diem. 

SALICINUM, Salicin, C 13 H 18 7 , — is a glucoside obtained from several 
species of Salix, the Willow, and Populus, the Poplar, trees of the nat. ord. 
Salicaceae. It is found also in Gaultheria procumbens, the wintergreen, nat. 
ord. Ericaceae; and in Betula lenta, the sweet birch, nat. ord. Betulacese; the 
volatile oils of which, distilled from the leaves of the former and from the bark 
of the latter, consist almost entirely of methyl salicylate (see next page). 

Salicin occurs in colorless or white and silky, shining crystalline needles, or a crystalline 
powder, odorless, of very bitter taste, permanent in the air, of neutral reaction; soluble in 
23.5 of water and in 88.5 of alcohol, in 3.3 of water at 8o° C. and 30 of alcohol at 6o° C, 
insoluble in ether or chloroform. Dose, gr. x-xxx [av. gr. xv.] 

Acidum Salicylicum, Salicylic Acid, HC 7 H 5 3 , — is a monobasic organic 
acid, existing naturally in combination in various plants but generally pre- 
pared synthetically from phenol. It occurs in light, fine, white, prismatic nee- 
dles, or a crystalline powder, odorless, of sweetish, afterwards acrid taste and acid 
reaction, permanent in the air; soluble in about 460 of water, but readily 
soluble in water containing 8 per cent, of Borax or 10 per cent, of Sodium 
Phosphate. It is soluble in 2.7 of alcohol, in 15 of boiling water, in 3 of ether, 
in 42 of chloroform, and is very soluble in boiling alcohol. Dose, gr. v-xx 
[av. gr. xij.] 

Salicylic Acid is obtained either synthetically by combining the elements of Phenol 
with those of Carbonic Acid, and subsequent purification, — or from natural Salicylates as 
the Oil of Wintergreen and Sweet-Birch, — or from Salicin, by heating with caustic potash 
and treating with hydrochloric acid. The acid prepared from natural sources was formerly 
thought to be purer and more efficient than that prepared artificially, but recent observa- 
tions have demonstrated that the synthetic product is equally pure and reliable. 

Official Salicylates. 

Sodii Salicylas, Sodium Salicylate, NaC 7 H d O s , — a white, amorphous powder, soluble in 
0.9 of water and in 9.2 of alcohol, also in glycerin. Dose, gr. v-xxx [a v. gr. xv.] 

Strontii Salicylas, Strontium Salicylate, — a white, crystalline powder, soluble in 19 of 
water and in 61 of alcohol. Dose, gr. v-xxx [av. gr. xv.] 



SALICINUM. 411 

Methylis Salicylas, Methyl Salicylate, — is produced synthetically or is obtained from 
Gaultheria procumbens, the wintergreen, nat. ord. Ericaceae; and in Betula lenta, the sweet 
birch, nat. ord. Betulaceae; the volatile oils of which, distilled from the leaves of the former 
and from the bark of the latter, consist almost entirely of methyl salicylate. The label 
must state the source, and the product should contain not less than 98 per cent. CH3C 7 H 5 3 . 
It is soluble in all proportions in alcohol or glacial acetic acid. Dose, ttjjv-xxx [av. Trgxij] 
suspended in sugared water. 

Phenylis Salicylas, Phenyl Salicylate, Salol, C 13 H 10 O 3 , — is the salicylic ester of phenyl, 
and occurs as a white, crystalline powder, odorless and almost tasteless, nearly insoluble in 
water, soluble in 10 of alcohol, and very soluble in ether, chloroform and oils. On being 
warmed with an alkali it splits up into Salicylic Acid 60, and Phenol 40. Dose, gr. v-xv 
[av. gr. vijss], frequently repeated, in compressed tablets or in cachets, or suspended by muci- 
lage of acacia or of tragacanth. 

Physostigminae Salicylas, Physostigmine Salicylate, — is described under Physostigma. 

Unofficial Salicylates and Other Derivatives. 

Oleum Betulae, Oil of Betula {Oil of Sweet Birch), — is a volatile oil distilled from the 
bark of Betula lenta, the Sweet Birch. It is identical with Methyl Salicylate (see above), 
and nearly identical with Oil of Gaultheria. Russia leather derives its odor from this oil. 
Dose, TTjJv-xxx [av. Tt#xv.] 

Oleum Gaultheriae, Oil of Gaultheria, Oil of Wintergreen, — the volatile oil of Gaultheria 
procumbens, an American plant of the nat. ord. Ericaceae, is a liquid of peculiar and aro- 
matic odor, sweetish, warm taste, and a slightly acid reaction. It is readily soluble in alcohol, 
and consists of Methyl Salicylate 90 per cent. Dose, tt£v-xxx [av. nj?xv.] It is nearly iden- 
tical with the Oil of Betula. 

Aspirin is the trade name af Acetyl-salicylic Acid, and occurs in white, crystalline needles 
of agreeable taste, soluble in 100 of water, freely in alcohol or ether. Dose, gr. v-xv in capsules 
or wafer or dry on the tongue, washed down by cold water. It should be dispensed in waxed 
paper. 

Novaspirin is the trade name of the Di-salicylate ester of methylene-citric acid, and contains 
62 per cent, of Salicylic Acid. It is practically insoluble in water, acts similarly to Aspirin, 
but is less powerful and better tolerated, and can be given for longer periods and in larger doses. 
Dose, gr. xv several times daily. 

Mesotan, — the methyl-oxymethyl-ester of salicylic acid, is a yellow fluid, miscible in all 
proportions with alcohol, ether and oils. It is readily absorbed by the skin, and is used with 
friction as an external remedy in rheumatism, mixed with an equal quantity of olive oil. 

Salipyrine, Antipyrine Salicylate, Ci8Hi 8 N 2 4 , — is produced by heating Salicylic Acid 
and Antipyrine in molecular proportions. It is a white, crystalline, odorless powder, very 
soluble in alcohol, soluble in 200 of cold and 40 of boiling water. Dose, gr. v-xxx. It is 
best administered in wafers, as a powder, or in mixture, rubbed up with glycerin and flav- 
ored with raspberry syrup. 5 

Salophen, A cetylpar amino phenyl Salicylate, — contains the equivalent of nearly 51 per 
cent, of Salicylic Acid, and occurs as minute, white, crystalline scales odorless and tasteless- 
insoluble in water, soluble in alcohol; decomposed by alkalies into salicylic acid and acetyl, 
para-amino-phenol; also decomposed by the organism as demonstrated in the urine 
Dose, gr. v-xv, up to !5j or jss in the 24 hours. 

Saloquinine, Salochinin, — the salicylic ester of quinine, occurs as a tasteless, crystalline 
powder, insoluble in water. It is said to possess the virtues of quinine as well as those of 
salicylic acid, and is used efficiently as an antipyretic and anti-neuralgic. It contains 
about 73 per cent, quinine and may be used as a tasteless substitute. Dose, gr. x-xxx. 

Diplosal, Acidum Salicylico-Salicylicum, — the salicylic ester of salicylic acid occurs 
as a white crystalline powder, odorless and tasteless, insoluble in water. 100 parts of 
Diplosal = 106.2 parts of salicylic acid = 1 24 parts of Sodium Salicylate. Dose, gr. vijss-xv. 

Spirosal, Monoglycol Salicylate, — the Salicylic ester of Monoglycol, occurs as an oily 
fluid, almost colorless and odorless. It is easily absorbed by the skin causing very little 
irritation and used mixed with alcohol (1 to 2 or 3) or olive oil (1 to 8) or in 50 per cent, 
ointment. 



412 SALICINUM. 

Incompatibles. 

Incompatible with Salicylic Acid and the Salicylates are: Acids (mineral), Ferric salts, 
Lead Acetate, Lime-water, Potassium Iodide, Quinine salts, Sodium Phosphate, Spirit of 
Nitrous Ether. With Salol are: Alkalies with heat, Borneol, Bromine- water, Camphor, 
Chloral Hydrate, Euphorin, Ferric Chloride, Naphthalene, Phenol, Pyrocatechin, Resin, 
Thymol. With Aspirin are: heat, moisture, and alkalies, also their carbonates and bi- 
carbonates. 

Physiological Action. 

Willow-bark is highly astringent, and feebly tonic, but is never employed 
medicinally owing to its bulk. Salicin is a bitter tonic, also antifermentive, 
antiseptic and highly destructive to low organisms. It is feebly antipyretic. 
It prevents the reaction between amygdalin and emulsion, also that of ptyalin 
on starch. It is well borne by the stomach, seems to be devoid of toxic 
power on man, and is mainly excreted as salicylic, salicyluric and salicylous 
acids, being first changed in the bowel into saligenin and glucose. 

Salicylic Acid is an energetic antipyretic, antiseptic and germicide. Locally 
it is anhydrotic and stimulant, its prolonged contact with the skin causes swell- 
ing and exfoliation of the epidermis, the cast-off flakes being thicker in direct 
proportion to the strength of the preparation employed. It is irritant to mucous 
membranes, and when inhaled it causes sneezing and cough. In small doses 
it stimulates the stomach, heart and respiration, but moderate quantities derange 
the stomach, causing nausea and vomiting; while large doses depress the heart's 
action and the respiration after a primary excitation of both, lower the arterial 
tension, relax the vessels, produce free prespiration, and reduce the tempera- 
ture in fever. It causes symptoms resembling those of cinchonism, including 
a sense of fulness in the head, roaring and buzzing in the ears, disturbances of 
sight and hearing, excessive sweating, dilated pupils, and delirium. A toxic 
dose produces extreme dyspnea, a slow and laboring pulse, depression of the 
heart and arterial tension, and gradual failure of the respiration, until death 
occurs from asphyxia. Large doses continued for some time may produce 
bed-sores from depression of the circulation, but do not affect the peripheral 
nerves as to either motion or sensation. In the blood it is first changed to 
sodium salicylate, but a portion is again set free and uniting with glycocoll 
forms salicyluric acid, coloring the urine green. It is slowly excreted with the 
secretions generally, especially in the urine, sweat, saliva, and bile. It stimu- 
lates the kidneys, and increases the acidity of the urine, but may so irritate 
the kidneys as to produce albuminuria and hematuria. It largely increases 
the elimination of urea and uric acid. It is destructive to the torula and other 
low organisms, and prevents alcoholic fermentation, also that caused by the 
organic ferments (pepsin, ptyalin, etc.). In solutions containing bacteria 
it will prevent their development if present in the proportion of i in 1 500, and 
will destroy them in the strength of 1 in 250 (Bucholz). 

Sodium Salicylate is remarkably antipyretic in doses of gr. xv, given 4 or 5 



SALICINUM. 413 

times in 24 hours. It is a powerful diaphoretic, and an efficient cholagogue, 
and is supposed to possess the curious property of increasing the fluidity of the 
bile, at the same time that it promotes its secretion, other cholagogues increas- 
ing the proportion of solids therein (Brunton). It greatly increases the elim- 
ination of uric acid and urea, and in other respects it acts like the acid, but 
with less energy. Its antiseptic and germicidal powers are nearly equal to those 
of salicylic acid. 

Phenyl Salicylate (Salol) is decomposed in the small intestine, and in 
overdoses may produce the tinnitus aurium and other symptoms of salicylic 
acid, as also the smoky urine and other effects of phenol. As an antipyretic 
it ranks high, and acts with sufficient power to depress the temperature below 
the normal point. It causes profuse sweating and sometimes depression when 
so employed. It increases nitrogenous elimination, and though itself but feebly 
germicidal it is one of the most efficient intestinal disinfectants, the products 
of its decomposition in the intestinal canal being active germicides. 

Acetyl Salicylic Acid (Aspirin) acts like a salicylate, but produces less of 
the local and systemic side effects, by reason of its slower liberation of salicylic 
acid. In full doses it produces cinchonism and may cause digestive dis- 
turbances and general edematous erythema, but is usually better borne by 
the stomach than salicylic acid or the salicylates, has a more continuing 
influence, and its analgesic and antipyretic actions are much more marked. 
In large dose it acts as a powerful sudorific, and it markedly increases the 
elimination of uric acid and other nitrogenous excreta. 

Therapeutics. 

The Salicin derivatives are employed chiefly in acute and subacute rheu- 
matism, in which they possess great power to modify and overcome the severe 
symptoms, though exercising no permanent influence on the causative factors 
of the disease. They are most suitable to strong and vigorous patients, and 
if they do not relieve the symptoms quickly their use should be abandoned. 
The activity of Salicin depends probably on its conversion into salicylic acid 
in the organism, which being slow and imperfect, this agent is not suitable for 
rapid results, and is seldom employed. 

Salicylic Acid is irritant to the stomach and for internal use has been largely 
displaced by its sodium salt, though some clinicians believe it to be more effi- 
cient in rheumatic fever than any salicylate. It is much used by dermatologists 
as a local application in skin diseases characterized by much thickening of the 
epidermis and in the parasitic skin affections. It is the active ingredient of corn 
remedies, and is a useful application in gangrenous wounds, eczema of the 
hands or feet, cancer, burns, and fetid perspirations, in the last affection being 
u3ed in solution with borax. 

Sodium Salicylate is more soluble than the acid and less irritant to the stom- 



414 SALICINUM. 

ach, while in doses about 50 per cent, larger it is equally efficient. It is em- 
ployed in 3- to 5-grain doses internally after meals, to arrest gastric fermentation 
and to prevent acidity and flatulence. It is used instead of the acid in acute 
inflammatory rheumatism, muscular rheumatism, phlebitis, rheumatic neuritis 
and other irregular forms of rheumatism, with immediate benefit in most cases, 
and it sometimes gives temporary relief in chronic rheumatism. In gout and 
its manifestations, especially migraine and sciatica, it frequently proves highly 
effective; and it has been used with satisfaction in cases showing a tendency 
to the formation of gall-stones. It is very efficient in non-syphilitic inflam- 
mations of the eye-ball, whether rheumatic or not, especially interstitial 
keratitis, but must be given in large doses to be effective. It is highly efficient 
in quinsy, and has been commended as an alterative diuretic for the removal 
of serous pleuritic effusions. When large doses are prescribed the patient 
should be kept in bed, and if necessary stimulants should be administered 
to counteract its depressant action. The salicylates are contraindicated in 
meningeal inflammation or congestion, middle ear disease, renal insufficiency, 
albuminuria, and nephritis. 

Phenyl Salicylate (Salol) is efficient for duodenal catarrh, catarrh of the 
bile-ducts and catarrhal jaundice; also in the bilious form of sick-headache, 
and in some forms of neuralgia. Its greatest power is manifested in acute 
rheumatism, in which many clinicians maintain that it has no superior, if given 
in 15- to 30-grain doses, up to 2 drachms in the 24 hours, and continued for 
some time after the acute symptoms have subsided. In large doses, it is 
liable to induce renal irritation and symptoms of phenol poisoning. In all 
affections associated with micro-organisms in the intestines, as acute diarrhea, 
cholera, dysentery, and typhoid fever, it has done most excellent service, 
even in Asiatic cholera. It is a remedy which some consider of very great 
value in typhoid fever but is gradually falling into disuse with the general 
tendency to discard intestinal antiseptics in the treatment of this disease. It 
is highly praised in epidemic influenza (grippe), having proved itself remarka- 
bly efficient in recent epidemics of that affection. It proves an efficient disin- 
fectant in catarrh of the bladder, its constituents being excreted with the 
urine and coming in contact with the vesical mucous membrane for a con- 
siderable length of time. It is much quicker in its action upon the urine 
than ammonium benzoate, as in a day or two ordinarily the urine loses its 
foul odor and alkalinity and becomes clear. Its therapeutic value depends 
chiefly upon its property of splitting up in the alkaline fluids of the intestine 
into Salicylic Acid and Phenol compounds, whereby it effects the thorough 
antisepsis of the intestinal tract and performs the work of its constituent 
elements upon the organism. Externally it is employed as an antiseptic 
and deodorant powder against impetigo, eczema, sycosis and other skin dis- 
eases; and has done good service as an insufflation in the treatment of ozena. 
In spirituous solutions (5 per cent.) it is used with various flavoring agents in 



SALVIA. 415 

the preparation of mouth-washes and dentifrices, and it enters into the composi- 
tion of soaps, face powders, and other toilet articles. A mixture of equal parts 
of Camphor and Salol, heated together, has given good results in the treatment 
of suppuration of the middle ear, giving no pain and setting up no inflammation 
of the part. 

Acetyl Salicylic Acid is used with good results as an intestinal antiseptic, 
also in acute and muscular rheumatism, gout, pleurisy, chorea and to combat 
pain in migraine, neuralgia, and the fulgurant crises of locomotor ataxia. It 
is one of the most useful drugs which we possess in the treatment of acute 
tonsillitis, in which it is not only given internally but dusted upon the 
inflamed tonsils by means of a cotton applicator thrice daily. 

Salophen is tasteless and non-toxic, while probably equal to salol in efficiency. 
It has been used with great satisfaction in acute rheumatism, rheumatic ar- 
thritis, typhoid fever, cholera, neuralgia, sciatica, gastro-enteritis, pyelitis and 
cystitis. In long-standing sciatica a 10 per cent, solution hypodermically into 
the gluteal muscles has given good results. It has been employed with decided 
benefit in intestinal dyspepsia with flatulence, also externally in 10 per cent, 
ointment in psoriasis with good results. 

Salipyrine or Antipyrine Salicylate has given excellent results in acute 
and chronic rheumatism, rheumatic sciatica, neuralgia and influenza; and 
has proved efficient in metrorrhagia from various causes, given in doses of 
15 to 30 grains thrice daily. In 50 such cases treated by Orthman no un- 
pleasant effects were observed, but Scharfe reports a case of serious poisoning 
by two doses of 15 grains each, taken four hours apart. Its constituents 
may be administered in conjunction in the proportion of Salicylic Acid 3 and 
Antipyrine 2, in proper dose for each case, with just as good results as are 
afforded by Salipyrine itself (Squibb). 

A large number of unofficial Salicylates and other derivatives in which 
the salicylic radicle is liberated in the intestine or after absorption into the 
blood, have been introduced with the view to lessening the gastric irritation 
which attends the use of Salicylic Acid and Sodium Salicylate. These 
compounds while very useful in some instances are not entirely free from 
gastric effects, are often expensive, and are not superior to Sodium Salicylate 
as a rule when it is given with large doses of Sodium bicarbonate which 
markedly lessen gastric irritation. 

SALVIA, Sage (Unofficial), — the leaves of Salvia officinalis, the common garden Sage, 
a perennial plant of the nat. ord. Labiatae, native in Southern Europe but cultivated in our 
gardens for its strong, fragrant odor. They contain tannin, resin, etc., and a volatile oil 
which consists of Salviol, Ci Hi 6 O, camphor and terpenes. There are no official prepara- 
tions. Dose of the powdered leaves, gr. xx-xlv [av. gr. xxx], in infusion. 

Sage is aromatic, stimulant, tonic, and astringent. It was highly esteemed in ancient 
times, and even yet is popular as a domestic cure-all with many people. In infusion it 
may be used as a beverage in febrile conditions and to check sweating, also for the night- 
sweats of phthisis. Like other members of the same class it has a slight influence over 
enteralgia and flatulence. It makes a good astringent and stimulating gargle. 



416 SANGUINARIA SANGUINARIA. 

SAMBUCUS, Elder (Unofficial), — the flowers of Sambucus canadensis, the common 
Elder, a shrub of the nat. ord. Caprifoliaceae. The plant contains a small quantity of a vola- 
tile oil, also a resin and valerianic acid. Dose, gr. xxx-3 j, in hot infusion. 

Elder-flowers are stimulant and diaphoretic, also diuretic in some degree. The berries 
are diaphoretic and laxative, while the inner bark is a hydragogue cathartic and in large doses 
emetic. Formerly the inspissated juice of the berries was employed as an alterative in rheu- 
matism and syphilis, but the flowers are now used only for flavoring purposes. Elder-flower 
Water (Aqua Sambuci) is an excellent vehicle for collyria and lotions. 

SANGUINARIA, Blood-root, — is the dried rhizome and roots, collected in 
autumn, of Sanguinaria canadensis, a perennial plant of the nat. ord. Papa- 
veraceae, which grows throughout the United States, being one of the earliest 
and most beautiful of the spring flowers. It has a single white flower on an 
erect stalk, the petals often tinged with rose or purple. It contains the 
alkaloids Sanguinarine, C20H15NO4, Chelerythrine, found also in Chelidonium, 
Protopine, present also in Opium, and Homochelidonine; with citric and malic 
acids, resins, gum, etc. The salts of its alkaloids are of brilliant red and 
orange colors and are soluble in water. Dose of the powdered root as an 
expectorant, gr. j-v [av. gr. ij.] 

Preparations. 

Tinctura Sanguinariae, Tincture of Sanguinaria, — strength 10 per cent. Dose, as an 
expectorant, njjv-xxx [av. njjxv.] 

Sanguinarina, Sanguinarine, C 20 H 15 NO 4 (Unofficial), — is the chief alkaloid and prob- 
ably the active principle of the plant. Dose, as an expectorant, gr. 3*2-$. As found in 
commerce it is generally a mixture of the alkaloids. 

Incompatibles are: Alkalies, Tannic Acid, Metallic salts, and other alkaloidal precipi- 
tants. 



Physiological Action. 

Sanguinaria is sialagogue, expectorant and emmenagogue, an emetic, a 
cardiac paralyzer, a violent irritant, a narcotic poison and an alterative. 
Its taste is bitter and acrid. It causes violent sneezing when, inhaled, 
increases secretion by irritating the secretory organs as it is eliminated, and 
in full doses produces salivation, catharsis and vomiting with great depression. 
Overdoses are violently irritant, the heart's action being at first increased, 
together with the arterial tension, then markedly depressed, and finally 
paralyzed by stimulation of its inhibition. The reflexes are lowered by 
paralysis of the spinal centres, muscular contractility is impaired, the pupils 
are dilated, the temperature is lowered, cold sweats, great thirst and collapse 
supervene, and death occurs by paralysis of the cardiac and respiratory centres, 
often preceded by convulsions. Locally used, Sanguinaria is a feeble escharotic. 

Sanguinaria is a member of the poppy family, and its alkaloids bear a close 
resemblance to those of opium. Sanguinarine causes tetanus and high excite- 
ment, and stands between codeine and thebaine in its action on the central 
nervous system. It causes violent peristalsis of the bowel, increases the saliva, 
and is emetic and expectorant. 



santalum album santalum rubrum. 417 

Therapeutics. 

Sanguinaria is used in small doses of the tincture as a gastric tonic and an 
hepatic stimulant in atonic dyspepsia and duodenal catarrh. Affections of 
the respiratory tract are often benefited by it, especially asthma, subacute 
bronchitis and chronic nasal catarrh, in which expectorant doses (gtt. v) of 
. the tincture should be given, and in the latter affection the powdered drug 
may be used as a sternutatory. A decoction forms an efficient gargle in the 
sore-throat of scarlet fever. Sanguinaria is a serviceable remedy in chronic 
bronchitis and in amenorrhea of functional character, also in functional 
impotence from irritability of the organs, with daily seminal losses and relaxa- 
tion of the genitalia. By many practitioners it is considered a specific emetic 
in croup, but others look upon it with disfavor as too uncertain and harsh in 
its action. The emetic dose of the tincture is ttrxv-xxx. 

Locally, the powdered root is well employed as an application to foul ulcers 
and fungous granulations, also by insufflation to nasal polypi, and for chronic 
hypertrophy of the nasal mucous membrane. 

Sanguinarine has been used in doses of gr. T V to J as an expectorant with- 
out irritating the stomach, and in still smaller doses (gr. A to -fa) to stimulate 
the gastric and intestinal secretions. Sanguinaria, its preparations and 
alkaloids are powerful poisons and are rarely used at the present time, being 
replaced by more efficient remedies. 

SANTALUM ALBUM, White Sandalwood,— the source of the official Oil 
of Santal, is not itself official. It is a tree of the nat. ord. Santalaceae, having 
its habitat in India but now nearly exterminated there. Santalum citrinum, the 
yellow Sandalwood, from the Hawaiian and Fiji Islands, is more commonly 
met with in commerce. 

Oleum Santali, Oil of Santal, {Oil of Sandalwood), — a volatile oil distilled from the wood 
of Santalum album; a pale-yellow liquid, soluble in alcohol, of peculiar and aromatic odor, 
pungent taste and acid reaction. Dose, ti^v-xv [av. TTjjviij], in emulsion or capsules. 

Sandalwood is a very agreeable perfume. The Oil is astringent to mucous 
membranes, producing dryness of the fauces, thirst, colic, and a sense of ful- 
ness in the renal regions. In concentrated from it is a local irritant, but the 
effects of large doses have not been studied. It is extensively used in chronic 
bronchitis and in gonorrhea, forming the contents of proprietary capsules which 
are sold for the cure of the latter disease in all drug stores. It is prescribed 
in soft capsules containing Tfl,v and x three times daily after meals. 

SANTALUM RUBRUM, Red Saunders (Unofficial),— is the heart- wood of Pterocarpus 
santalinus, a tree of the nat. ord. Leguminosae, native in India. It comes in chips or as a 
coarse powder, nearly inodorous and tasteless, not imparting any red color to water when 
micerated in it, but coloring alcohol, ether and alkaline solutions a bright red. The wood 
has no medicinal properties and is employed solely for the purpose of coloring alcoholic 
preparations. It is a constituent of Tinctura Lavandulae Composita. 
27 



418 SANTONICA — SAPO 

SANTONICA, Levant Worm seed (Unofficial),— is the dried, unexpanded 
flower-heads of Artemisia pauciflora, a small, perennial plant of the nat. ord. 
Composite, which grows in Asia Minor , and contains a volatile oil and the 
peculiar, crystalline principle Santonin. Dose, gr. x-lx. 

Santoninum, Santonin, C 15 H 18 3 , — the inner anhydride or lactone of 
santonic acid, obtained from Santonica, occurs in colorless, prismatic crystals, 
turning yellow on exposure to light, odorless, of bitter after-taste, and neutral 
reaction, nearly insoluble in cold water, but soluble in 43 of alcohol, 1.7 of 
chloroform, also in solutions of the caustic alkalies. Dose, gr. J-J for a child, 
gr. J-iij [av. gr. j] for an adult, not repeated soon as the action of the drug is 
slow. 

Trochisci Santonini, Troches of Santonin (Unofficial), — each troche contains about ^ 
grain of Santonin, with Sugar, Tragacanth, and Stronger Orange Flower Water. Dose, j-v. 
Santonin and its preparation are sensitive to light and should be kept in amber-colored 
bottles tightly corked. 

Santonin is anthelmintic to the round- worm (ascaris lumbricoides) , also 
but in less degree to the thread- worm (oxyuris vermicularis) . It is taken into 
the blood as Sodium Santoninate, and affects the cerebral faculties and the 
vision; objects appearing at first blue, green, or red, then yellow (chromatopsia) , 
often succeeded by blindness for a week or more. Toxic doses disturb the con- 
sciousness of the patient, produce a sort of intoxication, tremors, weakness, 
with enfeebled respiration and slowing of the pulse, coldness of the surface, 
vomiting, sweating, mydriasis, convulsions, and death from failure of respira- 
tion. A dose of 2 grains is said to have proved fatal to a feeble child five years 
old. It is excreted by the kidneys, coloring the urine if acid a greenish- 
yellow, if alkaline a reddish-purple, and it produces enuresis. 

As an anthelmintic Santonin is the most certain agent against the round- 
worm, and is best administered in powder with calomel at bedtime after a day 
of fasting, a senna-draught or a saline purge being used the following morn- 
ing. It also acts fairly well in suppository against the thread-worm, but is 
inoperative against tape-worm. It has also been prescribed with great 
benefit for nocturnal incontinence of urine, and for certain eye affections, 
particularly amblyopia from atrophic or inflammatory changes in the retina 
and optic nerve. It should never be given to children during a fever, nor 
when the bowels are constipated, for fear of toxic results. 

SAPO, Soap (White Castile Soap), — is Soap prepared from sodium hydrox- 
ide and olive oil ; a whitish solid, hard, yet easily cut when fresh, of faint, pe- 
culiar odor free from rancidity, a disagreeable alkaline taste and alkaline re- 
action ; readily soluble in water and in alcohol. It is an ingredient of two of 
the official pills, and two liniments and the Compound Extract of Colocynth. 

Sapo Mollis, Soft Soap (Green Soap), — is Soap prepared from potassium 
hydroxide and linseed oil; a soft, unctuous mass, of a yellowish-brown color, 



SARSAPARILLA. 419 

soluble in about 5 of hot water and in 2 of hot alcohol. The name Green Soap 
is a misnomer, as it is not green in color. 

Insoluble Soaps are combinations of the oily acids with earths and metallic 
oxides, as the Soap of Lime, official as Linimentum Calcis, and the Soap of 
Lead Monoxide, the former Lead Plaster. 

Sapo Animalis, Curd Soap, official in the Br. Phar., — is made with Soda and a purified 
animal fat consisting chiefly of Stearin. Used in pills and suppositories. 
V Sapo Medicatus, official in the French Codex, — is a Soda soap prepared from expressed 
J Almond Oil. 

Saponification is a process of double decomposition between a fat (stearate, palmitate or 
oleate of glyceryl) and an alkali, in which glycerin and the metallic salt of the fatty acid are 

oleates and palmitates of various bases. Nearly all soaps are oleates or palmitates (or both) 



formed. "The glycerin, not being saponifiable, is set free, but the fatty acid (stearic, palmitic 
or oleic) unites with the salifiable base to form soaps, which are therefore mixed stearates, 



of sodium or potassium (or both). Hard soaps are sodium soaps, soft soaps are potassium 

V 



ffj* soaps. 



Preparations. 

Emplastnun Saponis, Soap Plaster (Unofficial), — has of Soap 10, Lead Plaster 90, Water 
q.s. 

Linimentum Saponis, Soap Liniment, — has of Soap 6, Camphor 4%, Oil of Rosemary 1, 
Alcohol 70, Water to 100. Opodeldoc is a similar preparation. Soap Liniment is an ingre- 
dient of Chloroform Liniment. 

Linimentum Saponis Mollis, Liniment of Soft Soap {Tincture of Green Soap), — has 
of Soft Soap 65, Oil of Lavender 2, Alcohol to 100. 

Soap is laxative and antacid; externally it is a stimulating discutient, 
and is used for cleansing the skin, removing fatty substances and soft- 
ening the epidermis, but if too long applied it may prove decidedly irritant. 
It is a good antidote in poisoning by acids, and should be administered freely 
in such cases until more energetic alkalies can be obtained. In aqueous solu- 
tion it makes a useful enema for constipation, or a plug of soap may be inserted 
into the rectum. 

Soft Soap is a powerful detergent stimulant and is much employed in skin 
diseases, especially eczema rubrum, in which the tincture is rubbed on, the dis- 
eased skin well washed and then covered with a bland ointment. The tinc- 
ture is the most elegant form for use, and may be diluted with three parts of 
alcohol for shampooing the scalp. 

The Liniment is used with friction in sprains, bruises and stiff joints, being 
a little more stimulating than camphor-liniment. It makes a good basis for 
extemporaneous liniment prescriptions. 

SARSAPARILLA, — is the dried root of Smilax meMca, and other species 
of Smilax, plants of the nat. ord. Liliaceas, growing in Mexico, Honduras and 
Jamaica. There are six commercial varieties on the market, which are put up 
in differently formed bundles. It contains starch, resin, calcium oxalate, an 
essential oil, and three active glucosides belonging to the saponin group, viz. — 
Parillin, Saponin, and Sarsaponin, the last of which is the most important, 
being actively poisonous to the red blood cells. 



420 SASSAFRAS. 

Preparations. 

Fluidextractum Sarsaparillae, Fluidextract of Sarsaparilla. — Dose, n£xx-5j [av. njjxxx.] 

Fluidextractum Sarsaparillae Composition, Compound Fluidextract of Sarsaparilla, — 
has of Sarsaparilla 75, Glycyrrhiza 12, Sassafras 10, Mezereum 3, Glycerin 10, Diluted Alco- 
hol to 100. Dose, iT£xx-5j [av. ngxxx.] 

Syrupus Sarsaparilla? Compositus, Compound Syrup of Sarsaparilla, — has of the Fluid- 
extract 20, Fl. ext. of Glycyrrhiza i|, Fl. ext. of Senna 1^, Alcohol 1.94, Syrup 75, Oils of 
Sassafras and Anise and Methyl Salicylate, each 0.02. Dose, 5j _ 5j [av. 3iv.] 

Syrup of Sarsaparilla (Unofficial), — much used to flavor soda-water, is a mixture of the 
oils of sassafras and gaultheria in syrup. 

Incompatibles . 
Incompatible with Sarsaparilla preparations are Galls in infusion, Lead Acetate, Lime- 
water. With the Compound Syrup of Sarsaparilla, Mercuric Chloride. 

Those who believe that Sarsaparilla has any action ascribe to it diuretic, 
diaphoretic, tonic and alterative properties. Careful physiological experiments 
with the drug and its principle have so far given negative results. It has been 
used as a so-called "blood-purifier" in scrofula, chronic abscesses, necrosis, 
old ulcers, and many cutaneous diseases, but is generally combined with other 
agents of undoubted activity. The compound decoction is considered a good 
agent in tertiary syphilis, especially in debilitated subjects; while the other 
preparations are commonly employed as vehicles for potassium iodide and mer- 
curic chloride in syphilis of any form. 

SASSAFRAS, Sassafras, — is the dried bark of the root of Sassafras varii- 
folium, an indigenous tree of the order Lauraceae, collected in early spring or 
autumn, and deprived of the periderm. It contains a volatile oil, the principal 
constituent of which is Safrol (see below). Dose, 3j-iv [av. 3ijss.] 

Sassafras Medulla, Sassafras Pith (Unofficial), — is the dried pith of the same tree. 
When macerated in water it yields a mucilage which is not precipitated upon the addition 
of alcohol. 

Safrolum, Safrol, Ci Hi O^ (Unofficial), — is the methylene ether of allyl pyrocatechol, 
found in oil of sassafras, camphor oil, and other volatile oils. It is largely used in the manu- 
facture of soap to disguise the odor of the fatty bases. Dose, ttjtj-x [av. n^v.] 

Preparations. 

Oleum Sassafras, Oil of Sassafras, a volatile oil distilled from Sassafras, — a yellowish 
or reddish-yellow liquid, having the odor of Sassafras, a warm, aromatic taste and a neutral 
reaction, readily soluble in alcohol. Treated with cold nitric acid it becomes of a dark 
red color, and is finally converted into a red resin. Dose, njrj-iv [av. TTjnij.] 

Infusum Sassafras, Infusion of Sassafras (Unofficial), — is a popular "tea" which may 
be taken ad libitum. When made from the bark, and taken internally as well as applied 
locally, it is almost a specific for the rash produced by poison oak (Hinton). 

Sassafras is a constituent of the two compound Sarsaparilla preparations. 

It acts as a stimulant diaphoretic when used in quantity of the hot infusion. 

It enjoys a popular reputation as a " blood-purifier," and is employed chiefly 

in combination with Sarsaparilla and Guaiacum in cutaneous disorders and 

rheumatic and syphilitic affections. The oil is chiefly used for flavoring in 

mixtures and confectionery. The syrup popularly known as " Sarsaparilla " 

is composed of Oil of Sassafras and Oil of Gaultheria, in syrup. 



SCAMMONttJM SCILLA. 421 

SC AMMONIA RADIX, Scammony Root, — is the dried root of Convolvu- 
lus Scammonia, a plant of the nat. ord. Convolvulaceae, growing chiefly in 
Syria and Asia Minor, yielding not less than 8 per cent, of total resins, with 
gum, sugar, starch, etc. The active principle, Scammonin or Jalapin, is 
probably identical with the Convolvulin of Jalap, and is contained in the root 
and the resin. Dose, gr. j-x [av. gr. iv.] 

Rssina Scammoniae, Resin of Scammony, — soluble in alcohol and in ether. Dose, gr. 
j-v [av. gr. iij.] 

Exfcractum Colocynthidis Compositum, — (see page 240) contains 14 per cent, of Resin 
of Scammony, and is an ingredient of the Compound Cathartic Pill, and the unofficial 
Vegetable Cathartic Pill. 

Scammony is an active cathartic, stimulating the liver and the intestinal 
glands, and causing free purgation in a few hours with considerable griping. 
Though quite drastic in action it is somewhat uncertain as a purgative and 
is generally employed in combination with similarly acting agents. It is 
sometimes used as a drastic purgative for children with calomel, when an 
active cathartic is indicated. In the same way it is the appropriate agent 
on the principle of derivation in dropsies and cerebral affections, also in torpid 
states of the intestines with much slimy intestinal mucus; but it is contra- 
indicated in cases attended by irritability of the stomach and bowels. 

SCILLA, Squill, — is the fleshy, inner scales of the sliced dried bulb of 
Urginea maritima, a perennial plant of the nat. ord. Liliacese, growing on the 
shores of the Mediterranean. The Pharmacopoeia provides a biological assay 
known as the " one-hour frog method" for squill and the other members of 
the Digitalis group. The reader should look up the article on Digitalis 
where the method is briefly described and the biological strength of Squill 
and its preparations are tabulated. Squill contains the glucosides — Scilli- 
toxin, acrid and bitter, the most active principle; Scillipicrin, acting on the 
heart; and Scillin, causing numbness and vomiting; also Sinistrin, a mucilag- 
inous principle. The Scillitin of the older writers is a complex substance. 
Dose of the powdered drug, gr. j-v [av. gr. ij.] 

Preparations. 
Fhiidextractum Scillae, Fluidextract of Squill (Biologically assayed). — Dose, Trgj-v[av. 

Tj£JSS.] 

Tinctura Scillae, Tincture of Squill (Biologically assayed), — 10 per cent. Dose, miv-xxx 

[av. TT£XV.] 

Ace turn Scillae, Vinegar of Squill, — 10 per cent. Dose, ttjjv-xxx [av. ttjjxv.] 

Syrupus Scillae, Syrup of Squill, — has of the Acetum 45, with Sugar 80 and Water to roo. 
Dose, TT#x-3j [av. ttjjxxx.] 

Syrupus Scillae Compositus, Compound Syrup of Squill, — has of the fiuidextracts of 
Squill and Senega, each 8, Tartar Emetic 0.2, Water 1, Syrup to 100. Is known popularly 
as Coxe's Hive Mixture, and contains less than one grain of Tartar Emetic to the fluid ounce 
(15 grains in 17 fl. ozs.). Dose, for children, mjv-3j, the latter being an emetic dose; for 
adults, as an expectorant, ttj?xx-x1v [av. ttjxxx.] 

Pilula Ipecacuanhae cum Scilla, Pill of Ipecacuanha with Squill (B. P.), contains about 
5 per cent of Opium. Dose, gr. iv-viij. 



42 2 SCOPARIUS. 



Incompatibles 



Incompatibles are: as for glucosides (see page 8), and in addition with the Compound 
Syrup those for Tartar Emetic (see page 133). 

Squill is one of the oldest of drugs, being mentioned in the Ebers papyrus, 
1550 b. c, and written about by Pythagoras, 580 b. c, Hippocrates, 460 b. c. 
and Pliny, 50 a. d. In small doses it is expectorant, in larger ones emetic and 
diuretic, and in overdoses a violent irritant poison, producing nausea, vomit- 
ing, purging, gastro-enteritis, strangury, bloody urine, perhaps suppression of 
urine, paralysis and convulsions, with death by paralysis of the heart in systole. 
Medicinal doses slow the heart, making the pulse stronger and slower, raising the 
arterial tension, and increasing the flow of urine. Its action upon the circu- 
lation closely resembles that of Digitalis and for this reason it has been classi- 
fied by modern pharmacologists with the Digitalis Allies (see Digitalis). 

Squill is employed in medicine for its expectorant and diuretic effects. It 
is especially applicable in cardiac dropsy, combined with digitalis or the saline 
diuretics, and in chronic bronchitis, in which it may be associated with ipecac, 
ammonia, asafetida, or benzoin. It is used in croup, but is usually combined 
in this affection with some other emetic, as tartar emetic in the compound syrup, 
a mixture which may produce very depressing effects and should be used with 
caution. In whooping-cough and other irritant coughs with tickling sensa- 
tions in the throat the syrup or vinegar is often of great service. It may be 
used in cases of decompensation in valvular disease if digitalis fails. 

The action and uses of Squill should be studied in connection with those 
of Digitalis and Ipecacuanha. 

SCOPARIUS, Scoparius, (Broom) (Unofficial), — is the dried top of Cytisus 
Scoparius, the Broom plant, a common garden shrub of the nat. ord. Legu- 
minosae, having small, downy leaves and numerous large golden-yellow 
flowers. It contains Sparteine, C15H26N2, a volatile, liquid alkaloid, which 
contains no oxygen, but possesses very decided basic qualities; and Scoparin, 
a neutral principle. There are no official preparations. Dose, gr. v-xxx 
[av. gr. xv.] 

Sparteinae Sulphas, Sparteine Sulphate, — white rhombohedral crystals, or a granular 
powder of slightly saline and bitter taste, very soluble in water and in alcohol. Dose, gr. 
-i6~h [av. gr. |] hypodermically, gr. $-ij by the mouth. Small doses, gr. T V-i> every 5 
hours, for cardiac action; larger, gr. j-ij, for diuresis (Clarke). Larger doses are necessary, 
say gr. jss-iij, ter die (Prior). 

Incompatibles are as for alkaloids (see page 6). 

Broom- tops are diuretic and laxative, also emetic and cathartic in large 
doses. They have been a favorite diuretic and vehicle for other diuretics in 
the treatment of dropsies, both cardiac and renal, and are considered most 
reliable in dropsy of renal origin, but are contraindicated in acute renal affec- 
tions, and where pulmonary congestion or inflammation exists. 

Sparteine resembles Confine in action, paralyzing the peripheral termina- 



SCUTELLARIA SENEGA. 423 

tions of the motor nerves, though affecting the central nervous system but slightly. 
It depresses the heart, slowing its rate and weakening its contractions. 
When injected intravenously it produces a slight rise of arterial tension for a 
short time, but has no effect on the blood-pressure when given internally. It is 
much less poisonous than coniine or gelsemine, and proves fatal to animals by 
paralyzing the end-organs of the phrenic nerves in the diaphragm. It was 
formerly supposed to act similarly to Digitalis on the heart and kidneys, but 
experimental and clinical observations have shown that it possesses no such 
power comparable with that of the latter agent. It has been extravagantly 
praised as a remedy in cardiac affections requiring stimulation of the heart's 
action with the slightest possible increase of arterial tension, in mitral and aortic 
regurgitation, mitral stenosis, cardiac palpitation and arrythmia, chronic Bright's 
disease, exophthalmos, and asthma. In the treatment of the opium habit 
Jennings found it serviceable at the periods of depression and Potts found it 
of value in the treatment of tremor, as in paralysis agitans, in doses of gr. 
f-§ thrice daily. The claims made for it by enthusiastic reporters have not 
been substantiated generally, and it is no longer used to any great extent in 
practice. 

SCUTELLARIA (Unofficial), — is the dried plant Scutellaria lateriflora, Skull-cap, an 
indigenous, perennial herb of the nat. ord. Labiatae, growing in moist places and along 
ditches. It contains a little volatile oil, traces of a bitter principle, besides fat, tannin and 
sugar. Dose, gr. x-xxx [av. gr. xv.] 

Fluidextractum Scutellariae, Fluidextract of Scutellaria (Unofficial). — Dose, tijx-xxx 
[av. ttjjxv.] 

Scutellaria produces no very obvious effects when taken internally. By some practitioners 
it is said to have tonic, nervine and antispasmodic powers, and it has been used in domestic 
practice to calm the nervous system in diseases characterized by restlessness, tremors, spasms, 
twitching of the muscles, and hyperesthesia, as chorea, delirium tremens, nervous exhaustion 
from fatigue or over-excitement, hydrophobia, hysteria and epilepsy. The Scutellarin of the 
eclectics is not a proximate principle, but an extract precipitated by alum from a concentrated 
aqueous tincture. It is given in dose of gr. j-iv. 

SENEGA, — is the dried root of Poly gala Senega, an indigenous, perennial 
plant of the nat. ord. Polygalaceae, having small, white flowers in a close spike 
at the summit of the stem. Its principal constituent is the glucoside Senegin, 
C 32 H 54 18 , which is identical with Saponin and closely allied to Digilonin. 
Dose of Senega, gr. x-xxx [av. gr. xv.] 

Preparations. 

Fluidextractum Senegae, Fluidextract of Senega. — Dose, Tt^x-xxx [av. ttrxv.] 

Syrupus Senegae, Syrup of Senega, has of the fluidextract 20, Syrup 80. Dose, 5 j-ij [av. 
5M 

Syrupus Scillae Compositus, Compound Syrup of Squill, — contains 8 per cent, of Senega. 
(See under Scilla, page 421.) 

Incompatibles are as for glucosides (see page 8). 

Physiological Action and Therapeutics. 

Senega is a stimulating expectorant, a diuretic and a diaphoretic. It causes 
irritation of the throat, with some salivation and gastro-intestinal irritation, 



424 SENNA. 

an inclination to cough, increased bronchial secretion, and perhaps some diu- 
resis and diaphoresis. Inhaled as a snuff it is very irritant to the mucous mem- 
brane of the nose, causing cough, sneezing and nasal catarrh. Senegin is vio- 
lently irritant and a powerful depressant of the heart, and the vascular, ner- 
vous and muscular systems. It is excreted by the bronchial mucous mem- 
brane, the kidneys, and the skin, all of which it stimulates and in large quan- 
tity irritates. 

The use of Senega is chiefly that of a stimulating expectorant in chronic 
bronchitis, the second stage of acute bronchitis, asthma and croup, also as a 
diuretic in dropsy due to renal disease. It removes the tightness and op- 
pression experienced in the subacute chest affections, relieves cough and 
rapidly promotes expectoration. When the mucus is tough and scanty this 
remedy is of no value. 

SENNA, — the dried leaflets of Cassia acutifolia, Alexandria senna, or of 
Cassia angustifolia, India, senna, shrubs of the nat. ord. Leguminosae, growing 
in Egypt and India. They contain an amorphous glucoside, Cathartic Acid, 
which forms salts with bases and may be decomposed into glucose and cath- 
artogenic acid. Other constituents are Sennapicrin and Sennacrol, both glu- 
cosides; Catharto-mannit, a peculiar, unfermentable sugar; also Chrysophanic 
Acid in small quantity, sugar, and various salts. Dose, 5 ss_ ij [ av - 3j-] 

Preparations. 

Fluidextractum Sennae, Fluidextract of Senna. Dose, tt£x-3 j [a v. ttjjxxx.] 

Syrupus Sennae, Syrup of Senna, — has of the fluidextract 25, Oil of Coriander £, Syrup 
to 100. Dose, 3ss-ij [av. 5J-] 

Confectio Sennae, Confection of Senna (Unofficial), — has of Senna 10, Cassia Fistula 16, 
Tamarind 10, Prune 7, Fig 12, Sugar 55I, Oil of Coriander 7, Water to 100. Is sold under 
the trade names Tamar-Indien, and Tropical Fruit Laxative. Dose, 5 ss— ij [av. 3J-] 

Infusum Sennae Compositum, Compound Infusion of Senna (Black Draught), — has of 
Senna 6, Manna 12, Magnesium Sulphate 12, Fennel 2, Boiling Water 80, Cold Water to 100. 
Dose, B ij— vj [av. §iv.] 

Pulvis Glycyrrhizae Compositus, Compound Licorice Powder (See under Glycyrrhiza), — 
contains 18 per cent, of Senna. Dose, oss-5 jss [av. 3j.] 

Syrupus Sarsaparillae Compositus, Compound Syrup of Sarsaparilla JSee under Sar- 
SAPARILLa), — contains i£ per cent, of the fluidextract of Senna. Dose, 3j-c5 j [av. 3iv.] 

Incompatible with Senna are: Mineral Acids, Carbonates, Cinchona infusion, Lead 
Acetate, Lime-water, Mercuric Chloride, Silver Nitrate, Tartar Emetic. 

Senna is a very efficient and safe cathartic, producing copious yellow stools 
in about 4 hours, with considerable griping and flatulence, which may be less- 
ened by combining it with carminatives. Its action is expended chiefly on 
the small intestine, and it increases both peristalsis and intestinal secretion. 
It has no irritant quality in ordinary doses,' and does not produce hypercatharsis, 
or leave constipation as an after-result. It may cause hemorrhoids and in- 
crease the menstrual flow in women. Given to a nursing mother her milk 
will acquire purgative powers. In some very susceptible persons the odor of 



SERUMS AND VACCINES. 425 

the leaves or the infusion will cause an evacuation of the bowels. Its odor 
and taste are particularly disagreeable, especially when administered in 
infusion. 

Senna would probably take rank as our best and safest cathartic but for 
the nauseousness of its smell and taste. It is a favorite laxative in England 
for children, and is used with great benefit in habitual constipation or where 
prompt evacuation of the bowels is required. In hemorrhoids and anal fissure 
it is employed to produce soft and easy motions; but if a tendency to hemor- 
rhoids exists, the use of this drug in cathartic doses will cause irritation of the 
part and induce an acute attack. For the same reason it is contraindicated 
in hemorrhage or inflammation of the intestinal mucous membrane, menor- 
rhagia, and abortion. The least disagreeable of its preparations are the con- 
fection and the compound licorice powder. 

SERA, SERUMS, AND VACCINES. Serum-therapy proper is the pro- 
phylactic and curative treatment of certain infectious diseases by the subcuta- 
neous or intravenous administration of a blood-serum containing an antibody 
(antitoxic, bactericidal, etc.) which is specific to the particular disease. As 
generally used however, the term includes also the treatment of some of these 
affections by vaccines and by the toxic products (toxins) of attenuated cul- 
tures of their respective microbes; but these toxins, though sometimes grown 
on blood-serum, may be produced on other media, and are never administered 
in a blood-serum, as the antibodies invariably are. 

Immunity. Many of the facts pertaining to immunity have been known 
since the earliest times, and have been used as the basis of experimental re- 
search from very remote periods. Mithridates, King of Pontus, 2000 years 
ago, experimented with vegetable and animal poisons on himself and criminals 
for the purpose of producing in himself immunity against poison, and was famil- 
iar with the therapeutic value of the blood of ducks or geese which had been 
fed freely with poisons. Vaccination of healthy individuals against variola 
with equine virus, the infectious material of horse-pox, was practised by the 
ancient Hindoos and Persians, and inoculation with variolous matter was 
employed for immunizing purposes by the Arabs and Chinese in the 10th cen- 
tury. In 1 72 1 Lady Mary Montague, having learned of the latter method in 
Constantinople, introduced it into England. It produced in many cases a less 
severe form of the disease than that caused by natural infection, and it conferred 
immunity against variola, but met with slight support, chiefly because every 
inoculated person became a new and dangerous focus of infection, leading to 
the further spread of the disease. 

Jenner in 1798 having for twenty years observed and experimented with 
"variola-vaccine," which was known as a preventive of small-pox to the people 
in Gloucestershire, urged the systematic vaccination of all persons with the 
contents of the cow-pox vesicle. This method spread rapidly, and became 



426 SERUMS AND VACCINES. 

well-nigh universal in a few years. It may now be regarded as proven that cow- 
pox is really small-pox, attenuated by its passage through cattle, and causing a 
mild form of the disease which confers immunity against variola for several 
years. 

The discovery of the bacillus tuberculosis in 1882, and of tuberculin in 1890, 
stimulated the study of immunity to such a degree that bacteriology and its 
kindred topics have become a separate department of science, having its own 
text-books and specialists. 

Leeuwenhoek (c 1700) discovered bacteria, but held them to be animalculae, and they were 
so considered until recent years, when the researches of bacteriologists and botanists showed 
conclusively that they are minute and unicellular plants. Davaine (1863) discovered the first 
pathogenic organism known, the bacillus anthracis, and pronounced it to be the cause of an- 
thrax. Pasteur (1880) discovered that fowls could be immunized against chicken-cholera, by 
inoculating them with a culture of the bacilli of that disease, attenuated in virulence by heat and 
drying, and declared that "it is possible for man to eradicate every contagious disease from off 
the face of the earth." He next introduced his protective vaccine for anthrax, which is still 
employed, and has saved the lives of countless sheep and cattie. In 1885 he applied the in- 
oculation method to rabies, using emulsions of the spinal cords of animals dead from that 
disease, and attenuated to varying degrees of virulence by drying. Koch in 1882 published his 
discovery of the bacillus tuberculosis, and in 1800 announced his method of combating tuber- 
culous infection by inoculating the subject with tuberculin, an extract of the products of 
pure cultures of the tubercle bacillus. Salmon and Smith (1886-7) showed that immunity 
could be produced not only by the use of attenuated cultures, but also by a culture that had 
been completely killed (sterilized) by heat. Roux and Chamberland (1887) discovered that 
animals may be immunized by inoculating them with edema fluid from the lesions of a case 
of the disease freed from bacteria, i.e., a bacterial toxin formed in the organism. Pfeijfer 
(1892) showed that immunity could be produced by killed bacteria alone, without the 
toxins of their culture; and discovered the bacteriolysin of Asiatic cholera. Behring (1890) 
discovered that animals could be passively immunized against diphtheria by a single ad- 
ministration of the blood-serum of another animal which had obtained a high degree of 
immunity against that disease by injections of toxin; and, together with Kitasato demon- 
strated that the same principle is applicable to tetanus. Many observers had noted the 
fact that normal blood-serum is naturally bactericidal, and Metchnikoff showed that such 
action is largely due to phagocytosis, the enveloping and destruction of bacteria by the leuco- 
cytes. Wright (1903) discovered that this process is promoted by chemical substances 
(opsonins) in the blood, which act in some way upon the invading bacteria, preparing them 
for assimilation by the leucocytes before their toxins can affect the cells of the organism. 
He also worked out the dosage and rational indications for treatment by killed bacteria 
(bacterial vaccines) and made their general use possible. Recent work has had for its 
object the widening of the field of usefulness of biologic products and the refinement of 
their preparation. 

Antigens are substances which, when introduced into the organism, cause 
it to produce antibodies, which confer active immunity on the subjects against 
that particular antigen for a varying period of time; and in the case of the 
antitoxins, this blood-serum introduced into another individual, confers 
passive immunity on the latter. The antibodies now recognized are the 
antitoxins, bacteriolysins, opsonins, agglutinins and precipitins, the last two 
having no immunizing or therapeutic action, though of great value for diag- 
nostic purposes. 

Toxins are specific poisons produced by bacterial growth in suitable 
media, and when circulating in the organism they are the immediate causes of 
many of the symptoms of the acute infectious diseases. After the discovery 



SERUMS AND VACCINES. 427 

of the bacillus tuberculosis other micro-organisms were found constantly 
associated with certain infectious diseases, notably tetanus, diphtheria, chol- 
era, pneumonia, erysipelas and typhoid fever. The specific microbes of these 
affections were at first believed to be the immediate cause of their respective 
disorders, but later researches have shown that such diseases are due to the 
action of chemical poisons (toxins) produced by their specific bacteria growing 
on suitable soils either within the animal organism or outside it. The toxin 
produced by any particular bacterium varies greatly in power through very 
slight circumstances. It may be weakened or increased in virulence by the 
cultivation of its bacteria on different culture media or on the same media 
with different surroundings as to oxygen, temperature, etc. ; also by passing 
successive generations of these organisms through a definite series of animals, 
chosen for their natural insusceptibility or susceptibility thereto. The patho- 
genic microbes of several diseases may be cultivated in test-tubes, forced 
to acquire an increased or lessened degree of virulence or toxin-producing 
power as required, separated from the poisonous products of their metabolic 
life-work, and by the inoculation of either their progeny or their chemical 
products (toxins) the corresponding diseases may be reproduced upon healthy 
animals in almost any desired degree of intensity. 

The treatment of infectious diseases by their toxins is based upon the theory 
that the latter cause the organism to produce substances which are inimical to 
the bacteria producing them. The treatment of tuberculosis by Koch's tuber- 
culin and the inoculations of Haffkine against cholera are examples of true toxin 
treatment. The vaccinations of Jenner for variola and of Pasteur for rabies are 
of the same nature when employed as remedial methods, the material being 
obtained from a morbid product of the disease in the one case and from the dis- 
eased tissue itself in the other, the culture medium in both being the blood and 
tissues of the infected animal organism. Bacterial vaccines (Bacterins), con- 
tain some toxins, modified by heat, in addition to the killed bacteria. It has 
been frequently observed that patients afflicted with malignant disease have 
been greatly benefited by an intercurrent attack of erysipelas, in consequence 
of which the tumors seemed to undergo retrogressive changes. This has 
suggested the employment of the toxins of streptococcus erysipelatis and 
bacillus prodigiosus (Coley's fluid) in inoperable sarcoma, and may lead to 
the treatment of other diseases by the toxins of bacteria hitherto unasso- 
ciated with them. 

The injection of a toxin, in gradually increasing doses at proper intervals, 
will confer active immunity upon the animal so treated against the corresponding 
disease and its particular bacteria. This immunity may be passively transferred 
to another animal by injecting into its cellular tissue the blood-serum of the 
immunized one, and this serum will also act remedially on a subject of the disease 
if administered early in its course (Behring). The immunizing and curative 
action of the serum is believed to be due to the existence of an antibody in the 



428 SERUMS AND VACCINES. 

blood of the inoculated animal, elaborated by the living cells of its tissues as a 
defence against the action of the toxin. These facts and hypotheses form the 
basis of the treatment of certain diseases by antitoxic and bactericidal sera. 

Antitoxins are produced in the blood by the cells of the organism when 
certain bacterial toxins are injected into it at definite intervals and in increasing 
quantity. They are highly specific, i. e. } effective only against the particular 
toxin producing them, which they neutralize in vitrio as well as in the organ- 
ism, by combining therewith according to the law of multiples. This action is 
best explained by Ehrlich's side-chain theory, which is briefly as follows: 
Every toxin molecule consists of a toxophore or poisonous part, and a hapto- 
phore or combining one. The latter unites with the albumin molecule (receptor) 
of the cell, with which it has the greatest affinity, forming a side-chain thereof. 
By the frequent repetition of this process the cell is stimulated to excess produc- 
tion of receptors, which, uncombined with toxin, are thrown off into the blood 
and tissues. These excess receptors constitute the antitoxin, which circulate 
in the blood and are ready to combine with fresh toxin on its introduction or 
formation in the body, before it is able to damage the cells of the organism. 

The discovery that the blood-serum of an immunized animal may be 
successfully employed for curative as well as prophylactic purposes against 
its particular disease upon other animals of the same or different species, was 
made by Professor Emil Behring of Berlin, in 1891. This was no chance dis- 
covery but was the legitimate result of logical reasoning and hard work, and 
is formulated under the title Behring' s Law, as follows: The blood-serum of 
an animal which has been artificially rendered immune against a certain infec- 
tious disease, when injected into the body of another animal, has power to pro- 
tect the latter individual against the same disease and to cure the disease after 
infection has occurred. 

Ehrlich has shown that Behring's law is valid also for the chemical poisons, Ricin and 
Abrin, the respective toxalbumins of the ricinus palm and the jequirity bean. The blood of 
animals slowly immunized by increasing doses of these toxins contains antitoxic substances 
named Antiricin and Antiabrin, which, if added to their respective poisons, will attenuate and 
even neutralize the latter. These facts are advanced as proof that the slowly increasing 
artificial immunity is not a simple tolerance acquired by the organism, as Sternberg taught, 
but is due to the production of new antagonistic and defensive substances by the living cells 
of the organism. 

The chief representatives of the antitoxic sera are those of diphtheria and 
tetanus, though antitoxins for other disease are recognized, and have been used 
with varying effect. Among the latter are antitoxins for hay fever, tuberculosis, 
symptomatic anthrax, snake venom, spider and scorpion poisons, and certain 
poisons in fish and plants. The only antitoxins official in the U. S. Phar. are 
those of diphtheria and tetanus (see infra). 

An Antitoxic Serum is prepared as follows: A highly virulent culture of the specific 
micro-organism of the particular disease, or still better, a strong toxin of tested strength pre- 
pared therefrom, is injected into the cellular tissue of a suitable animal, generally a horse, at 
first in very small quantity. The effect is soon shown by the onset of fever and other symptoms 
of acute disease, which are known as the "reaction." After an interval of time sufficient for 



SERUMS AND VACCINES. 429 

recovery from these symptoms, the injection is repeated with a stronger toxin, or with a 
larger quantity of the original toxin. This process is continued for several months, or 
until the animal no longer "reacts" to the poison, and then sufficient antitoxin is^presumed 
to exist in its blood to render it immune to the toxin and to the disease. After each in- 
oculation the animal's blood serum is tested as to its value by experiment on guinea-pigs 
of definite weights. When the desired degree of immunity is reached the animal is bled 
from the jugular vein under strict aseptic precautions, from 6 to 12 pints being taken from 
a horse, according to his size and general condition. The blood is received in sterilized 
flasks, which are carefully stoppered and stored on ice until the clot has separated from the 
serum. The latter is tested to determine its value in antitoxin, has phenol added to it in the 
proportion of 0.5 per cent., and is bottled in vials which contain in each the dose for one patient. 
The vials are labeled with a statement of the number of normal antitoxin units per mil of the 
contents, expressed in multiples of a standard normal serum. 

Bacteriolysins form one division of the Cytolysins, antibodies which possess 
the property of dissolving cellular elements under particular conditions, and 
occur in the blood as a result of the reaction following the injection of cellular 
elements as antigens. The dissolving action of the bacteriolysin depends on 
the presence of two bodies, the complement (alexin, cytase), present in 
normal blood-serum, and the ambocepter (immune body), which is present in 
the immunized serum, and acts to prepare the bacteria so that the complement 
can act dissolvingly upon them. Usually there is not enough complement pres- 
ent in the immunized serum to effect bacteriolysis, and more is added by mix- 
ing normal serum with the immunized serum before administration. 

The first bacteriolysin known was that of Asiatic cholera, discovered by 
Pfeiffer in 1892, and this, with the bacteriolysin of typhoid fever, are the prin- 
cipal representatives of the bacteriolytic sera. The therapeutic use of bacterio- 
lytic sera has been limited, from the fear that their employment in a diseased 
person would set free poisons resulting from the solution of the bacteria present 
in the body. 

Opsonins (Bacteriotropins) are chemical substances existing in the blood- 
serum of animals immunized against streptococci, pneumococci, etc., which 
have neither an antitoxic nor a bacteriolytic action, yet confer immunity 
against the same infection when introduced into the blood of other animals. 
Denys (1895) showed that bacteria treated with sera containing these sub- 
stances are taken up and digested by the leucocytes. Wright (1903) found 
similar substances in normal blood-serum, and called them Opsonins (o\j/ov, 
cooked meat), because they prepare the bacteria for the devouring action of 
the phagocytes. He devised a method of ascertaining the opsonic value of 
any particular blood-serum, which, when compared with that of normal 
serum, gives the Opsonic Index of the individual for any particular infectious 
disease. He also made the important discovery that the opsonic powei of 
the blood in infectious disease may be raised and maintained at a high level 
by injecting a killed (sterilized) culture of the same bacteria that are doing 
the mischief. This is the basis of the modern vaccine-therapy, the so-called 
Bacterial Vaccines of today being suspensions in salt solution of the same 
bacteria which have caused the patient's infection, and have been killed 
(sterilized) and accurately measured as to the number present in the vaccine. 



43 O SERUMS AND VACCINES. 

The determination of the opsonic index is technically very difficult for the 
general practitioner, and is subject to such variations that it is not available 
usually as a diagnostic or prognostic guide, and even among trained bacteri- 
ologists there is considerable skepticism as to its practical value, though it 
undoubtedly gives a clue to the probable infecting agent in obscure cases. 

Bacterial Vaccines (Bacterins). The term vaccine was originally applied 
to the infective virus or antigen of vaccinia (cow-pox), but in modern usage 
has been extended to include the antigens of all infectious diseases. In the 
preparation of stock vaccines the pathogenic bacteria are grown in pure culture, 
then killed by heat, suspended with their toxin in sterile physiological salt 
solution, protected from contamination by an antiseptic, and standardized to 
contain a definite number of bacteria in each milliliter. They are used 
by injection, subcutaneously or intravenously, to develop in the patient's body 
a condition of active immunity against the corresponding pathogenic germs 
or their toxins, by raising the opsonic value of his blood, and thereby promoting 
the phagocytosis of invading bacteria. The advantage of this active immuniza- 
tion for prophylactic purposes depends on the facts that these vaccines are 
incomparably cheaper and simpler to prepare than the sera, and that the active 
immunity conferred by them is more durable than the passive immunity pro- 
duced by the latter. On the other hand their immunity does not set in immedi- 
ately as is the case with the passive form, but only after 8 to 14 days of treatment. 

This method of immunization was first tried by Ferran in 1884, who at- 
tempted protective vaccination with artificial cholera cultures during a great 
epidemic of cholera in Spain, but with poor results. Haflkine, using pure 
cultures attenuated by warmth, conferred immunity against cholera on many 
thousands of persons in India. PfeirTer and Kolle placed the method of vac- 
cination with killed bacteria on a scientific basis and put it to practical test 
against cholera in Japan in 1902. 

The prophylactic use of bacterial vaccines has been most successfully applied 
against anthrax (in domestic animals), symptomatic anthrax (rauschbrand), 
and the infections of typhoid fever, cholera and plague. Its therapeutic em- 
ployment is applied to those diseases which are combated by phagocytosis and 
not by bacteriolysic or antitoxic action, including the infections caused by the 
staphylococcus, streptococcus, pneumococcus, gonococcus, and the bacilli of 
tuberculosis, influenza, and the colon bacillus. Vaccine therapy has met with 
success in gonorrheal arthritis, also in pneumococcic and staphylococcic 
infections, especially the latter; and is of value in pulmonary tuberculosis 
with mixed infection. 

Stock vaccines must be used in cases of tuberculous and gonorrheal infection, 
because of the technical difficulties encountered in growing their germs; and 
stock vaccines of the staphylococci will, in most cases, give about as good re- 
sults as personal (autogenous) ones. For all other germs the latter are superior 
to the stock vaccines. 



SERUMS AND VACCINES. 431 

Recently an improved type of vaccine has been brought forth and spoken 
of as a sensitized vaccine. In its preparation the bacteria are treated with 
the serum from animals immunized against the same organism. Sensitized 
bacterial vaccines are claimed to be more efficient in producing active 
immunity which occurs more quickly and lasts longer and the local and gen- 
eral reactions are greatly reduced or eliminated (Besredka). 

The blood, then, has three principal methods of resisting bacterial invasion; 
(i) an antitoxic action, (2) a bacteria dissolving (bacteriolytic) action, (3) a 
phagocytic action; so that it opposes the pathogenic germs by neutralizing the 
toxins generated by some varieties, by dissolving others, and by destroying 
other bacteria by the devouring action of the white blood-cells. The Antitoxins 
effect the first method, the Bacteriolysins accomplish the second, and the 
Opsonins promote the third. The principal affections which have been found 
eligible to the prophylatic or therapeutic influence of these agents may now be 
considered, beginning with the disease which has been most effectively combated, 
viz., diphtheria. 

Diphtheria. The antitoxin of this disease, though not the first to be dis- 
covered, is by far the first in practical importance. The bacillus of diphtheria 
was discovered by Loeffler and Klebsin 1884, its toxic products were isolated by 
Roux, and Sidney Martin demonstrated the chemical identity of the toxins 
produced in culture media with those produced by the bacillus in the human* 
organism. In 189 1 Behring discovered the antitoxin and established its preven- 
tive and curative properties. The clinical results obtained thereby were an- 
nounced by Roux at the Buda-Pesth Congress of Hygiene in 1894, and attracted 
universal attention. Since then the statistics of diphtheria serum-therapy have 
grown voluminous, have included a large number of reports from official and 
private sources of the highest professional authority, and the weight of evidence 
has steadily grown more and more favorable to this treatment of the disease. It 
is now generally conceded that under antitoxic treatment the mortality in all 
forms of diphtheria has been reduced from 40 per cent, and more to 15 per cent, 
and less, and if laryngeal and operative cases are excluded to less than 5 per 
cent. In laryngeal diphtheria the former mortality of 73 per cent, has been re- 
duced to about 27 per cent., thus almost completely reversing the figures repre- 
senting the deaths and recoveries from this form of the disease. These sta- 
tistics include over 68,000 cases reported from 1894 to 1905, by Roux, Welch, 
Virchow, the American Pediatric Society, and the Boards of Health of the Ger- 
man cities, Massachusetts, New York, London, Chicago, Boston, Baltimore, 
Washington, and Denver. A few writers contend that much of this decrease of 
mortality is due to improved hygienic surroundings, and deny the value of anti- 
toxin treatment, claiming that under it the deaths from pulmonary and renal 
complications are more common than formerly. Dr. Lennox Brown maintains 
that in London the diphtheria mortality without antitoxin treatment rarely 



43 2 SERUMS AND VACCINES. 

exceeds 20 per cent., and Bayeux states the mortality of this disease through- 
out the world as only 16 per cent. The general professional opinion agrees 
with that of Professor Klein, who stated at a meeting of the British Medical 
Association, in reference to this disease, that "the scientific basis for the ap- 
plication of antitoxic serum is as firmly founded and as thoroughly established 
as the use and application of any known drug." 

The clinical history of the disease under the antitoxin treatment, as recorded 
by its observers, shows an extraordinary decrease in the severity of the symptoms. 
A marked improvement in both the local and general symptoms is usually no- 
ticed within 24 hours after the injection of the serum. The membrane loosens 
and clears off rapidly, high temperature is lowered, and the pulse slows and 
gains in force (Washbourn). Evident signs of distress vanished within 24 
hours, and apparent strength and good-humor took the place of a previously 
low mental and physical condition (Kossel). In no case did the larynx become 
involved after the use of the serum if not so previously, and many cases show- 
ing laryngeal symptoms recovered without tracheotomy. Even in the fatal 
cases life was prolonged (Caiger). The remedy has decided power to prevent 
the spreading of the false membrane into the larynx and trachea. It is power- 
less to repair damage already done to the tissues by the diphtheria toxin, hence 
the earlier the serum is administered the better are its results. It is decidedly 
more efficient in the fibrinous form of the disease than in the septic form, and 
in cases of simple infection than in those of double or mixed infection. The 
statement that the liability to paralysis is not lessened, but is somewhat 
increased by antitoxin treatment, is based upon the increased incidence of 
paralysis in hospital statistics without considering its relation to the lessened 
mortality. Antitoxin saves cases which without its use would have died 
early of profound toxemia, cardiac failure, etc., only subsequently to develop 
some form of paralysis. Paralysis occurs in those cases in which antitoxin 
is given late in the course of the disease, and only with extreme rarity if given 
early and in sufficient amount. Paralysis never occurs when antitoxin is 
given for prophylactic immunization. The serum may cause certain unto- 
ward symptoms, as cutaneous eruptions, swellings, etc., but these are not 
serious and are not attended with danger to life. Its injection is very 
rarely followed by serious local disturbances, as abscess, and probably would 
never be complicated thereby if the serum were always pure and used with 
strict aseptic precautions. Welch states that in over 100,000 injections the 
serious mishaps directly attributable to the serum can be counted on the fingers. 
Among 10,000 cases at the Philadelphia Hospital for Contagious Diseases, 
Woody has never observed dangerous or alarming serum sickness. 

Poisonous symptoms are not believed to be caused by the antitoxin, but are 
due to some other constituent of the serum, for they may occur when the simple 
blood-serum of another species of animal is injected into the human subject. 
The most common one is a rash, usually an erythema, but sometimes papular 



SERUMS AND VACCINES. 433 

or urticarial, which occurs in about 35 per cent, of the cases, appearing as 
early as a few hours and as late as several weeks, with an average of six or 
seven days, after the injection. Pains in and swelling of the joints are occa- 
sionally experienced, and symptoms of septicemia have occurred, with 
irregular temperature, nephritis, and death. Instances of sudden death 
following the administration of antitoxin have been reported by several 
observers. The patients have been principally victims of asthma and status 
lymphaticus. Death has occurred from asphyxia as a result of spasm of the 
bronchioles; death which is not unlike that occurring in animals as a result 
of anaphylaxis. In this type of patient it is well to guard against this rare 
possibility by administering full doses of atropine to prevent spasm of the 
bronchioles. 

Clinically, most cases of diphtheria are of mixed infection, and as the anti- 
toxin is effective only against the toxin of the Klebs-Loeffler bacilli, the local 
antiseptic treatment of the throat is still insisted on. If thoroughly carried 
out in the incipiency it may destroy the dangerous streptococci and other mi- 
crobes, thereby preventing the mixed infection which proves so virulent; if con- 
tinued throughout the case and during convalescence it will minimize the dan- 
ger of infecting other persons. In some instances bacilli are found for several 
months after recovery. Such cases are known as diphtheria carriers, and 
though not manifesting the disease, may spread it to other individuals. In 
1 909 Schiotz, a Danish physician, observed that patients with staphylococcic 
sore throat seldom develop diphtheria when exposed, and also that patients 
in whom diphtheria bacilli persisted following the disease, the organisms disap- 
peared with the development of a staphylococcic sore throat. He applied 
this clinical observation in the treatment of cases with persistent diphtheria 
bacilli in the throat following the disease by the application of staphylococcus 
culture. A number of observers have reported good results by the use of 
this method, and it is to be considered, particularly in those cases which have 
resisted the usual methods of treatment. In a somewhat similar manner the 
lactic acid bacillus spray has been used. In both instances a successful 
result depends upon the fact that the staphylococcus and lactic acid bacillus 
override the diphtheria organism. • 

The antitoxin unit is fixed by law and is under the control, in the United 
States, of the Hygienic Laboratory of the Public Health Service. The 
immunity unit is the quantity of antitoxin which will neutralize 100 minimum 
lethal doses of toxin for a guinea-pig weighing 250 gms. 

"A number of test doses of the toxin are prepared, each containing a hundred times the 
minimum fatal dose. To each test dose is added a measured quantity of the serum in 
question. To one dose is added 0.01 c.c. of the serum; to another, 0.05 c.c. of the serum; 
to another, 0.1 c.c. of the serum; to another, 0.5 c.c; and to still another 1 c.c, and so on. 
The mixtures are now injected into guinea-pigs and the results observed. Animals not 
dying within four days were protected; local infiltration, wasting or death after the fourth 
day does not enter into the computation. The mixture containing the smallest amount 
of serum and yielding this result contains 1 immunity unit. If 0.05 c.c of a serum neu- 
28 



434 SERUMS AND VACCINES. 

tralizes ioo times the minimum lethal dose, each cubic centimeter contains twenty immunity- 
units. Antitoxin as placed upon the market, is labeled as containing a certain number 
of immunity units, and the measured quantity of serum necessarily varies, as the number 
of units obtained are rarely exactly the same in two animals." (Coplin.) 

The prophylactic dose for children is 500 to 1000 units, and for adults 
1000 to 2000 units. The immunity so conferred is only temporary, its 
duration depends on the quantity of antitoxin administered, and it gradually 
decreases as the antitoxin is eliminated. The prophylactic administration 
of antitoxin to those who had been exposed to the infection has been uni- 
versally recommended in spite of the fact that many persons are not sus- 
ceptible at the time of exposure because of the presence of natural diphtheria 
antitoxins in the blood. Many persons, no doubt, have been given antitoxin 
as a prophylactic when nature has supplied sufficiently to protect the 
individual. The practical difficulty has been the separation of those in which 
natural antitoxin was present in sufficient amounts to protect the individual 
from those in which its absence or diminished quantity rendered infection 
probable. Recently a simple test known as the intracutaneous reaction of 
Schick, has been found of considerable value in estimating the presence of 
natural immunity. In the performance of the test a dilution of diphtheria 
toxin is made of such strength that 0.1 mil. contains one-fiftieth of the 
minimum lethal dose for the guinea-pig. This amount is injected intracu- 
taneously and if a positive reaction results there appears from 24 
to 48 hours a circumscribed area of redness and slight infiltration 
which remains for about a week and then fades, a brownish pigmentic area 
remaining for a considerable length of time. A positive reaction, according 
to Schick, indicates that the natural antitoxins are considerably reduced or 
absent, and such individuals are susceptible to diphtheria. So far this test 
has been corroborated by Park and other observers. In a series of 700 
scarlet fever cases Park found a negative reaction in 57 per cent., and there- 
fore needed no immunization. Park has not observed any case of diphtheria 
after a negative Schick reaction, and feels safe in leaving a case with a 
negative reaction without immunization. The therapeutic dosage recom- 
mended by the committee of the American Pediatric Society, 1000 units as 
the initial dose for children under two years of age and for mild cases; 1500 
to 2000 units for older children, and all severe cases, is now considered too 
small. Larger doses are desirable, 10,000 to 20,000 to 30,000 units, admin- 
istered early make frequent repetitions unnecessary. In all cases the initial 
dose should be repeated or doubled if favorable results do not follow within 6 
or 8 hours after the first injection. The necessary amount for any case can be 
determined only by estimation of the quantity of toxin present as indicated by 
the symptoms; remembering that this quantity increases rapidly with every 
day after infection. The prognosis is unfavorable if the case is so far advanced 
before treatment that the toxin has had time to accumulate and to exert its par- 
alyzing influence on the nervous apparatus of the heart. As we have no 



SERUMS AND VACCINES. 



435 



exact method of determining the amount of toxin present in the blood and 
tissues, it is the part of wisdom to give large doses. S. S. Woody, whose 
experience covers a personal observation of over 10,000 cases at the 
Philadelphia Hospital for Contagious Diseases, claims for large doses a 
prompter local cure, a quicker improvement in the patient's general condi- 
tion, permanence of curative action, avoidance of complications, reduction 
in mortality and harmlessness. Woody believes that the minimum dose 
should be 10,000 units; and for tonsillar cases he administers 30,000 to 
60,000 units; with the extension of the exudate to the palate, uvula and nose 
of three days' duration or thereafter from 150,000 to 300,000 units. Simple 
nasal cases, 20,000 units; nasal cases with marked toxemia, 50,000 to 150,000 
units; and laryngeal cases, 30,000 to 45,000 units. The result has been a 
lowering in mortality according to the following table: 



Year. 


No. of Cases. 


Deaths. 


Per Cent. 


Dosags. 


1908 
1909 
1910 
1911 
1912 


1,426 

2,153 
1,870 

1,895 
1,676 


127 

144 
120 
130 

IOI 


8-55 
6.69 
6.42 

6.86 
6.02 


Very small. 

First year large doses were used. 
Larger doses about as used in 1909. 
Doses smaller than in 1909 and 1910. 
Larger doses used. 



The success of the treatment with antitoxin depends upon the earliness 
with which the disease is recognized and the promptness with which anti- 
toxin is administered. When administered on the first day of the disease 
the fatality is almost nil. 

Official Preparations. 

Serum Antidiphthericum, Antidiphtheric Serum (Diphtheria Antitoxin), — a fluid, hav- 
ing a potency of not less than 250 antitoxic units per mil, separated from the coagulated 
blood of the horse, or other large domestic animal, which has been properly immunized 
against diphtheria toxin. It must be kept in sealed glass containers in a dark place, at a 
temperature between 4.5 and 15 C. It is a yellowish or yellowish-brown, transparent 
or slightly turbid liquid, with sometimes a slight granular deposit; nearly odorless, or having 
an odor due to the presence of an antiseptic used as a preservative. Antidiphtheric Serum 
gradually loses in potency, the loss in one year varying between 10 per cent, and 30 per 
cent. The serum must come from healthy animals, must be sterile, must be free from toxins 
or other bacterial products, and must not contain an excessive amount of preservative (not 
more than 0.5 per cent, of phenol or cresol, when either of these is used), and the total 
solids must not exceed 20 per cent. The standard of strength, expressed in units of anti- 
toxic power, shall be that established by the United States Public Health Service. Dose, 
average (U. S. P.), 10,000 units. Protective, 1000 units. 

Serum Antidiphthericum Purificatum, Purified Antidiphtheric Serum (Antidiphtheric 
Globulins, Concentrated Diphtheria Antitoxin, Diphtheric Antitoxin Globulins, Refined and 
Concentrated Diphtheria Antitoxin), — it is a solution in physiological solution of sodium 
chloride of certain antitoxic substances obtained from the blood serum or plasma of the 
horse, or other large domestic animal, which has been properly immunized against diph- 
theria toxin. After the serum has been collected the antitoxin-bearing globulins are sepa- 
rated from the other constituents of the serum and dissolved in water; and sufficient 
sodium chloride is then added to make a solution containing from 0.6 to 0.9 per cent, of 
the salt. It has a potency of not less than 250 antitoxic units per mil. It mustbe^kept 



436 SERUMS AND VACCINES. 

in sealed glass containers in a dark place, at a temperature between 4.5 and 15 C. Dose, 
average (U. S. P.), 10,000 units. Protective, 1000 units. 

Serum Antidiphthericum Siccum, Dried Antidiphtheric Serum {Dried Diphtheria Anti- 
toxin), — dried Antidiphtheric Serum is obtained by the evaporation of either Antidiph- 
theric Serum or Purified Antidiphtheric Serum in a vacuum over sulphuric acid or other 
desiccating agent, or by passing oyer it a current of warm air freed from bacteria. It has 
a potency of not less than 4000 units per gramme. It must be kept in hermetically sealed, 
amber-colored glass containers free from air, at a temperature between 4.5 and 15 C, 
preferably in a dark place. The dried serum is either in the form of orange or yellowish 
flakes or small lumps, or as a yellowish- white powder, without odor. The Serum is soluble 
in nine parts of distilled water, but the solution is opalescent and slightly viscous; it may 
be dissolved more readily in larger amounts of distilled water or physiological solution of 
sodium chloride. Immediately before use the Serum must be dissolved in recently boiled 
and cooled distilled water under the most rigid aseptic conditions. The solution must be 
used immediately and if there should be any serum or solution remaining, it must be dis- 
carded. Dried Antidiphtheric Serum if kept as directed does not lose in potency, as does 
the liquid serum. Dose, average (U. S. P.), 10,000 units. Protective, 1000 units. 

Tetanus. This was one of the first diseases to be studied successfully by 
the bacteriologists, and its antitoxin was the first one prepared. Breiger 
in 1880 showed that a crystalline substance of high toxicity could be 
obtained from tetanic fluids, and that it would reproduce the symptoms of 
tetanus when injected into healthy animals. Rosenbach found the tetanus 
bacillus in human cases of the disease, and Nicolaier demonstrated its existence 
in soils. Kitasato soon afterwards obtained pure cultures of the bacillus, and 
demonstrated the immunizing power of the serum of animals inoculated with 
its toxin. 

The toxin of tetanus is a toxalbumin of extraordinary potency, and is per- 
haps the most virulent poison known. Whereas the fatal dose of Strychnine 
for a man weighing 70 kilos is from 30 to 100 milligrammes (gr. ss-jss), that 
of the tetanus toxin is estimated at 0.23 milligramme (gr. -g-^-o). In laboratory 
experiments the disease is prevented and cured by its antitoxin with almost 
absolute certainty, but the conditions are in every respect different from 
those which obtain in cases of accidental infection, the amount of toxin 
present in the animal being known, and the antitoxin being administered at 
the same time with the toxin or very soon afterwards. The disease is clinically 
unrecognizable until the nervous system has been sufficiently damaged to pro- 
duce symptoms of nerve lesions, and the toxin is firmly united with the proteins 
of the central nervous tissue before symptoms develop, until which a diagnosis 
is impossible. The case is usually far advanced when professional assistance 
is first sought, and is therefore not so amenable to treatment as diseases which 
manifest their symptoms by progressive stages. * 

The study of tetanus statistics shows that its mortality prior to the use of 
antitoxin was from 70 to 90 per cent., in the acute form 80 to 90 per cent., and 
in the chronic type about 40 per cent. The available statistics of cases treated 
by antitoxin give the general mortality under this treatment as between 40 and 
50 per cent., the reduction being chiefly manifested in the subacute and chronic 
cases, acute tetanus showing a mortality of 70 to 80 per cent. There is much 
difference between the results reported from certain countries, indicating a wide 



SERUMS AND VACCINES. 437 

variance in either the potency of the sera employed or the virulence of the in- 
fecting bacilli. In Italy the disease seems to be amenable to antitoxin as well 
as to other methods of treatment, particularly that by phenol injections, while 
the reports from other countries are much less favorable. 

On account of the natural difficulties in treating this disease by antitoxin 
at the late period when the symptoms are manifested, and from the fact that 
the serum is powerfully immunizing and harmless, the tendency is to adopt a 
prophylactic method in all cases, giving a full immunizing dose as soon as pos- 
sible after the infliction of a wound received under circumstances which indicate 
a possible tetanus infection. For this purpose not less than 1500 antitoxic 
units should be administered. Along with this treatment the usual preven- 
tive measure should be employed, including excision of the part or the actual 
cautery if the wound is recent. The actual cautery, or the application of a 
strong solution of corrosive sublimate with tartaric acid, or the injection of 
phenol solutions, are the most effectual methods of combating the tetanus 
germs in the wound. For curative purposes the serum should be injected 
as soon as possible, the quantity being determined according to its stated 
strength, the gravity of the symptoms, the patient's age and the time since 
infection. The serum must be fresh to be effective, and as a curative agent 
should be given so as to reach the nerve centres as quickly as possible, 
therefore 5000 units are given intraspinally, or 10,000 units intravenously, 
and repeated as indicated. 

Official Preparations. 

Serum Antitetanicum, Antitetanic Serum (Tetanus Antitoxin), — a fluid having a 
potency of not less than 100 units per mil, separated from the coagulated blood of the horse, 
or other large domestic animal, which has been properly immunized against tetanus toxin. 
It must be kept in sealed glass containers in a dark place, at a temperature between 4.5 
and 1 5 C. It is a yellowish or yellowish-brown, transparent or slightly turbid liquid with 
sometimes a slight granular deposit nearly odorless, or having an odor due to the presence 
of the antiseptic used as a preservative. Antitetanic Serum gradually loses in potency, 
the loss being greater at higher than at lower temperatures. The serum must come from 
healthy animals, must be sterile, must be free from toxins or other bacterial products, and 
must not contain an excessive amount of preservative (not more than 0.5 per cent, of phenol 
or cresol, when either of these is used), and the total solids must not exceed 20 per cent. 
The standard of strength expressed in units of antitoxic power, shall be that established by 
the United States Public Health Service. Dose, average (U. S. P.), 10,000 units. Protec- 
tive, 1500 units. 

Serum Antitetanicum Purificatum, Purified Antitetanic Serum {Antitetanic Globulins, 
Concentrated Tetanus Antitoxin, Refined and Concentrated Tetanus Antitoxin), — a solution 
in physiological salt solution of certain antitoxic substances obtained from the blood serum 
or plasma of the horse, or other large domestic animal, which has been properly immunized 
against tetanus toxin. After the serum or plasma from the immunized animal has been 
collected, the antitoxin-bearing globulins are separated from the other constituents of the 
serum or plasma and dissolved in water; and sufficient sodium chloride is then added to 
make a solution containing from 0.6 to 0.9 per cent, of the salt. It has a potency of not 
less than 100 units per mil. It must be kept in sealed glass containers in a dark place, at a 
temperature between 4.5 and 15 C. Purified Antitetanic Serum must comply with the 
requirements for loss of potency, control, labeling and standard for potency under Serum 
Antitetanicum. Dose, average (U. S. P.) 10,000 units. Protective, 1500 units. 

Serum Antitetanicum Siccum, Dried Antitetanic Serum (Dried Tetanus Antitoxin), — 
dried Antitetanic Serum is obtained by the evaporation of either Antitetanic Serum or 



438 SERUMS AND VACCINES. 

Purified Antitetanic Serum in a vacuum, over sulphuric acid or other desiccating agent, 
or by passing over it a current of warm air freed from bacteria. It has a potency of not 
less than 1000 units per gramme. It must be kept in hermetically sealed amber-colored 
glass containers, free from air, at a temperature between 4.5 and 15 C, preferably in a 
dark place. Dried Antitetanic Serum is either in the form of orange or yellowish flakes or 
small lumps, or a yellowish-white powder, without odor. The serum is soluble in nine 
parts of distilled water, but the solution is opalescent and slightly viscous; it may be dis- 
solved more readily in larger amounts of distilled water or physiological solution of sodium 
chloride. For use, the serum must be dissolved in recently boiled and cooled distilled water 
under the most rigid aseptic conditions. The solution must be used immediately and, if 
there should be any serum or solution remaining, it must be discarded. Dried Antitetanic 
Serum if kept as directed does not lese in potency, as does the liquid serum. It is sometimes 
used as a dusting powder or for local application to infected wounds. It must comply with 
the requirements for control and labeling under Serum Antitetanicum and the standard of 
strength, expressed in units of antitoxic power, shall be that established by the United 
States Public Health Service. Dose, average (U. S. P.), 10,000 units. Protective, 1500 
units. 

Tuberculosis. Tuberculin, announced in 1890 as a remedy for tuber- 
culosis by Professor R. Koch of Berlin, was subsequently stated by him to be 
an extract of the products of pure cultures of the tubercle bacillus, made with 
glycerin and water. In its preparation tubercle bacilli are grown from four 
to six weeks in 5 per cent, glycerin bouillon. The cultures are then filtered 
and the filtrate evaporated to one-tenth of its volume. The resulting dark 
brown, syrupy fluid is known as Tuberculin and represents practically a 50 
per cent, glycerin extract of the soluble products of the growth of the tuber- 
cle bacillus. This substance is also known as Old Tuberculin (O. T.) and 
is the preparation usually referred to when speaking simply of Tuberculin. 
This understanding will prevent confusion in the mind of the reader who 
confronts the vast amount of literature upon the different varieties of tubercle 
bacillus products, extracts, etc., practically all of which are designated as 
modified tuberculins. In the preliminary statement to the International 
Medical Congress, the chief point made by Koch was that guinea-pigs could 
be rendered immune to inoculated tuberculosis by means of this agent, but 
even this has been denied by other observers. In his extended paper it was 
stated that the remedy would not directly kill the bacilli, but that it acted 
powerfully and specifically upon the living tuberculous tissue, caused a 
necrotic condition thereof and hastened its disintegration; also that it might 
be expected to increase the resistant power of healthy tissue and thereby 
starve the bacilli, check their increase, and lead in many cases to the cure of 
the disease. The actual result, however, as Virchow and others soon 
pointed out, was to soften and disintegrate quiescent deposits and to dissemi- 
nate the bacilli throughout the body, forming new foci of active infection in 
other situations. The severe reactions, which followed the injections of the 
lymph in many instances, proved that serious risk must attend its general 
use; and that, like most remedies for phthisis, it could do good only in a few 
carefully selected cases. 

Professor Koch acknowledged that tuberculin is only serviceable in the 
initial stage of phthisis and in cases of simple infection, also that when the 



SERUMS AND VACCINES. 439 

case is complicated by the presence of other microbes it is of no service and 
often does harm. His statements as to its limitations were ignored in the en- 
thusiasm excited by the discovery; the lymph, as it is frequently called in 
Germany, was administered in advanced cases of mixed infection, and in 
poisonous doses, causing severe reactions, both local and general, so that 
many cases succumbed quickly under its use. A profound disappointment 
followed, tuberculin became thoroughly discredited, and its use was almost 
universally abandoned. It has become of interest again through the studies 
and reports of careful clinical workers who have witnessed good results when 
its use was restricted to selected cases, and particularly because it has found 
a rather definite field of usefulness in diagnosis. Interest has also been 
aroused in the efforts to produce a tuberculin preparation free from toxicity, 
though retaining an immunizing and germicidal quality. 

The violent action of the original tuberculin, together with its source, 
prove it to be a true bacterial toxin. Taken by the mouth its action is 
uncertain, being subject to the action of the digestive fluids. In the dose of 
one milligramme injected hypodermically upon healthy subjects, it gives rise 
to slight pains in the limbs and a transient sense of fatigue; but the same 
quantity injected upon tuberculous subjects produces a very powerful 
reaction. The manifestations of the reaction are: (i) general or constitu- 
tional, ^2) focal, at the site of the tuberculous process, and (3) local, at the 
point of inoculation. The constitutional effects are similar to those accom- 
panying an acute exacerbation of the disease. About 3 hours after the 
injection a decided rigor occurs, which is followed by a rapid rise of tempera- 
ture and pulse-rate; also pains in the limbs, a sense of great fatigue, drowsi- 
ness, nausea and loss of appetite, these effects lasting from 12 to 15 hours. 
In cases of advanced phthisis with cavities, after the injection of tuberculin 
the temperature has risen to 105. 8° F., and this falling suddenly, collapse has 
occurred and the patients have died. The elevation of temperature is the 
most constant general manifestation and may be the only evidence of reac- 
tion where small doses are given. The focal reaction in cases of lupus is 
manifested by a feeling of tightness with heat and burning over the face and 
nose and an eczematous exudation sets in, which continues about 48 hours 
and dries into crusts on the surface of the lesion. After two days these 
symptoms begin to subside, and after nine days the crusts have fallen off and 
the affected tissue appears shrunken, red and shiny, like the surface of a 
lupus patch which has been scraped with a Volkmann's spoon. In pulmon- 
ary cases the reaction is evidenced by increase in the physical signs of 
inflammatory activity, the cough increases, there are great distress and 
dyspnea, the patient feels decidedly worse and occasionally suffers a slight 
collapse. In gland and bone tuberculosis there is increased swelling with 
redness and pain. When the reaction has subsided the patient feels com- 
paratively well and is generally better than before. The local reaction at the 



44© SERUMS AND VACCINES. 

point of inoculation is characterized by redness, tenderness and swelling. 
The local reaction may be present when the dose is so small as to cause no 
focal or general disturbances. This fact has been utilized in the cutaneous 
diagnostic tests of von Pirquet and Moro. These tests with their technic 
of application are described in text-books of diagnosis. 

The present opinion with regard to tuberculin therapy is divided. There 
are excellent observers who claim that it is useless, and others who claim for 
it a distinct therapeutic value. Practically all are agreed that when given 
it should be administered • in such small doses at first to render a general 
reaction unlikely and to increase the dose of subsequent administration at 
specific times with the greatest caution to prevent reactions. This will 
necessitate starting with doses considerably below the tuberculin tolerance 
of the individual. Subsequent doses are given at five and seven day inter- 
vals, and by some observers, twice weekly. The initial dose, the increment 
of increase, the length of time between doses depend so largely upon the 
various factors present in a given case, that specific rules cannot be stated. 
Individualization is of such vital importance in the success of tuberculin 
therapy, that the failure to appreciate it has led to many failures in its use. 
Brown recommends the following beginning doses which have been used by 
the writer. For old Tuberculin (O. T.) and Bouillon Filtrate (B. F.) the 
usual beginning dose may be 0.0000005 or 0.000001 mil, though in* a few, 
especially if febrile it may be 0.0000001 or 0.00000001 mil. Bacillen Emul- 
sion (B. E.) and Tuberculin Residuum (T. R.) the initial dose should be 
0.00001 gm. for afebrile and 0.0000001 gm. for febrile patients. In children 
and in febrile patients the dose is smaller than in afebrile adults. New 
Tuberculin (T. R.) is the mildest of all preparations and is very suitable for 
the beginning treatment of susceptible individuals (Citron). The various 
tuberculins have their advocates and the writer prefers Bacillen Emulsion. 
Certain observers have noted that this preparation tends to produce infiltra 
tions at the site of injection. Meyer and Rupple have advised the employ- 
ment of sensitized Bacillen Emulsion by which is meant an emulsion treated 
with tuberculous serum of a cow containing so-called anti-tuberculin, with 
the result that infiltrations are much less or entirely absent (Citron). If at 
any time during the course of treatment a reaction occurs the dose should be 
reduced to, or below, the doses which previously gave no reaction and the 
subsequent advance made more cautiously. The maximum dose to be 
reached varies in different individuals; in B. E. 5 mg. should not be exceeded, 
while in O. T. and B. F. 1 mil is the usual maximum dose (Brown). When- 
ever tuberculin is administered the patient should be under direct control of 
the physician and a careful record of the temperature range, general and focal 
reaction kept. Better results are obtained if maximum rest, fresh air and 
good food can be secured with the tuberculin therapy. It is contraindicated 
in the presence of high fever, marked asthenia, myocardial weakness with 



SERUMS AND VACCINES. 44 1 

excessively rapid pulse, advanced disease, hemorrhage and the presence of a 
serious complication such as empyema, etc. The selection of suitable cases 
for tuberculin treatment is a matter of considerable difficulty. It must be 
remembered that tuberculin is a poison which acts by stimulating the body 
forces. In a patient in whom the disease is acute and active the system is 
more or less overwhelmed with poisons produced at the site of the lesion and 
in such a case tuberculin is contraindicated. On the other hand, there are 
cases which are afebrile or have slight fever, slight constitutional disturbance 
and limited local involvement of a chronic nature in which the warfare 
between the infecting tubercle bacilli and the body forces seems to be waging 
in the balance, and the patient seems to gain but little under active, hygienic, 
dietetic care. In this type of case the writer has seen good results follow 
careful use of tuberculin. Tuberculin has been used not only in pulmonary 
tuberculosis, but in the treatment of tuberculosis of almost every organ, 
viz., skin, eye, ear, larynx, bones and joints, genito-urinary system, etc., etc. 

Preparations {Unofficial). 

Tuberculinum, Tuberculin (Koch), — is a glycerin extract of the culture fluid upon which 
the bacilli have been grown, concentrated to -^th its original volume, and filtered through 
porcelain to remove the bacilli. 

Tuberculin Residuum (T. R.) New Tuberculin (Koch), — is prepared by drying living 
virulent cultures in vacuo, grinding them into a fine dust, and after extracting certain soluble 
constituents with saline solution the residue is rubbed up with water to form an emulsion, which 
is standardized so that i mil represents the active substance found in 10 mg. of the dried 
tubercle bacilli. Initial dose mg. T ^ ¥ . 

New Tuberculin, Bacilli Emulsion (Koch) (B. E.), — is a suspension of pulverized tuber- 
cle bacilli in glycerin and water,, containing 5 mg. of the bacillar substance in each mil. 
Initial dose, t %q mg., diluted with normal salt solution. 

Tuberculin Denys, Bouillon Filtrate (B. F.), — consists of the nitrate from bouillon cultures 
of the tubercle bacillus, and contains all the soluble products elaborated by the bacilli while 
growing on bouillon. It differs from the original tuberculin in that no heat is used in its prep- 
aration and that it is not concentrated. Initial dose, T oVo m g- 

A Tuberculosis Antitoxin superseded tuberculin for several years in the treatment of 
tuberculous disease, but has fallen into disuse. Boinet immunized goats with injections of 
tuberculin, and used their serum in a few cases with decided benefit. Fisch injected horses 
with Koch's new tuberculin, and treated some 20 cases with their serum, reporting gratify- 
ing results. Paquin in 1897 reported on 393 cases, claiming 93 complete cures. Holmes 
in 1899 reported on 50 cases treated with most encouraging results. The reports of Ambler 
in 1899, and Stubbert in 1900, cover 136 cases, with 55 apparent cures. Mircoli in 1900 
published statistics of 2889 cases, 385 of which were cured and 1064 improved. Maragliano 
of Genoa has treated a large number of cases with serum obtained from immunized horses, 
which he found to contain agglutinins, bacteriolysins, and antitoxins. In 1899 he published 
statistics of 445 cases including his own and others, and stated that the local signs of the 
disease disappeared in 27 per cent, of the cases, the weight increaased in 57 per cent., and 
the bacilli disappeared in 43 per cent. In 1901 he reported 130 cases treated by himself, 
of which 36 were cured and 58 improved. He states that cases of unmixed infection, with 
circumscribed foci of disease, slight surrounding consolidation, and but little fever, are 
distinctly benefited by the treatment and some are even cured thereby, but that those with 
much broncho-pneumonic consolidation or with cavities do not show any great improve- 
ment, and that it is impossible to cure without reinforcing the strength of the organism. 

Marmorek's serum is obtained from horses which have been immunized with a particu- 
lar tuberculosis toxin; and is, unlike Maragliano's, a pure antitoxic serum. He regards it as 
a specific remedy for all diseases caused by the bacillus tuberculosis. Rectal injections of 
5-10 mils are given every day or every second day for three weeks, and this may be repeated 
after 10 days. 



442 SERUMS AND VACCINES. 

A study of the results obtained by the antitoxin treatment of tuberculosis by many other 
observers shows that this serum has failed. 

Sarcoma. The Treatment of Inoperable Sarcoma by the Mixed Toxins of 
Erysipelas and Bacillus Prodigiosus. — The occasional disappearance of 
malignant tumors during, or after, an intercurrent attack of erysipelas had 
been repeatedly observed, prior to Fehleisen's discovery of the streptococcus 
of erysipelas, in 1881. This fact led Fehleisen, Bruns, and others to treat a 
number of cases of inoperable cancer by inoculation with cultures of the 
streptococcus of erysipelas. Although a few remarkable results were ob- 
tained, some deaths occurred, and further attempts were abandoned. Coley, 
in 1 89 1, influenced by a remarkable recovery of an inoperable round-cell 
sarcoma, which disappeared under an attack of accidental erysipelas and 
remained well for a period of seven years, began a series of personal investi- 
gations; first, with the cultures of the living organism and later with the 
toxins. In 1891-92, he treated twelve cases of inoperable sarcoma and car- 
cinoma with repeated injections of the living bouillon cultures, in several 
cases with complete disappearance of the tumors. In some cases there was 
necrobiosis and discharge, in others diminution by absorption without break- 
ing down. These changes were always more marked in sarcoma than in 
carcinoma. 

The great difficulty in producing erysipelas, together with the dangers 
attending such inoculation (he had two fatal cases in twelve), led him to try 
the effect of the toxic products produced in the bouillon cultures. These 
experiments were begun in 1892, first with the erysipelas toxins alone (bouil- 
lon cultures treated by 58 C. heat) and later, in order to intensify the viru- 
lence of the erysipelas he added to the streptococcus cultures the bacillus 
prodigiosus. Roger of the Pasteur Institute found that when the bacillus 
prodigiosus was grown with the same culture of the streptococcus erysipelatous, 
the virulence of the latter was greatly increased, although he had never 
used the cultures on the human being, nor had he suggested its use as a 
therapeutic measure. The filtered cultures were used at first, but later the 
unfiltered cultures containing the dead bacilli and streptococci were found to 
be more effective. The earlier preparations were made by Dr. B. H. Buxton, 
late Professor of Experimental Pathology at Cornell Medical School. This 
combination has been used by Coley since 1893 U P to the present time. 
About 8 years ago, Dr. Martha Tracy, of the Cornell Medical School Labo- 
ratory, found that the preparation could be better standardized by growing 
the cultures separately, and, by adding a certain definite quantity of the steril- 
ized prodigiosus protein to each milliliter of the streptococcus broth. This 
later method is at present employed. 

The technic and method of treatment may be found in Coley's papers, 
one published in the "Proceedings of the Royal Society of Medicine, " 



SERUMS AND VACCINES. 443 

November, 1909, and the other in the Transactions of the Third Interna- 
tional Cancer Research Conference, Brussels, 1913. 

Coley up to the present time has practically limited the method to the 
treatment of inoperable sarcoma, although a number of inoperable carcinomas 
have disappeared under the use of the toxins, and have remained well for a 
long enough period of years to justify classifying them as cures. 

The initial injections are preferably made remote from the tumor, either 
in the pectoral regions or buttocks. After the susceptibility of the patient 
has been determined, if the tumor is easily accessible, best results are usually 
obtained by alternating with local injections. For the remote injections, it 
is important that the minimum dose should not be over J TTl, and for 
the local injections (made into the tumor itself) f-J TTl is sufficient to 
start with. Accuracy of the dose may be obtained by diluting the toxins 
with 3 to 4 times the amount of freshly boiled water. The dose should be 
increased by § Tfl, daily up to the point of producing a marked reaction, 
temperature 102 to 104 F., after which 3 to 4 treatments a week should be 
sufficient. If used as a prophylactic after primary operation, smaller doses — 
just enough to give f— 1° T. are sufficient, and this does not interfere with 
the patient's daily routine of life. 

If due care is taken to secure asepsis, and if one is careful not to give too 
large doses, or initial dose, the toxins are practically devoid of danger. In 
a very few cases irritation of the kidneys developed, and it is therefore 
well to have regular analyses of the urine made during the period of treatment. 

Coley 's last paper, read before Brussels Congress in 191 3, contains a 
report of 80 personal cases successfully treated with the toxins, as well as a 
tabulated list of 102 cases successfully treated by other men. 

Of the personal cases successfully treated with the toxins, 59 have re- 
mained well over three years, namely: 

13 well from 15-20 years 

5 well from 10-15 years 

25 well from 5-20 years 

16 well from 3-5 years 

The tables of other men's cases treated with the mixed toxins, show 63 
having remained well over three years : 

4 well from 15-20 years 

8 well from 10-15 years 

19 well from 5-10 years 

32 well from 3-5 years 

It is worthy of note that all types are represented in this series of cases, 
but the type least favorably influenced by the toxins, is the melanotic. 

It is a noteworthy fact that seventeen of Dr. Coley's successful cases 
were lymphosarcomas; this is especially interesting, inasmuch as there are no 



444 SERUMS AND VACCINES. 

cases on record of a cure of lymphosarcoma either by surgery or #-ray, after 
more than one gland had become involved. 

Coley believes that the most promising field for the toxins lies in the 
routine administration immediately after primary operation, keeping the in- 
jections up for a number of months. He also advocates the preliminary use 
of the toxins in sarcomas of the long bones, before amputating, in the hope of 
saving the limb, and reports upwards of twenty cases in which the limb as 
well as the life of the patient had been saved by such preliminary treatment. 

Streptococcus Infections. Denys (1896) succeeded in obtaining a strep- 
tococcus serum, and explained the mechanism of its action. He showed that 
it contained bacteriotropins (opsonins), and promoted phagocytosis when tested 
by animal experiment or in a test-tube. Marmorek maintains that all strep- 
tococci produce the same toxin, and that the serum of animals immunized 
against one form of streptococcus is effective against the toxins of all varieties. 
Other observers generally disagree with him in regard to these contentions, 
and are endeavoring to produce a serum which will be as polyvalent as possible, 
by immunizing with many species of streptococci. It is generally conceded 
that this serum is harmless, and that in cases of pure streptococcus infection 
it will destroy the organisms and control the symptoms caused by their toxin, 
unless used too late for any remedy to be effective. Some authorities consider 
it neither bactericidal nor antitoxic in its action. 

Antistreptococcus Serum has been employed with varying success in ery- 
sipelas, puerperal fever and several forms of septicemia and pyemia due to 
streptococcus infection. Marmorek treated 411 cases of erysipelas with his 
serum, and reported a mortality of only 3! per cent. He. used it also in 16 
cases of puerperal fever, of which seven, due to streptococcus infection, re- 
covered; one, due to bacterium coli, died; and among eight of mixed infection 
with streptococcus, bacterium coli and staphylococcus, five died. Williams 
reported 14 cases of severe puerperal septicemia treated with this serum, and 
2 deaths. Reports of 70 cases so treated by various physicians show only 
2 deaths; among them being 29 of erysipelas, 15 of puerperal septicemia, n 
of infected wounds, and smaller numbers of septic cellulitis, cerebro-spinal 
meningitis, scarlet fever, septic measles, pyemia, and acute gangrene. Pack- 
ard and Wilson found records of 117 cases treated with antistreptococcus 
serum during 1901-2, of which 114 showed either a marked temporary im- 
provement or a prompt recovery. These cases included puerperal septicemia, 
erysipelas, tuberculosis with pyogenic infection, general pyemia, local strep- 
tococcus infections, and a few cases of simple and pernicious anemia which 
seemed to be decidedly improved by injections of this serum. A combina- 
tion serum, obtained from animals immunized by injections of both diph- 
theria toxins and streptococcus cultures, is used in advanced cases of 
diphtheria with double infection. 

A streptococcic vaccine (strepto-bacterin) has given very satisfactory results 



SERUMS AND VACCINES. 445 

in the same class of cases as the serum, also as a preventive and curative treat- 
ment in scarlet fever. A recent improvement in this vaccine is the so-called 
sensitized streptococcic vaccine in which a standardized suspension of a num- 
ber of strains of killed streptococci are treated (sensitized) with polyvalent 
antistreptococcic serum. Sensitized vaccines act more promptly and the 
resulting immunity is more lasting and the local or constitutional reaction 
less severe or absent (Besredka). Whether the serum or the vaccine is the 
most valuable therapeutic agent has not yet been definitely established. 

Antistreptococcus Serum is obtained from the horse immunized by inoculations with 
cultures rendered highly virulent by passing them through several rabbits, and then grown on 
a medium which preserves their virulence. After injection for a year with such cultures of 
the living streptococci of gradually increasing toxicity, the animal's serum is considered suffi- 
ciently powerful for use. There is no recognized unit of strength, therefore no general dose 
can be stated. Its dosage is usually expressed in mils and in order to obtain definite results 
large doses (100-200 mils) should be given. 

Staphylococcus Infections have been treated with both sera and vaccines, 
but with little success, except in furunculosis, carbuncle, and suppurating acne, 
in which the vaccines have given satisfaction whenever they have been employed. 
The initial dose is from 50 to 100 million for acne to 300 million for carbuncle. 
Staphylo-vaccine, as an adjuvant to tuberculin in tuberculous cases of mixed 
infection, has been of value. 

A polyvalent staphylo-vaccine, containing the three types of staphylococci 
(the S. albus, S. aureus, and S. citreus), is preferred by some clinicians, and is 
on the market, but the vaccines of S. albus and S. aureus are also furnished 
separately by the manufactures. 

Gonococcus Infections include urethritis, peri-urethritis, prostatitis, vesi- 
culitis, cystitis, epididymitis, orchitis, endometritis, salpingitis, peritonitis, 
conjunctivitis, iritis, endocarditis, arthritis, and even pleurisy and septicemia. 
Antigonococcic serum, prepared from the blood of immunized rams, has proven 
a valuable remedy for gonorrheal arthritis, but has not given good results in 
urethritis or epididymitis. A gonococcic vaccine may be of value in some 
of the complications, especially in gonorrheal iritis, and acts beneficially in 
some cases of chronic gonorrhea. A polyvalent gonococcic vaccine, prepared 
from prostatic fluid or pus from cases of chronic gonorrheal prostatitis, is 
used for the treatment of chronic gonorrhea, its sequelae and complications. 
The dose of the serum is 2 to 4 mils every 3 days, gradually increased to 6 or 
8 mils every 5th day; of the vaccine, 10 to 30 million bacteria in acute cases, 
30 to 50 million in subacute or chronic cases, every 5 days. 

Pneumococcus Infections. Specific Treatment by Means of Anti-pneumo- 
coccic Serum. — Recently as a result of the experimental and clinical studies 
made at the Rockefeller Institute, the specific treatment of acute lobar pneu- 
monia with antipneumococcic serum has been recommended. An essential 
to the successful use of antipneumococcic serum is the recognition of the 
fact that pneumococci morphologically and culturally alike, differ vastly in 



446 SERUMS AND VACCINES. 

their immunological reactions. According to their immunological reactions 
they have been divided into four groups. The antipneumococcic serum 
used is derived from animals immunized against the specific type. In this 
way a serum of high potency has been obtained against organisms of Type i, 
serum of less potency against organisms of Type 2, a serum of very slight 
potency against organisms of Type 3, and a serum of no potency against 
organisms of Type 4. Clinically the application of the serum, therefore, is 
of practical value only in cases due to pneumococci of Types 1 and 2. Sixty 
per cent, of the cases of pneumonia belong to these types (Cole). Fortunately 
there are few cases of Type 3, although the mortality is high and of the re- 
maining number belonging to Type 4, the mortality is relatively low. Cole 
reports that "cases of Type 1 infection so far treated with serum is not large, 
but the results have been very encouraging. Seventy-two cases have now 
been treated by this method. Before beginning serum about one-third of the 
patients died. Of the 72 since serum treatment was commenced, 6 have died, 
a mortality of only a little over 8 per cent. Moreover, of these 6 fatal cases, 
one patient died late in convalescence from a pulmonary embolism, one died 
on the fifty-fourth day of the disease from a complicating general streptococ- 
cus infection, and two received serum treatment only when they were "in 
extremis." {Pennsylvania Medical Journal, February, 191 7.) Cole states 
further that in regard to the administration of the serum "the amount re- 
quired has differed in the different cases, depending on the severity. Our 
plan is to give 80 mils and repeat this dose every 1 2 hours until the tem- 
perature and pulse rate fall. Some cases have received 500 mils, or even more; 
in other cases one to two doses have been sufficient. To guard against the 
administration of serum to patients who are sensitive to such injections, it is 
our custom to give to all pneumonia patients on admission to the hospital 
0.5 mil of horse serum subcutaneously in order to desensitize them. By the 
time the type of organism is determined, in 6 to 8 hours, we have con- 
sidered it safe to go ahead with the treatment. So far in over 100 cases re- 
ceiving serum of the various types there have been no alarming or unfavor- 
able results. A large number of the patients receiving the large doses of 
serum suffer from serum sickness after a week or 10 days. The symptoms, 
while sometimes distressing, are never serious, and if the serum is efficacious, 
this disturbance is of course negligible." 

Cerebrospinal Meningitis. Meningococcus Serum was introduced into 
therapeutics by Jochmann (1906), after it had been found to contain agglutinins 
and bacteriolysins, and to protect animals against a lethal dose of meningococci. 
It is a polyvalent bacteriolytic serum obtained from horses treated with a number 
of strains of the diplococcus intracellularis freshly cultivated from lumbar fluid. 
Flexner has perfected the preparation of an antimeningococcus serum for 
intraspinal injection which has proven of greatest value in reducing the 
mortalitvof this dread disease. Flexner's serum attacks the micro-organisms 



SERUMS AND VACCINES. 



447 



directly and has given the best result in those cases in which it was given 
early. The cases in which it has failed have probably been due to certain 
uncommon strains of meningococci. It should be administered in dose of 
20-30 mils, into the spinal canal, after lumbar puncture and the withdrawal 
of 30-50 mils, of spinal fluid; the serum having been gently warmed. If nec- 
essary the injections are repeated daily until an effect on the body tempera- 
ture is apparent. 

Typhoid Fever. PfeifTer (1894) was the first to prepare typhoid toxin 
and antitoxin, and produced a serum which gave good results in some cases. 
As yet a generally satisfactory serum has not been produced although Chante- 
messe of Paris claims good results with one which he prepared. *At present, 
interest centres around the typhoid vaccine which has acted so efficiently as 
a prophylactic. For this purpose three injections of a suspension of killed 
bacteria are given at intervals of 10 days. The first dose is 500,000,000 
and the second and third doses 1,000,000,000 bacteria. The vaccine as usu- 
ally prepared contains 1,000,000,000 to the mils, and can readily be admin- 
istered subcutaneously with a small, sterile syringe after the part has been 
sterilized with iodine. It was first utilized as a prophylactic on a large scale 
in the British Army in India. Its subsequent adoption by other countries 
and the United States marked the death knell of typhoid which so long had 
been among the scourges of armies encamped, particularly, in times of war. 
In the Spanish- American War 20,728 out of 107,973 men had typhoid fever 
and 1580 died. Vaccination in the United States army was begun in 1909 
and made compulsory in 191 1. The result has been the practical eradication 
of the disease from the service. The following table is from Russell's recent 
article. 



Typhoid 


Fever, 1907 to 


IQI3, 


for the Whole Army 


, Officers 


\nd Enlisted Men, 




American and Native Troops. 






Cases. 






Deaths 




Occurring Among 
Those Who Were 
















Vaccinated. 




Mean 
Strength. 


No. 


Ratio per 

1000 of 

Mean 

Strength. 


No. 


Ratio per 
1000 of 

Mean 
Strength. 


Percentage 

of Total 

Cases. 




Year. 


Cases. 


Deaths. 


1907 


62,523 


237 


3-79 


19 


O.30 


8.0 






1908 


74,692 


239 


3 


20 


24 


O.31 


IO. O 






1909 


84,077 


282 


3 


35 


22 


O.26 


7.8 


I 


O 


1910 


8i,434 


198 


2 


43 


14 


0. 17 


7-i 


7 





1911 


82,802 


70 





85 


8 


O.IO 


11. 4 


11 


1 


1912 


88,478 


27 





31 


4 


0.044 


14.8 


8 





1913 


90,646 


3 





03 





0.0 


0.0 


1 


O 



Antityphoid vaccination is safe and is destined to become more and more 
in use in private practice, particularly in localities where typhoid is endemic 



448 SERUMS AND VACCINES. 

and among youths and young adults, the age of greatest susceptibility. It 
has been practiced with success in a number of hospitals where nurses and 
others are exposed to infection. It is to be recommended to tourists and 
vacationists who while travelling are subjected to varying water and food 
supplies. Following the injection there is not infrequently a local reaction 
consisting of redness and tenderness and in some instances slight tenderness 
of the adjacent lymph glands. A systemic reaction, slight fever and malaise, 
occurs in 5 to 10 per cent, of the cases. The injection is contraindicated in 
the presence of an acute illness such as tonsillitis, gonorrhea, etc. It is 
generally acknowledged that the preventive inoculation produces only a 
temporary immunity lasting about two to two and one-half years and that 
under its influence the disease, if it occurs at all, pursues a milder and less 
fatal course than is usual. Typhoid vaccination has not been found of value 
in the treatment of the disease except in those patients in whom the bacilli 
persist in the urine and feces after the attack has subsided. These patients 
are prone to become carriers of the infection and are sources of danger. The 
treatment of chronic carriers is often unsuccessful. The use of an autogenous 
vaccine offers the best chance for success (McCrae). 

Cholera Asiatica. The exceedingly rapid course of this disease and the 
difficulty of obtaining a curative serum containing a sufficient quantity of pro- 
tective substances to neutralize the rapidly-produced toxins, are the factors 
which have hindered the development of the serum treatment of cholera. 
Tetrop, who studied the epidemics of 1892-94, claims that the benefit of serum 
was markedly evident in cases in which it was the only treatment employed. 
During an epidemic at Nagasaki in 1902 the Japanese physicians used a pro- 
tective toxin inoculation and an anticholera serum, prepared in the imperial 
laboratory at Tokio under the direction of Dr. Kitasato. All persons employed 
at the quarantine station and in the cholera hospital received two immunizing 
injections, and although constantly in contact with the disease no case of cholera 
occurred among them. In some 700 cases of cholera the mortality was only 
about 35 per cent., but very few cases proved fatal when the serum treatment 
was administered within reasonable time. These statements were made by the 
Japanese medical officer in charge of the quarantine hospital to American army 
surgeons who were stationed there in attendance on their own cholera patients 
removed from a transport in September, 1902. The epidemic of that year in 
the Philippine Islands had a mortality of fully 75 per cent, with the ordinary 
treatment carried out under American medical supervision. 

A serum, containing both antitoxins and bacteriolysins, prepared by Kraus 
(1909) has been used in Russia by intravenous injection, with beneficial results 
on the mortality, but whether this was due to the antibodies or to the normal 
saline solution, has not been determined. 

The studies of Lazarus and Pf eiffer showed that the blood-serum of persons 
who have recovered from Asiatic cholera is protective to animals against fatal 



SERUMS AND VACCINES. 449 

doses of the cholera spirilla, and that this property is bactericidal rather than 
antitoxic in character; also that the dead spirilla are themselves toxic, and capable 
of acting similarly to the living germs. Haffkine cultivates the spirilla in bouil- 
lon and then kills them by the application of heat, without destroying the toxic 
material which adheres to their bodies. The inoculation of human subjects 
with this product is followed by severe reaction, both local and general, and is 
believeckto cause the production of a protective principle in the blood-serum. 
A preliminary inoculation is made with a weak virus, which produces a mild 
reaction, and after five or six days a more virulent preparation is injected, the 
reaction subsiding in another five days, when the subject is believed to be pro- 
tected. In 42,445 such inoculations no mishap or injury to health resulted, 
and the British medical officers who were assigned to the duty of verifying the 
effects report that these were highly favorable, and that the statistics demonstrate 
for this method a remarkably protective power against Asiatic cholera in a 
country where the disease is endemic. 

Plague. The serum treatment of plague has been extensively used in 
recent epidemics of that disease, and although the commissions sent to India 
from England, Germany and Russia reported unfavorably upon the results 
obtained by them, the experience of individual observers indicates a decided, 
though as yet indefinite value for this method. The best known antiplague 
serum is that of Yersin. Administered in doses of 10 to 20 mils, subcutane- 
eously or intravenously, it protects for a period of ten to fourteen days. 
Kolmer states that combined active and passive immunization, effected by 
means of injections of a pest vaccine and an antipest serum, will probably 
exert a protective action of several months' duration, and should be used by 
physicians, nurses, and others during epidemics of plague. Yersin's curative 
serum is both antitoxic and bactericidal, and is obtained from horses immun- 
ized by injections of plague bacilli. After its use Calmette found that phagocy- 
tosis began at once, and the bacteria disappeared within a few hours. The 
temperature dropped in 4 to 5 hours, but often rose again for 8 to 12 hours, and 
finally fell at the beginning of an early convalescence. Lustig's serum is ob- 
tained from animals immunized with a nucleo-protein extracted from dead 
plague bacilli by treatment with acids and alkalies. Haffkine's vaccine is 
of little avail after plague has once developed, but it does exert an important 
prophylactic influence, reducing the rate and severity of the disease in a given 
locality. 

The dose of the curative sera is large. Calmette gave 20 mils of Yersin's serum in- 
travenously, and repeated the injections daily, sometimes giving 320 mils in one day. 
Choksey recommends doses of 60 to 100 mils of Lustig's serum, up to 300 mils or more, 
administered hypodermically. 

Rabies. There is abundant proof that the specific virus of rabies is 
produced by a micro-organism, though none such has yet been demonstrated 
by the bacteriologists. Pasteur discovered that the virus is most abundant 
29 



450 SERUMS AND VACCINES. 

in the spinal cord of the rabid animal and showed that its inoculation upon a 
healthy animal will produce the characteristic symptoms of the disease, also 
that the virus may be attenuated in virulence by drying the spinal cord con- 
taining it. He also found that by the repeated inoculation of viruses of in- 
creasing virulence an animal is rendered immune to rabies, whether the infection 
is introduced by the bite of a rabid animal or by any other method of inoculation. 
Upon these facts he founded his preventive treatment of this disease, which 
consists in the daily inoculation of the bitten person with emulsions of gradually 
increasing virulence, made from the dried spinal cords of rabbits that have 
died from inoculated rabies. Sections of the spinal cord, usually 2 to 3 mm. 
in length, are triturated and suspended in normal salt solution for injection 
(see Hydrophobia, Part III). This procedure is possible because of the long 
period of incubation which averages 50 days, the great majority of cases 
occurring between 20 and 90 days (Ravenel). This method of treatment 
should be begun as soon after the bite as possible and is useless after the 
symptoms have declared themselves (Ravenel). The duration of the im- 
munity produced by the Pasteur treatment is not definitely known though 
animals manifest it for several years. In man a second bite unless following 
very shortly after the first one should call for another course of treatment. 

Tizzoni and Cantani have published reports on the cure of rabies after its 
actual outbreak. They found that an alcoholic precipitate from the serum of 
highly immunized animals not only gave protection against rabies, but also 
cured the disease even after its first symptoms had manifested themselves. 

The local care of the wound produced by the bite should receive prompt 

attention. Incise if necessary to freely expose, cleanse and cauterize 

thoroughly. 

Statistics published by the New York Pasteur Institute state that during five years 658 
cases were treated at that institution, with a mortality of 0.76 per cent. ; and at the Paris Institute 
during the same period there were 7,341 cases treated, with a mortality of 0.3 per cent. The 
two sets together give 7,999 cases treated, with a mortality of 0.34 per cent. 

Syphilis. The success of salvarsan in the treatment of syphilitic mani- 
festations and its failure to produce results in tabes and paresis seemed to 
emphasize the belief held by many clinicians that these diseases were para- 
syphilitic and not syphilitic until Noguchi, in 1913, demonstrated the Spiro- 
chaeta pallida in the nervous tissues. This observation, confirmed by others, 
gave rise to the question why are these so resistant to the usual antisyphilitic 
treatment. The explanation was offered that salvarsan like certain other 
substances did not reach the cerebro-spinal fluid and hence did not come in 
contact with the organism in the nervous tissues. The intraspinal injection 
of salvarsan was found dangerous. Swift and Ellis, in 1913, introduced a 
method of preparing salvarsan for intraspinal injection, which apparently 
caused no ill effects and appeared beneficial. The patient was given an 
intravenous injection of neosalvarsan and after the lapse of an hour a quan- 
tity of blood was withdrawn, the serum separated and heated to 5 6° C. and 
then injected into the spinal canal. This treatment known as "autosero- 



SERUMS AND VACCINES. 45 1 

salvarsan therapy" and the "intraspinal injection of salvarsanized serum" 
has given good results in the hands of a number of observers and bids fair 
to become of value in those cases in which the disease is recognized early 
before advanced degenerative changes have occurred in the brain and cord 
The treatment is a new one and its status a matter of future study. 

Serpent Venom. The active principle of serpent venom is a toxalbumin 
analogous in character to the bacterial toxins. When taken by the mouth it 
is harmless. Venomous serpents are almost immune to serpent venom, non- 
venomous ones share this immunity in a less degree, and the mongoose and 
some other animals possess it in marked degree, probably by inheritance 
from many generations of bitten ancestors. Sewall in 1887 showed that 
pigeons can be immunized against crotalus venom by successive and increas- 
ing inoculations of the poison. Calmette discovered that the blood-serum of 
an animal so immunized is protective against the effects of the bite of a 
venomous serpent, and Fraser found that when immunization is performed 
with cobra venom the resulting serum is protective against the virus of sev- 
eral other serpent species. 

Calmette's Antivenene is the recognized serum for serpent bites, and has been 
used successfully in many cases. While particularly effective against cobra 
venom it is less efficient against that of the crotalus and other vipers. Martin 
has shown that it is of no service for Australian serpents and McFarland for 
American snakes. The dose is 20 to 40 mils repeated frequently, but other 
recognized measures should not be neglected. A ligature should be applied 
above the wound, which should be laid open, well sucked, and surrounded 
by injections of an aqueous solution of calcium chloride. 

Mallein is a glycerin extract of the culture products of the bacillus mallei, 
the micro-organisms of glanders. When this toxin in injected into animals 
affected with that disease, it produces a strongly marked febrile reaction, similar 
to that caused by tuberculin in tuberculous subjects. It is extensively employed 
in veterinary practice for the purpose of testing horses suspected of being infected 
with glanders. An antitoxic serum, obtained in the usual manner, has been 
used in a few cases of human glanders; one of which, reported by Dupuy, 
recovered under its administration from a severe attack of the disease. 

Normal Serum. The injection of normal horse serum will check hemor- 
rhage when other methods have failed, supplying in hemophilia the principle 
which promotes coagulation. Its use in hemorrhagic conditions is not based 
upon any specific immunity content but rather upon the supplying of some 
material necessary to promote coagulation. Its injection is followed, in 
some instances, by urticaria, subnormal temperature, rapid pulse, rapid 
breathing, and in some instances cyanosis and collapse. It may cause a 
fatality, although this event is rare. It is more common for a slight urti- 
carial rash with joint pains to occur from a few days to two weeks after the 
injection. Dose, 10 to 50 mils subcutaneously. 



452 SERPENTARIA — SILICON. 

SERPENT ARIA, Serpentaria {Snake-root), — is the rhizome and roots of 
Aristolochia Serpentaria, or of Aristolochia reticulata, indigenous herbaceous 
plants of the nat. ord. Aristolochiaceae, growing in rich, shady woods, with 
purple flowers arising from joints near the roots. It contains a volatile oil, a 
camphor-resin and a bitter principle named Aristolochine, which is soluble in 
both alcohol and water. All its preparations should be made from the fresh 
root, as it deteriorates by keeping. Dose, gr. x-xxx [av. gr. xv.] 

Preparations. 

Fluidextractum Serpentariae, Fluidextract of Serpentaria (Unofficial) . — Dose, itjjx-xxx 
[av. ryxv.] 

Tinctura Serpentariae, Tincture of Serpentaria (Unofficial), — 20 per cent. Dose, 5 ss— ij 
[av. 5j.] 

Tinctura Cinchonas Composita, Compound Tincture of Cinchona, — has two parts of 
Serpentaria in 100.' (See under Cinchona.) 

Physiological Action and Therapeutics. 

Serpentaria is a stimulating expectorant and tonic, a diaphoretic, diuretic, 
emmenagogue, aphrodisiac, and somewhat of an antiperiodic. Its taste is 
warm and pungent, its odor is characteristic. Small doses promote appetite 
and digestion, increase the bronchial and intestinal secretions, the cutaneous 
circulation and the surface temperature, and produce mental exhilaration. 
Large doses are irritant, causing nausea and vomiting, vertigo and headache, 
colic, borborygmi, rectal tenesmus, flatulent distention and frequent but not 
watery stools. The irritant action seems to produce gas rather than fluid. 
Pruritus ani and hemorrhoids are occasionally caused by its use. 

Serpentaria is chiefly employed as a vehicle for other stimulant drugs. 
In bronchial affections it is valuable as a stimulating expectorant. In ady- 
namic pneumonia it is a good vehicle for ammonium carbonate, and in the 
exanthemata it is useful when much depression exists. It is indicated in 
asthenic conditions generally, and in the amenorrhea of anemia and chlorosis 
it is an efficient emmenagogue in many cases. It will often restore the waning 
sexual power in functional impotence, while in bilious vomiting it frequently 
checks the nausea and settles the stomach. It is used as a vehicle for cin- 
chona in remittent fever. Its diaphoretic and diuretic properties are so 
slight as to be of little value in therapeutics; in fact this drug has fallen 
largely into disuse because of other more efficient remedies. 

SILICON, Si. is next to oxygen the most abundant element in nature, 
its combinations forming about a fourth of the earth's crust. The oxide, Silica, 
Si0 2 , is familiar in the form of sea-sand, flint, quartz, etc., also as silicates of 
aluminum, etc. in clay, granite, glass, felspar and sandstone. It is present in 
the stems of grasses and the teeth and bones of animals. Silicates of Aluminum 
Magnesium, Potassium, and Sodium are used in medicine and surgery. 



SINAPIS. 453 

Official Silicates. 

Talcum Purificatum, Purified Talc, — is a purified, native hydrous magnesium silicate 
sometimes containing a small amount of aluminum silicate. 

Terra Silicea Purificata, Purified Siliceous Earth {Purified Infusorial Earth), — is a form 
of Silica (Si0 2 ) purified by boiling with diluted hydrochloric acid, washing and calcining. 
It is a fine, bulky, white, pale gray or buff powder. 

Unofficial Silicates. 

Kaolinum, Kaolin, — a native aluminum silicate. 

Talcum, Talc, — a native hydrous magnesium silicate, a white or grayish-white powder, 
inodorous and tasteless, insoluble in water. 

Magnesii Silicas Hydratus, Hydrated M agnesium Silicate, Meerschaum, 2MgO,3Si0 2 + 
2H 2 0, — a mineral used for the manufacture of smoking-pipes, and employed in France as a 
substitute for Bismuth Subnitrate in obstinate choleraic diarrhea, to protect the intestinal 
mucous membrane or as an absorbent. It is given in fine powder and in doses of 3j-iv per 
diem. 

Sodii Silicas, Sodium Silicate, Na 2 S0 3 + H 2 0, — occurs in white lumps or as a white 
powder, partly soluble in water, more freely in a dilute solution of soda. Dose, gr. x-3j. 

Liquor Sodii Silicatis, Solution of Sodium Silicate, Soluble Class Solution, — is a semi- 
transparent viscid liquid, of sharp saline taste and alkaline reaction. It usually contains about 
20 per cent, of Silica and 10 per cent, of Soda, and is used on bandages to make immovable 
dressings, being lighter than plaster and stronger than starch. Its Incompatibles are Acacia, 
Acids, and Alcohol. 

Liquor Potassii Silicatis, Solution of Potassium Silicate, — also known as Soluble Glass 
Solution, — is used for immovable dressings in the same manner as the preceding. A mixture 
of 2 parts of this solution with one of the soda salt solution is said to set more quickly and 
firmly than either solution separately. Diluted (1 to 4) the solution of Potassium Silicate has 
been applied locally in erysipelas, gonorrhea, cystitis, and vaginitis, as an antiseptic with good 
results. 

Talc is used as a dusting powder in various skin affections, and for infants; 
in insufflating powders, and as a remedy for diarrhea, also in the preparation 
of the official waters and other pharmaceutical preparations. 

Sodium Silicate may be administered internally to animals in comparatively 
large doses without detriment to their general condition. It has fallen into 
disuse although formerly employed with reputed benefit in gout, hyperacid- 
ity, and pulmonary tuberculosis, in the latter disease inhibiting progress by 
inducing the formation of firm scars and coarse capsules, and by changing 
the process of disintegration into a fibrous condition of the pulmonary tissue 
(Robert). 

SINAPIS, Mustard, — is official under the two following titles, but the 
pharmacopceial preparations are directed to be made from Black Mustard only. 

Sinapis Alba, White Mustard, — the seed of Sinapis alba, an annual plant of 
the nat. ord. Cruciferse, cultivated in gardens. It has yellow flowers in racemes, 
and ribbed pods with a long> ensiform beak. Dose, as emetic, 5j _ iij [av. 
5ijss.] 

White Mustard contains Myrosin, a ferment, and Sinalbin, a crystalline substance, which 
reacting on each other in the presence of water produce Sulpho-cyanate of Acrinyl, a rubefacient 
principle allied to the volatile oil of black mustard. It also contains Sinapine, an alkaloid, 
Erucic or Brassic Acid, and a bland, fixed oil, all three of which are contained also in black 
mustard. 



454 SINAPIS. 

Sinapis Nigra, Black Mustard, — is the seed of Brassica nigra, an annual 

plant of the nat. ord. Cruciferas, native of Europe, but naturalized in the United 

States. It has small, yellow flowers on peduncles at the end of the branches, 

also smooth, erect pods with a short beak. Dose, as emetic, 5 J — iij [av. 5 ijssj 

Black Mustard contains Myrosin, a ferment, and Sinigrin (potassium myronate), which 
reacting on each other in the presence of water produce the Sulpho-cyanide of Allyl, or Volatile 
Oil of Mustard. It also contains Sinapine, an alkaloid, Erucic, or Brassic Acid, and a bland, 
fixed oil; all three of which are contained also in white mustard. 

Preparations. 

Oleum Sinapis Volatile, Volatile Oil of Mustard, (Sulpho-cyanide of Allyl) C 4 H 5 NS, — 
a colorless or pale yellow liquid, of pungent, acrid odor and taste and neutral reaction, almost 
insoluble in water but freely soluble in alcohol and in ether. It is a volatile oil produced 
synthetically or made from the seed. Dose, itj>§-| [av. tt£|.] 

Emplastrum Sinapis, Mustard Plaster, — Consists of Black Mustard, the fixed oil re- 
moved by percolation with Benzin, mixed with Solution of Rubber and spread on paper, 
cotton, cloth or other fabric. Each ioo square centimeters should contain about 2.5 Gm. 
of Mustard. This preparation was official in the U. S. P. VIII as Charta Sinapis. For 
local use. 

Lmimentum Sinapis Compositum, Compound Liniment of Mustard (Unofficial), — has of 
the Volatile Oil 3, Fluidextract of Mezereum 20, Camphor 6, Castor Oil 15, Alcohol to 100. 

Thiosinamin, Allyl Sulpho-carb amide, (C 3 H 5 )SCN2H3 (Unofficial), — is prepared by 
heating together Oil of Mustard 3, Alcohol 3, and Ammonia 6. It occurs as colorless crys- 
als, which are very soluble in alcohol and in ether, and moderately so in water. The addi- 
tion of Antipyrine in one-half the quantity renders it soluble in water to the extent of 15 
per cent. (Michel). It produces a local reaction when injected for lupus, or where sclerotic 
tissue is present, which it softens and permits of its absorption. It is used for the removal 
of scars, corneal opacities, and keloid; also for lupus, fibrous deposits in joints, stenosis of 
the esophagus, and for deafness due to thickening of the drum or fixation of the aural bones. 
Dose, gr. ss-j, thrice daily by mouth; or n£x-xx of a 10 per cent, solution in absolute alcohol, 
hypodermically every third day. Though usually well borne Thiosinamin may produce 
poisonous symptoms. 

Fibrolysin is the trade name of a chemical combination of Thiosinamin and Sodium 
Salicylate, which is soluble, non-toxic in therapeutic dosage, and rapidly splits up into its 
constituents when used intravenously or by intramuscular injection. It is reported to be of 
great value in promoting the absorption of scar tissue, and is admirably adapted for hypodermic 
use. Dose, gr. v gradually increased to gr. xl every 1, 2 or 3 days, by hypodermic injection. 

Mustard is not irritant until its oil is developed by the action of water, and 
then it requires time to produce its local effects, which are rubefacient and 
counterirritant, also vesicant after its prolonged application. It stimulates 
the nervous system and produces heat, redness, severe burning pain and finally 
local inflammation, leaving sores which heal with difficulty and often become 
gangrenous. The oil is highly irritant, and powerfully germicidal even in the 
dilution of 1 to 33,000 (Koch). Taken internally in full doses it may excite 
severe gastro-enteritis. Mustard taken internally in small doses is a condiment 
and carminative, in full dose it acts promptly as an emetic when mixed with 
warm water. 

Mustard paste is used for disinfecting the surgeon's hands, after washing 
with sterilized corn meal as a mechanical cleanser (Park). Mixed with water 
it is commonly employed as a local application to redden the skin, cause counter- 
irritation, relieve pain, and stmulate the heart, the vascular system, and the 
respiratory apparatus, as in muscular rheumatism, neuralgia, colic, gastralgia, 



sodium. 455 

inflammation of the throat, larynx, bronchi, lungs, pleurae and pericardium; 
also as a derivative in headache, cerebral congestion, and suppressed menstrua- 
tion. When action of a mild character is desired it may be diluted with flax- 
seed or flour. Internally it may be employed as an emetic in indigestion or nar- 
cotic poisoning. Its use as a condiment is familiar, acting by stimulation of the 
gastric mucous membrane. In overdoses it may excite severe gastritis. White 
Mustard seed, unground, has been used as a laxative, as it produces no irritation. 
The Oil is used chiefly as an ingredient of stimulating liniments, but may be 
employed internally as a gastric stimulant in doses of J to \ drop. 

SODIUM, Natrium, Na. — This metal is represented in medicine by a 
number of official salts, which are generally colorless or white, and with very 
few exceptions are readily soluble in water. Some of them are found native, 
as the Chloride, in sea-water, salt lakes, salt mines; the Nitrate, in Peruvian 
deserts; and the Borate, in dry lakes of Persia, California, etc. The Carbonate 
occurs in the ashes of marine plants. From the Chloride is prepared the Sul- 
phate, from this the Carbonate, and from the latter most of the other salts are 
prepared. All sodium salts impart a yellow color to flame, which should not 
appear more than transiently red when observed through a blue glass. The 
latter cuts off the yellow rays but allows the violet ones of potassium to be seen. 

Sodium Salts and their Preparations. 

Sodii Hydroxidum, Sodium Hydroxide, Soda, NaOH, — is a white, hard, opaque solid, 
deliquescent in moist air, efflorescent in dry air, odorless, of intensely acrid and caustic taste 
and strongly alkaline reaction, soluble in 0.9 of water at 25 C, and in 0.3 of boiling water, 
very soluble in alcohol. Is a powerful caustic, but milder than Potassa, and should be kept 
in well-stoppered bottles made of hard glass. 

Liquor Sodii Hydroxidi, Solution of Sodium Hydroxide, Solution of Soda, — contains not 
less than 4.5 per cent, of the hydroxide, and is prepared by dissolving 56 of Soda in 944 of 
Distilled Water. It is a clear, colorless liquid, odorless, of acrid and caustic taste and 
strongly alkaline. Dose, njrv-xxx [av. tijjxv], well diluted with water. 

Sodii Acetas, Sodium Acetate, NaC 2 H 3 2 -l-3H 2 0, — large, transparent prisms, efflo- 
rescent in dry air, odorless, of saline, bitter taste and a neutral or faintly alkaline reaction, 
soluble in 0.8 of water and in 19 of alcohol at 25 C, in \ of boiling water and in 2 of boiling 
alcohol. Dose, gr. v-xxx [av. gr. xv.] 

Sodii Carbonas Monohydratus, Monohydrated Sodium Carbonate, Na 2 C0 3 +H 2 0, — a 
white, crystalline, granular powder, soluble in water and in glycerin, insoluble in alcohol and 
in ether. Dose, gr. j-vij [a v. gr. iv.] 

Sodii Bicarbonas, Sodium Bicarbonate, NaHCO s , — an opaque, white powder, per- 
manent in the air, odorless, of cooling, saline taste, and a slightly alkaline reaction; soluble in 
10 of water, insoluble in alcohol,decomposed by hot water and converted into normal Carbonate. 
Of it 20 grains neutralize 16.7 grains of Citric Acid, or 17.8 grains of Tartaric Acid. It is 
a constituent of Pulvis Effervescens Compositus. Dose, gr. x-xxx [av. gr. xv.] 

Trochisci Sodii Bicarbonatis, Troches of Sodium Bicarbonate, — each troche contains of 
the Bicarbonate about 3 grains, with Sugar, Nutmeg, and Mucilage of Tragacanth. 

Sodii Citras, Sodium Citrate, — a white, granular powder, of cooling and saline taste, very 
soluble in water, slightly soluble in alcohol. Dose, gr. v-xxx [av. gr. xv.] 

Sodii Chloras, Sodium Chlorate NaC10 3 (Unofficial), — colorless, transparent tetrahe- 
drons, permanent in dry air, odorless, of cooling, saline taste and neutral reaction; soluble in 
1.1 of water and in about 100 of alcohol, also in 0.5 of boiling water and in about 40 of boiling 
alcohol. Should be kept in well-stoppered bottles, and should not be mixed or heated or 
triturated with readily oxidizable or combustible substances. Dose, gr. j-x [av. gr. iv.] 



456 sodium. 

Sodii Chloridum, Sodium Chloride (Common Salt), NaCl, — white, hard, cubical crystals 
or a crystalline powder, permanent in the air, odorless, of a purely saline taste and neutral 
reaction; soluble in 2.8 of water at 25 C, and in 2.7 of boiling water. Almost insoluble in 
alcohol. Dose, gr. x-oj [av. as emetic 3iv.] 

Sodii Ethylas, Sodium Ethylate, Caustic Alcohol, C 2 H 5 NaO (Unofficial), — is a white 
powder, often having a brownish tinge, dissolving in water with a hissing sound. Upon 
contact with the smallest quantity of water or moist living tissue it splits into alcohol and 
caustic soda. An alcoholic solution is made by dissolving sodium in absolute alcohol, and is 
used as a caustic. Chloroform decomposes it at once into ether and sodium chloride. It 
should be kept in a cool place, as it is liable to explode. 

Sodii Nitras, Sodium Nitrate (Chili Nitre, Chili Saltpetre), NaN0 3 (Unofficial), — color- 
less, transparent crystals, slightly deliquescent, odorless, of cooling, saline and bitter taste, 
and neutral reaction; soluble in water, scarcely soluble in cold alcohol. Dose, gr. v-xxx 
[av. gr. xv.] 

Sodii Sulphas, Sodium Sulphate (Glauber's Salt), Na 2 S0 4 + ioH 2 0, — large, colorless, 
transparent, monoclinic prisms, rapidly efflorescent in air; of cooling, saline taste and neutral 
reaction; soluble in slightly over 1.0 of water at 25 C, and in 0.47 of boiling water, insolu- 
ble in alcohol. Dose, gr. v-xx; as a purgative §ss-j [av. §ss.] 

The Arsenate is described under Arsenum; — the Benzoate under Benzoinum; — the 
Borate under Acidum Boricum; — the Bromide under Bromum: — the Solution of Chlori- 
nated Soda under Chlorum; — the Iodide under Iodum; — the Hypophosphite and Phos- 
phate under Phosphorus; — the Nitrite under Amyl Nitris — the Salicylate under Salicin; 
— the Sulphite and Thiosulphate, under Acidum Sulphurosum; and the Phenosulphonate 
under Phenol. 

Incompatibles. 

Incompatibles with Sodium Compounds are as for Potassium compounds (see page 386), 
those with Sodium Salts are given under their respective acid constituents, as the Carbonate 
under the title Carboneum, the Sulphate under Acidum Sulphuricum. 

Physiological Action. 

The action of the Sodium salts is similar to that of the Potassium salts, 
except that the former are feebler as alkalies, are not so depressant, and are 
not so poisonous to the cardiac muscle or the nerves. They are* diffused more 
slowly, are neither absorbed nor excreted so readily, and have not so marked 
diuretic action. Locally applied in large doses to muscular and nervous tissues 
they are paralyzant, but not so powerfully as potassium salts. Sodium urate 
is not soluble like the urates of lithium and potassium, and is therefore much less 
readily excreted, forming the masses called chalk-stones in gouty subjects. Soda 
is a less active escharotic than potash, having less affinity for water. Liquor 
Sodii Hydroxidi renders the secretions more alkaline, but does not alter nutri- 
tion to the extent that the potassium solution does. The Acetate is con- 
verted into the carbonate in the blood, and is a less active diuretic than the 
corresponding potassium salt. The Carbonate is irritant to the stomach, and 
is chiefly used in the preparation of the other salts. The Nitrate is mildly 
purgative and diuretic, and in solution is solvent to false membranes. The 
Ethylate is antiseptic, and a powerful but almost painless escharotic. 

Sodium Bicarbonate has the same action as the corresponding potassium 
salt, except that it is more slowly absorbed and is less depressant. It is antacid, 
antipruritic, and analgesic, the latter being manifest when the drug is applied 
in solution on gauze placed around painful joints and muscles. Internally 



sodium. 457 

in small doses it is neutralized by the hydrochloric acid of the gastric juice; 
in medium doses it is solvent ,to the gastric mucus, slightly irritant to the 
stomach, and sedative to the gastric nerves; in large doses it renders the 
stomach contents neutral or alkaline and stops the gastric digestion. 

Sodium Chloride, common salt, is one of the most important and abundant 
of the saline constituents of the animal organism, existing normally in the 
blood. In very dilute solution it enables water to dissolve both albumins 
and globulins, and renders water non-irritant to the animal tissues and harm- 
less to the red blood-corpuscles. For these purposes the solution employed 
is one of 0.9 per cent., known in experimental physiology as the normal salt 
solution. In substance or in concentrated solution, this salt is very irritant 
to cut surfaces, mucous membranes, muscle and nerve tissues. Taken into 
the stomach in quantity it irritates that organ and induces vomiting. When 
absorbed in excess of the normal requirements of the body it causes the 
peculiar nervous irritation expressed by the sense of thirst; which is relieved 
only by the ingestion of water in sufficient quantity to enable the excess to be 
dissolved and excreted by the kidneys. It is rapidly absorbed, and rapidly 
excreted; and acts as a hemostatic, decreases the secretion of mucus, is a vermi- 
fuge against thread-worms, promotes the absorption of pleuritic exudations 
and dropsies, and has considerable power as an antiperiodic and an antiseptic. 
In excess it neither increases nor decreases the elimination of urea or other 
products of tissue-waste. The excessive ingestion of potassium salts (as in the 
cases of herbivorous animals and vegetarian cranks) increases the excretion of 
sodium chloride by a double decomposition between these salts in the blood, 
forming potassium chloride and sodium phosphate, which being foreign to the 
blood are constantly excreted. In this way, by a continuous vegetable diet 
the normal amount of sodium chloride in the organism may be greatly reduced, 
and the animal will feel the want of it and will often travel hundreds of miles 
to visit a salt-lick. 

Sodium Sulphate, administered by the mouth in dilute solution, excites active 
secretion in the intestines, especially in the small intestine, partly by its bitter- 
ness but also by its irritant quality and its specific power of stimulating the 
activity of the intestinal glands. The action is not an osmotic one, as was 
formerly taught. The stimulation caused by this salt extends to the liver and 
the pancreas, especially the former. The absorption of the secretions is impeded 
by the low difTusibility of the salt, the result being a large accumulation of fluid in 
the intestinal canal, which finds its way to the rectum and produces purgation. 
The more dilute the solution employed the more prompt will be the effect, and 
this salt will not produce catharsis if administered in concentrated solution. 
When injected into the blood it excites no intestinal secretion, does not act as 
a purgative, and produces no toxic effect. [Magnesium Sulphate is toxic when 
so administered.] The quantity of Sodium Sulphate to the pint of Carlsbad 
water (Sprudel) is 20 grains, in Friedrichshall 46^ grains, and in Hunyadi 



45 S SODIUM. 

Janos from 122 to 173 grains; the last being the most active hepatic stimulant of 
the three. A mixture of the Sulphate and the Bicarbonate is sold as the natural 
salt obtained by evaporation of Carlsbad water. 

The action of the other Sodium salts is described under the titles of the 
respective constituents to which their effects are mainly referable. 

Therapeutics. 

The Sodium salts mentioned in the first paragraph treating of their action 
are not much used internally, the corresponding Potassium salts being preferred, 
especially when it is desired to alkalinize the urine or to promote oxidation. 
In the alkaline treatment of stomach affections the Sodium salts are the most 
efficient, especially the Bicarbonate, which is in common use as a gastric sedative 
and antacid. This salt in powder or saturated solution on compresses is an 
efficient analgesic application for burns and scalds, also to relieve the pain at- 
tending large boils and rheumatism of the joints. It i s an efficient application to 
painful dental cavities, and to the gums in many cases of toothache. Dilute solu- 
tions are employed locally in eczema and itching skin affections. Internally it 
is used with benefit in frontal headache with constipation, to reduce the excretion 
of sugar in diabetes, and in doses of 5ij~iv to neutralize the acid toxins in diabetic 
coma. The Carbonate may be used in dilute solution locally as an 
antipruritic, also as an alkaline bath, to remove cutaneous scabs and scaly in- 
crustations. Added to the boiling water in which surgical instruments are ster- 
ilized, in the proportion of 1 per cent, it will prevent their rusting. The Sulphate 
is an efficient purgative and somewhat of an hepatic stimulant, and may be ad- 
ministered alone or with the bicarbonate in imitation of Carlsbad salts, for 
bilious disorders, gouty affections, chronic constipation, obesity and diabetes 
mellitus. The Chlorate has uses similar to those of potassium chlorate, and 
being more soluble can be used in stronger solutions, but this is of doubtful 
benefit for internal administration, as it possesses all the irritating power on the 
kidneys and destructive action on the blood possessed by the other salt. 
The Ethylate has been of service as a caustic in hairy growths, lupus and 
nevus, for the latter affection being painted over the growth with a glass rod. 
Caustic Soda is a better escharotic than caustic potassa, as it has less affinity 
for water, and hence does not destroy the tissues so deeply, nor has it the 
same tendency to run over adjacent parts. 

Sodium Chloride is employed in baths as a mild general stimulant and a 
cutaneous tonic, and in concentrated hot baths for chronic rheumatism and 
sciatica. As an anthelmintic for threadworms it is used by enema in the strength 
of two tablespoonsful to the pint of water. As the normal salt solution, 0.9 
per cent., it is employed to wash out wounds and to irrigate the nasal and 
abdominal cavities; also subcutaneously or by intravenous or rectal injection 
to supply fluid lost in cholera and severe hemorrhages, and to dilute toxins 



SPIGELIA STILLINGIA. 459 

in the blood and promote their elimination in uremia and other intoxications. 
A better solution would be one of 0.9 per cent., containing also a small quan- 
tity of the chlorides of calcium and potassium (Ringer). Internally it is 
used as an emetic and as an antidote in poisoning by silver nitrate. 

The therapeutics of the other sodium salts are described under the titles 
of the constituents to which their uses are chiefly referable. 

SPIGELIA (Pink-root) , — is the dried rhizome and roots of Spigelia ma- 
rilandica, the Carolina Pink, an herbaceous perennial of the nat. ord. Logan- 
iaceae, native of the Southern States; having large, showy flowers, scarlet or 
crimson externally, yellow within. It contains a toxic alkaloid named Spigeline 
a bitter principle and a volatile oil, also tannin, wax, resin, lignin and salts 
Dose, 3ss-ij [av. 5j] for an adult; gr. x-xx for a child of 3 years. 

Fluidextractum Spigeliae, Fluidextract of Spigelia. — Dose for an adult, 5 ss-i j [av. 5j]j 
for a child of 3 years, ttrx-xx. 

Infusum Spigeliae Compositum, Compound Infusion of Spigelia, Worm Tea (Unofficial), 
— has Spigelia 15, Senna 10, Fennel 10, Manna 30, Water 500. Dose, 3jss-v. 

Spigelia is anthelmintic against the round- worm (ascaris lumbricoides), 
and is in popular use as a vermifuge, administered with senna. In large doses 
it is an uncertain cathartic, and may produce serious symptoms, as vertigo, 
dimness of vision, dilated pupils, spasms and convulsions. These effects are 
most apt to occur when the drug fails to produce purgation, hence it is usually 
administered with an active cathartic. 

Spigelia Anthelmia, Demarara Pink-root, Worm-grass (Unofficial), — produces vomiting, 
dilated pupils, dyspnea, convulsions and death. If eaten by cattle they perish in great agony. 
It was at one time used in cardiac affections of rheumatic origin, also in rheumatic fever 
and in cardiac palpitation with dyspnea, due to mitral and aortic disease. A tincture 
(1 in 8) may be used in doses of tij?v-xx. 

STAPHISAGRIA (Stavesacre), — is the ripe seed of Delphinium Staphisagria, an annual 
or biennial plant of the nat. ord. Ranunculaceae, a native of Europe, having bluish or purple 
flowers in terminal racemes, and seeds in straight, oblong capsules. The seeds contain an 
alkaloid Delphinine, probably several other alkaloids, a bitter principle, a volatile oil and a 
fixed oil, etc. Dose, gr. ss-ij [av. gr. j.] 

Fluidextractum Staphisagriae, Fluidextract of Staphisagria, — Dose, Tijjss-ij [av. ttjjj.] 

Unguentum Staphisagriae, Ointment of Staphisagria (Unofficial), — contains of the pow- 
dered seeds 1 part with 2 each of olive oil and lard. 

Stavesacre is a violent emetic and cathartic, also parasiticide. The alkaloid is irritant to 
the skin if locally used, producing tingling, burning and inflammation. Internally, it lowers 
the activity of the heart and respiration,' produces a most profound adynamia, and may prove 
fatal from paralysis of the spinal cord and asphyxia. In many respects its alkaloid resembles 
Aconitine and Veratrine. The ointment is employed as a parasiticide against pediculi 
and the acarus scabiei. The fixed oil is probably equally effective. Delphinine has been 
used internally in asthma, rheumatism and neuralgia, and in the latter affection is well employed 
as an ointment (gr. xx to §j), applied over the course of painful superficial nerves. It has 
been suggested as an antipyretic and for dropsy. A tincture or fluidextract is a very efficient 
application against pediculi. 

STILLINGIA, Stillingia, — is the root of Stillingia sylvatica, the queen's 
delight, an indigenous, perennial plant of the nat. ord. Euphorbiaceae. It con- 
tains an alkaloid named Stillingine, also an acrid resin and a volatile oil. The 



460 STRONTIUM. 

fresh root should be used in making the preparations, as those from the dried 
root are almost inactive. Dose of the powdered root, gr. x-3j [av. gr. xxx.] 

Fluidextractum Stillingiae, Fluidextract of Stillingia, — Dose, Ti£x-3j [av. ttjjxxx.] 
Syrupus Stillingiae Compositus, Compound Syrup of Stillingia (Unofficial), — is composed 
of Stillingia, Corydalis, Iris, Chimaphila, Coriander, Xanthoxylum, Sambucus, Sugar, Water 
and Alcohol. For the formula, see U. S. Dispensatory, 17th edition. Dose, 3j-iv thrice 
daily. 

Physiological Action and Therapeutics. 

Stillingia in large doses is emetic and cathartic, in smaller doses is expec- 
torant, diaphoretic, diuretic, sialagogue and cholagogue, possessing the various 
properties which are considered alterative. Its taste is acrid and pungent, it 
increases the action of the heart, skin, kidneys, and bronchial mucous mem- 
brane, also the gastric, hepatic, intestinal and salivary secretions. Full doses 
excite epigastric pain, nausea and vomiting. 

Stillingia was formerly employed with Sarsaparilla and similarly acting 
drugs as an alterative in syphilitic affections, particularly in chronic cases of 
the tertiary form, in which the system is greatly reduced by the abuse of 
mercurials and iodides. In these cases it possesses considerable power. It 
is highly esteemed in strumous affections, in portal changes with jaundice 
following malaria, in intermittent fever, habitual constipation, and hemor- 
rhoids from hepatic obstruction. In ague the fluidextract with quinine or 
arsenic is a useful combination, and a strong decoction has been employed 
to ward off an impending paroxysm. The compound syrup, a model of poly- 
pharmacy, is largely used by physicians in the western and southern states. 

STRONTIUM, Sr. This metal is represented in medicine by four salts, 
the Bromide, Iodide, and Salicylate, which are respectively described under 
Bromum, Ioduh, and Salicinum, also the unofficial salt — 

Strontii Lactas, Strontium Lactate, (Unofficial), — a white, granular powder, or crystalline, 
nodules, of slightly bitter and saline taste; soluble in 4 of water, in less than \ of boiling water 
also in alcohol. Dose, gr. v-xxx. 

Strontium Peroxidatum, Strontium Peroxide (Unofficial), — is a fine, white, colorless and 
tasteless powder, practically insoluble in water, but decomposed by such contact into 
hydrogen peroxide and Strontium hydroxide, and finally with the liberation of oxygen. 
It contains at least 84 per cent, of Strontium peroxide, equivalent to n. 2 per cent, available 
oxygen. Its use is that of other peroxides and is applied usually in the form of an ointment 
or dusting powder. 

Incompatibles with Strontium Salts are: Alkalies, Carbonates, Chroma tes, Oxalates, Phos- 
phates, and Sulphates. 

The Strontium salts are among the recent additions to the materia medica. 
Their marked anti-putrescent and antiseptic properties were first noticed in 
1 89 1 by Germain See, on patients suffering from gastric dilatation. He found 
that in such cases the Bromide prevented the acetic and lactic fermentations 
and the formation of the gases of decomposition. The toxic action, hitherto 
attributed to the salts of strontium, has been ascertained to be due to barium, 
which was present in the commercial products used. When pure, they may 



STROPHANTHUS. 46 1 

be safely employed in the same doses, and in the same cases, as the correspond- 
ing preparations of potassium and sodium; while they are much less liable to 
cause eruptions and are more rapidly and completely eliminated by the kidneys. 

The Lactate has been successfully employed in albuminuria. It dimin- 
ishes the amount of albumin in Bright's disease, in the nephritis of rheumatic 
and gouty subjects, and in the albuminuria of pregnancy; for which purpose 
it should be given in full doses (gr. xxx) thrice daily. It is contraindicated 
when there is scanty urine or symptoms of uremia. Hare and others of wide 
experience seem to regard it of little value in albuminuria. The Peroxide is 
used for the same purposes as other peroxides and is applied usually in the 
form of an ointment or dusting powder. 

The actions and uses of the Bromide, Iodide and Salicylate are given under 
the titles Bromum, Iodum and Salicinum respectively. 

STROPHANTHUS, — is the ripe seed, deprived of its long awn, of Strophan- 
thus Kombe, an African climbing plant of the nat. ord Apocynaceae, from which 
the natives extract a toxic preparation known as the Kombe arrow-poison. It 
contains a crystalline glucoside, n&medStrophanthin, the active principle, which 
is an agent of great energy. When strophanthus is made into the official 
tincture and assayed biologically the minimum lethal dose should not be 
greater than 0.00006 mil of tincture or the equivalent of 0.0000005 Gm. of 
ouabain for each gramme of body weight of frog (see Digitalis article). Dose 
of Strophanthus, gr. ss-ij [av. gr. j.] 

Preparations. 

Extractum Strophanthi, Extract of Strophanthus (B. P.), — is prepared by percolation 
with ether and alcohol. Dose, gr. £-j. 

Tinctura Strophanthi, Tincture of Strophanthus (10 per cent.). — Dose tt#v-x [av. 
Ttjviij], or irj^-ij frequently repeated. This preparation is officially standardized according 
to the above biological assay. A stronger tincture (1 in 8) is on the market. Cornwall 
holds that TTgiij of the tincture should not be exceeded at a dose, except in extraordinary cases 
and where tolerance has been established. 

Strophanthinum, Strophanthine C31H48O12, — is a glucoside or mixture of glucosides 
obtained from the seeds, and is very soluble in water and in alcohol. It varies in composi- 
tion and power and its solutions are prone to decomposition. The official dose is gr. -gV 
by mouth and gr. ■£$ intravenously. 

Analogue. 

Ouabain, C 30 H 40 O 12 (Unofficial), — is a glucoside obtained from the root and wood of 
Acocanthera Ouabaio, an apocynaceous tree of the Somali coast; also from the seeds of Strophan- 
thus gratus, a climbing plant from Gaboon. The former furnishes an arrow poison used by 
the African natives. Ouabain occurs in colorless crystals, of feebly bitter taste; soluble 
in hot water and in spirit, slightly in cold water, insoluble in absolute alcohol, chloroform 
and ether. It is frequently though erroneously referred to as crystallized strophanthin 
or g-strophanthin Thorns (U. S. P. IX, Part II). Dose, gr. T y. 

Incompatibles. 
Incompatibles with Strophanthus are those for glucosides (see page 8) . 



462 strophanthus. 

Physiological Action. 

Strophantkus is primarily a muscle poison of great energy. It increases 
the contractile power of muscular tissue, and a poisonous dose fixes the muscles 
in permanent tetanic rigidity, the fibres being unable to resume their normal 
condition of partial flexibility. As the heart receives much more blood in a 
given time than any other muscle in the body, it is quickly and markedly affected 
by the strophanthus-charged fluid, and by regulating the dosage the cardiac 
muscle may be affected by a quantity which will not influence the other muscles. 

Small doses of Strophanthus act exactly like Digitalis on the heart, stimu- 
lating the contractions, increasing the force of the ventricular systole, and 
lowering the cardiac rate. At the same time the general blood-pressure is 
raised and diuresis is produced, both being due to the vis a tergo — the direct 
stimulation of the circulation from behind. Large doses paralyze the heart in 
systole and leave the cardiac muscle in a state of contraction resembling cada- 
veric rigidity. Strophanthus differs from Digitalis in being less irritant to the 
stomach, more rapid in its cardiac action, more quickly eliminated and there- 
fore not cumulative, more powerfully diuretic, and having no direct contrac- 
tile influence on the vessels. In full doses it sometimes produces diarrhea. 
It has little or no action upon the general nervous system, but its active princi- 
ple Strophanthin is a powerful local anesthetic and a myotic when applied to 
the conjunctiva. 

Therapeutics. 

Strophanthus is undoubtedly a valuable cardiac stimulant, from the rapid- 
ity of its action, as well as its non-interference with the calibre of the periph- 
eral vessels. It promptly relieves cardiac dyspnea, often modifies the pulse- 
rate in less than an hour, while the influence of a single dose upon the circula- 
tion persists for a long time. It may well replace digitalis in the treatment of 
acute dilatation of the heart, when a more rapidly acting cardiac stimulant is 
needed. It has been reported as exceedingly useful in the treatment of 
B right's disease for the dyspnea, orthopnea, dropsy and uremia; also in mitral 
insufficiency with great anasarca and dyspnea, in palpitation, exaggerated 
cardiac action, in weak heart, and for exophthalmos with tumultuous action of 
the heart; also in pulmonary edema due to valvular lesions or to pneumonia. 
Strophanthus should be given with great care. The drug and its tincture 
should not be given by mouth because of uncertain absorption; and as all the 
digitalis bodies are synergistic, it should not be given until two days have 
elapsed since the last considerable digitalis dosage (Halsey). It is adminis- 
tered best by the intravenous or intramuscular methods, not subcutaneously, 
which is painful. 

Ouabain is an extremely active poison and acts like strophanthin. It has 
the advantage over strophanthin of greater purity and uniformity of action. 



STYRAX — SULPHONMETHANUM. 463 

It is more powerful than Strophanthin and when given intravenously or intra- 
muscularly in the dose of gr. -rhr (diluted with 4000 to 8000 parts of normal 
salt solution) should not be repeated in 24 hours. It ought not to be given 
by the mouth because of uncertain absorption. It is used in place of Stro- 
phanthus or Strophanthin for the purposes enumerated above, especially in 
such emergencies as acute cardiac dilatation when a rapidly acting stimulant 
is required. Because of its stability it is used as a standard of comparison in 
the biologic assay of the digitalis bodies. 

STYRAX, Storax, — is a balsam prepared from the wood and inner bark of Liquidambar 
orientalis, the Oriental Sweet-gum, a tree of the nat. ord. Hamamelidacese, growing in Asia 
Minor. It is semi-liquid, sticky, opaque and gray-colored, of agreeable odor and balsamic 
taste, completely soluble (except accidental impurities) in an equal weight of warm alcohol. 
It consists of a volatile oil named Styrcl, CsHg; a crystalline solid Styracin, which is a cinna- 
mate of cinnamic ether; two peculiar resins, one hard, the other soft; and Cinnamic Acid, 
C9H9O2, a colorless, odorless, crystalline body, closely allied to Benzoic Acid, excreted in the 
urine partly as Hippuric Acid, and occurring also in the Balsams of Peru and Tolu. Dose of 
Storax, gr. v-xx [av. gr. xv.] 

Tinctura Benzoini Composita, Compound Tincture of Benzoin (Friar's Balsam), — 
contains 8 per cent, of Storax. Dose, ttkx-5 j [av. njjxxx.] 

Storax is a stimulant expectorant, an antiseptic and a disinfectant, acting both locally 
and remotely, like benzoin and the balsams. It is used with benefit in chronic bronchitis 
and other affections of the respiratory organs, also in chronic catarrhs of the genito-urinary 
passages, in gonorrhea and in amenorrhea. Externally it is employed in ointment as a 
detergent for foul ulcers, and as a parasiticide for scabies and phthiriasis. 

SUCCINUM, Amber (Unofficial), — the source of Oil of Amber, is a fossil resin, occurring 
in alluvial deposits, chiefly in Prussia, Bohemia, and Courland. It is usually associated 
with lignite, sometimes encloses insects and parts of vegetables, and consists of a volatile oil, 
a yellow resin, another resin, succinic acid, and a bituminous principle. Its source is 
thought to be an extinct coniferous tree, the Pinites succinifer, of which amber represents 
the exudation. The Kauri Gum from New Zealand is a similar substance. 

Oleum Succini, Oil of Amber (Unofficial), — is a volatile oil obtained by the destructive 
distillation of Amber, and purified by subsequent rectification; a pale yellow, thin liquid, of 
sp. gr. about 0.920, of empyreumatic and balsamic odor, warm, acrid taste, and neutral or 
faintly acid reaction, readily soluble in alcohol. Dose, gtt. v-x. 

Oil of Amber is stimulant, antispasmodic and diuretic, when used internally. Exter- 
nally it is irritant and rubefacient. It has been employed with benefit in epilepsy, hysteria, 
convulsions, amenorrhea and whooping-cough. As a liniment it is often used in chronic 
rheumatism, and has been applied along the spine in infantile convulsions, mixed with an 
equal part of laudanum and diluted with olive oil or brandy. 

SULPHONMETHANUM, Sulphonmethane, (Sulphonal), C7H16S2O4,— 

is diethylsulphone-dimethylmethane, the product of the oxidation of the mer- 
captol obtained by the condensation of acetone with ethylmercaptan. It 
occurs in colorless, odorless and nearly tasteless prismatic crystals, soluble in 
16 of boiling water, in about 365 of cold water, and in about 60 of alcohol; 
very soluble in boiling alcohol. Sulphonal is a very stable body, being 
unaffected by concentrated acids, alkalies or oxidizing agents, cold or warm. 
Dose, gr. x-xxx [av. gr. xij], in hot aqueous solution. 

Official Analogues. 

Sulphonethylmethanum, Sulphonethylmethane (Trional), C 8 Hi 8 S 2 04, — is diethyl-sul- 
phone-methylethylmethane, a product of the oxidation of the mercaptol obtained by the 



464 SULPHONMETHANUM. 

condensation of methylethylketone with ethyl mercaptan. It occurs in lustrous, bitter crystals, 
soluble in 200 of water at 25 C, readily soluble in hot water, in alcohol and in ether. It is 
an efficient hypnotic, prompter in action and less liable to produce ill effects than Sulphonal, 
but must be given in doses fully as large, gr. x-xxx [av. gr. xij.J 

iEthylis Carbamas, Ethyl Carbamate (Urethane), C 3 H 7 N0 2 , — is an ester of carbamic 
acid, obtained by the reaction of ethyl alcohol upon carbamide (urea) or one of its salts. It 
occurs in colorless crystals, readily soluble in water, alcohol, ether, or glycerin. Dose, gr. x-xxx 
[av. gr. xv]; but is best given in doses of 5 grains frequently repeated, up to 20 grains or more, 
as a full dose may cause vomiting. It is incompatible with many substances, and is best ad- 
ministered by itself. 

Unofficial Analogues. 

Tetronal, Diethylsulphon-diethyl-methane, — contains 4 ethyl groups to 3 in Trional and 
but 2 in Sulphonal. Dr. Lauder Brunton holds of the physiological action of the disulphones, 
to which group these three substances belong, that only those containing ethyl groups are 
active, and that the hypnotic activity is increased with the number of such groups. This, 
if substantiated in practice, would make Tetronal the most powerful hypnotic of the three, 
but it is scarcely heard of in practice. Dose, gr. x-xxx. 

Veronal, — is the trade name of Diethyl-barbaturic Acid or Diethyl-malonyl-urea. 
C 8 H 12 N 2 3 , a white, crystalline powder, of faintly bitter taste, soluble in 150 of water, and in 
1 2 of boiling water. Dose, as a hypnotic, gr. x-xv, an average dose being gr. vij, in some 
hot liquid, or in cachet, or as a tablet. 

Medinal, — is the trade name of the mono-sodium salt oj diethyl-bai baturic acid, and is 
freely soluble in water. Dose, gr. v-x or xv, dissolved in water or wine; hypodermically gr. 
vijss in Tijlxxv of distilled water; per rectum gr. vijss in 3j of water injected with a small 
syringe. 

Luminal, — is the trade name of Phenyl-ethyl-barbituric Acid. It is said to be more 
efficient as a sedative and hypnotic. It is a white, odorless and slightly bitter powder. 
Dose, gr. iij-v, a maximum of gr. xij should not be exceeded. 

Physiological Action and Therapeutics. 

Sulphonal was introduced several years ago as a harmless hypnotic which 
would produce sound and quiet sleep without unpleasant after-effects, without 
intoxicant or narcotic action, and having no unfavorable effects on the heart 
or circulation even in full doses. It rapidly came into general use as a hypnotic 
in mental diseases, in nervous insomnia and in sleeplessness from various causes. 
Many competent observers have recorded instances of toxic action following 
its use, and opinions are now greatly divided as to its therapeutical value. It is 
undoubtedly a dangerous drug, death having resulted from its use in a large 
number of cases. If it were not for the very evident advantage of the drug when 
used with care and under medical supervision, it would stand a very fair chance 
of being either excluded from practice or restricted by law (Squibb). Its pro- 
longed use has caused noises in the ears, headache, vertigo, weakness and 
incapacity for mental or physical exertion. The subject may pass into a con- 
dition of drowsiness or stupor, or may suffer from difficulty of speech ; and ptosis, 
edema of the eyelids and cyanosis may be experienced. In one case a single 
dose of 20 grains caused edema of the lower limbs after a very restless night. 
In another a dose of 20 grains taken nightly for 15 months was accompanied by 
complete cessation of menstruation. It has produced persistent skin eruptions 
in some cases and severe functional disturbances in others. The chief charac- 



SULPHONMETHANUM. 465 

teristics of chronic poisoning by this drug are as follows: — disturbances of di- 
gestion, shown by vomiting and diarrhea or constipation; disturbances of the 
nervous system, as ataxy and feebleness of the limbs, ptosis and ascending para- 
lysis; also ischuria and oliguria, sometimes albuminuria or hematoporphyrinu- 
ria. In order to secure elimination and to guard against cumulative action and 
consequent toxicity, its administration should be interrupted from time to time, 
and the patient taking it should be frequently purged. 

As a hypnotic Sulphonal acts admirably in many instances, if administered 
in hot fluids and about two hours before its action is required; but its efficacy 
decreases with use, and it is of no value whatever against insomnia due to pain. 
The average hypnotic dose is about 20 grains for a woman and 30 grains for 
a man. The dose is to be administered only once daily, and should be discon- 
tinued at the first sign of toxic action. In no case should its administration 
be continued over any great length of time. In cases of insomnia due to neu- 
ralgia and nervous excitement, the dose of sulphonal may be advantageously 
combined with a small dose of morphine, in proportion to suit individual cases, 
the mixture forming a safe and efficient hypnotic. An excellent hypnotic com- 
bination is made by mixing together 10 or 15 grains each of sulphonal and 
trional, to be taken in some hot liquid at bed-time. The trional producing 
early sleep and the sulphonal effects being manifested later, the patient will 
usually obtain a more prolonged result from the small dose of each agent ad- 
ministered together than from a larger dose of either alone. 

Trional is an efficient hypnotic, acting more rapidly than sulphonal, and 
usually without cumulative action or unpleasant after-effects. Many cases of 
poisoning, including several deaths, have been reported as caused by it; and in 
one case its prolonged administration gave rise to multiple neuritis and hemato- 
porphyrinuria (Hart) . It has been used with satisfaction as a hypnotic and seda- 
tive for the insane and in the treatment of narcomania. It acts well in chorea, 
and as an alternating substitute for the bromides in epilepsy. It is said to be 
particularly efficient in cases of slight psychical excitement accompanied by 
obstinate insomnia, also in many forms of delirium. When pain is present it 
may be administered in conjunction with phenacetin or acetanilid. When used 
for any long period the daily action of the bowels should be obtained, an alkaline 
water should be freely administered, and the drug be intermitted every week 
for one or two days. 

Ethyl Carbamate (Urethane) is a mild hypnotic for adults, but a safe and 
efficient one for children. It stimulates the respiration, and in medicinal doses 
does not affect the circulation; but in very large quantity it slows the heart, 
depresses the body temperature, and induces muscular relaxation and some 
degree of general anesthesia. 

Tetronal is theoretically more hypnotic than trional, but has not proved so efficient in 
practice and often causes vomiting. It is rarely used in this country. 

Veronal is a very efficient hypnotic in dose of 8 to 10 grains, given in some hot liquid when 
a rapid action is required. It induces a practically normal sleep, does not affect the heart. 

30 



466 SULPHUR. 

circulation or kidneys, and is free from after-effects. It is particularly efficient when mixed 
with Sulphonethylmethane. (Trional) in the proportion of two parts of the former to one of the 
latter, (gr. viij with gr. iv, or gr. x with gr. v). It sometimes causes some motor inco- 
ordination, especially of the lower extremities, also an erythematous eruption and neuralgia, 
and if continued it diminishes the solid and urinary excretions. It is highly praised as a 
hypnotic in neurasthenic or hysterical subjects, also as a sedative and antispasmodic in seasick- 
ness, whooping-cough, epilepsy and chorea, and for the arrest of night-sweats in phthisis. 
Alkalies should be given during its prolonged use, and the bowels kept open by salines. Seteral 
deaths have been recorded from the use of large doses. 

Medinal is rapidly absorbed and excreted, so that its hypnotic effect is prompt, uniform 
and reliable, while cumulative toxic effects are not so liable to occur as with veronal. It may 
be used hypodermically or by intramuscular injection in doses of gr. vi-xj, and is said to be 
particularly efficient in seasickness. 

Luminal — is said to produce sleep without depression of the respiration or circulation 
and without irritating the stomach and kidneys. It is claimed to be useful in nervous 
insomnia and the wakefulness and irritability of nervous diseases. 

SULPHUR, and SULPHIDES.— The non-metallic element Sulphur, S, 
is a brittle solid of a pale yellow color, permanent in the air, of crystalline texture 
and susceptible of several allotropic states, which are for the most part induced 
by heat. It is obtained native in several volcanic districts, or from the native 
Sulphides of Iron and Copper (iron and copper pyrites) by roasting, as it sub- 
limes at about 238 F. It is official in three forms, viz. — 

Sulphur Sublimatum, Sublimed Sulphur, S, — is prepared from crude 
Sulphur by sublimation and condensation. It is a fine citron-yellow powder, 
of faintly acid taste and acid reaction, insoluble in water or alcohol. Ignited 
it burns with a blue flame, forming sulphurous acid gas, and leaving no residue 
or only a trace. Dose, gr. x-3ij [av. 3j-] 

Sulphur Lotum, Washed Sulphur, S, — prepared by digesting sublimed 
sulphur with dilute water of ammonia, thoroughly washing with water and 
passing through a sieve. In this process the ammonia dissolves out any sulphide 
of arsenic which may be present and neutralizes any sulphurous or sulphuric 
acid. For its solubility and dose see Sulphur Pr^ectpitatum below. 

Sulphur Praecipitatum, Precipitated Sulphur, (Lac Sulphuris, Milk of 
Sulphur), S, — is prepared by boiling sublimed Sulphur with slaked lime and 
water, forming the sulphide and hyposulphite of calcium, which are then de- 
composed by HC1, and Sulphur is precipitated as a very fine powder which 
is next washed until the washings are tasteless, and dried with a gentle heat. 
The result is a very fine, yellowish-white, amorphous powder, odorless and 
almost tasteless, insoluble in water or alcohol but completely soluble in carbon 
disulphide or in a boiling solution of soda. By heat it is completely volatilized. 
Dose, gr. x-3ij [av. 5j.j 

Preparations of Sulphur. 

Unguentum Sulphuris, Sulphur Ointment, — has of Sublimed Sulphur 15, Benzoinated 
Lard 85, rubbed together until thoroughly mixed. 

Pulvis Glycyrrhizae Compositus, Compound Licorice Powder (see under Glycykrhiza), 
— contains 8 per cent, of Washed Sulphur. Dose, 5ss-jss [a v. 5j-] 

Sulphurous Acid and the Sulphites are described under Acidum Sulphurosum; the 
Sulphates under the titles of their respective bases. For Sulphuric Acid see Acidum Sul- 

PHURICUM. 



SULPHUR. 467 

Sulphides. 

Calcii Sulphidum Crudum, Crude Calcium Sulphide (Official in U. S. P. VIII as Calx 
Sulphurata), Sulphurated Lime, — is a mixture of CaS, CaSO-i, and Carbon, in varying pro- 
portions, containing at least 55 per cent, of the first. A pale, gray powder, of offensive 
taste and smell, and alkaline reaction, insoluble in alcohol, very slightly soluble in water. 
Dose, gr. T V-ij [av. gr. j.] 

Calcii Sulphidum, Calcium Sulphide, CaS (Unofficial), — a constituent of the preceding, 
is named Hepar Sulphur is, Liver of Sulphur, by the homeopathists, who prepare it by mixing 
equal parts of powdered oyster-shell and sublimed sulphur, and heating at a white heat in a 
crucible hermetically sealed. Dose, gr. ^$-\. 

Sulphuris Iodidum, Sulphur Iodide {Iodine Bisulphide) (Unofficial), — is prepared by 
fusing together Washed Sulphur 1 part and Iodine 4. It is a grayish-black crystalline solid, 
having the odor of iodine, an acrid taste and a faintly acid reaction, insoluble in water, but 
very soluble in disulphide of carbon and in about 60 of glycerin. Alcohol and ether dis- 
solve out the iodine, leaving the sulphur. Used only as ointment, gr. xxx to the § . 

Hydrogenii Sulphidum, Hydrogen Sulphide, Sulphuretted Hydrogen, H 2 S, — is used only 
for test purposes; a saturated, aqueous solution being one of the official reagents. It is a 
colorless gas, having the odor of rotten eggs, prepared by the action of dilute sulphuric acid on 
iron sulphide. It precipitates most of the metals from acid solutions as sulphides; that with 
Arsenic being yellow; with Antimony, orange; with Cadmium, yellow; with Copper, Lead, 
Mercury and Silver, black; with Bismuth, brown; with Gold and Platinum, brownish-black. 

Carbon Disulphide is described under Carboneum. 

Unofficial Allied Compounds. 

Ichthyolum, Ichthyol, Ammonium Sulpho-ichthyolate, C2 8 H 36 S 3 6 (NH 4 ) 2 , — is prepared 
from the product of the distillation of bituminous rocks from the Tyrol which contain fossil 
fishes. It occurs as a viscous, reddish-brown mass, of tarry odor and appearance and feebly 
alkaline reaction; soluble in water and in a mixture of alcohol and ether; mixes in all propor- 
tions with glycerin, fats and oils. It contains a large proportion of Sulphur, about 10 per 
cent. Dose, gr. j-x, up to 3jss daily, in pills or capsules, or dissolved in peppermint water. 
Sulpho-ichthyolates of Lithium, Sodium, and Zinc are on the market. 

Ichthalbin, Ichthyol Albuminate, — occurs as a grayish- white powder, odorless and 
almost tasteless, insoluble in water but soluble in alkaline solutions. It contains 7 5 per cent, 
of Ichthyol, and is used in syphilis, also in scrofula with a lowered condition of nutrition. 
Dose, gr. xv-xxx, thrice daily. 

Ichthargan, — is the trade name of a compound of Ichthyol and Silver, claimed to con- 
tain 30 per cent, of metallic silver and 15 per cent, of sulphur in organic combination. It 
is used locally in gonorrhea in 0.04 to 0.2 per cent, solution, and in 0.5 to 3 per cent, solution 
in trachoma. 

Ichthoform, — is a chemical compound of Ichthyol and Formaldehyde, and occurs as a 
dark-brown, practically odorless powder, insoluble in the usual solvents. Dose, gr. x-xxx 
thrice daily. 

Thigenol, — is the trade name of a solution of the sodium salts of synthetic sulpho-oleic 
acids containing 2.85 per cent, of sulphur in organic combination. It occurs as a dark- 
brown, syrupy fluid, soluble in distilled water, alcohol, or glycerin. It is odorless and 
almost tasteless, and is used locally in eczema, seborrhea, acne rosacea, and other skin dis- 
eases. Dose, gr. iij-x. 

Thiolum, Thiol, — is prepared by the sulphuration of certain non-saturated hydrocarbons, 
and is a product very similar to Ichthyol. It occurs in both dry and liquid form, the former, 
Thiolum siccum, as dark-brown lamellae or powder, of bituminous odor and bitter, astringent 
taste; soluble in water and in chloroform, sparingly in alcohol, insoluble in ether and in benzin. 
The liquid form, Thiolum liquidum, is a dark-colored, syrupy fluid, miscible in all proportions 
with water. Dose, internally, gr. j-iij. 

Tumenol, Tumenol, — is obtained by treating the unsaturated hydrocarbons of mineral 
oils with concentrated sulphuric acid. It occurs in several forms, solid and fluid, that known 
as Commercial Tumenol being considered the most generally useful. It is a dark-brown fluid, 
which can be employed in ointment and in tincture, externally. Tumenol-ammonium 
is the ammonium salt of tumenol sulphuric acid. 

Ferrichthyol, Calciumichthyol, Sodiumichthyol are derivatives of ichthyol containing 
respectively iron, calcium and sodium instead of ammonium. 



468 SULPHUR. 

Incompatibles with Sulphur are Potassium Chlorate, Potassium Permanganate, Calcium 
Chloride, and all oxidizers. With the Sulphides in solution are Mineral Acids, Metallic Salts. 
With Ichthyol are Acids, Alkaloids, Alkaline Carbonates and Hydrates, Iodine, Resorcinol. 

Physiological Action. 

Sulphur used externally is a mild vascular stimulant, causing slight dilatation 
of the vessels, and in some persons producing eczema. Applied to raw surfaces 
it is converted into sulphurous and sulphuric acids, and is powerfully irritant. 
It is parasiticide, especially to the itch-mite. Taken into the stomach it has 
no effect on that viscus, and most of it passes out in the feces unaltered; but 
a portion is converted in the intestinal canal by the alkaline bile into hydrogen 
sulphide and other sulphides, which are mildly laxative and diaphoretic. The 
former is excreted by the lungs, giving to the breath the smell of rotten eggs, 
also by the skin, discoloring silver articles carried about the person by forming 
a sulphide of silver. The Sulpides are partly absorbed into the blood and 
are excreted in the urine, chiefly as sulphates, and in the feces, which they 
blacken and render soft. Given in full doses they are irritant to the stomach 
and intestines, extremely nauseous to the taste and smell, increase the secretions 
of the intestinal glands, promote peristaltic action, and if used for any length 
of time they impair the blood, causing anemia, emaciation, tremor and great 
debility. 

Hydrogen Sulphide is very destructive to plant life. In animals it destroys 
the tissue functions, decomposing the blood and paralyzing the nervous and 
muscular systems. The symptoms of poisoning are those of asphyxia; mus- 
cular tremors occur and are followed by convulsions and death. This gas is 
often found in cesspools in large quantities, but in one case poisoning occurred 
from its excessive formation in the intestines and subsequent absorption into 
the blood. 

Crude Calcium Sulphide or Calx Sulphurata and Potassa Sulphurata are 
parasiticides and act like the sulphides as local irritants and in large doses as 
irritant poisons, producing narcotic symptoms and convulsions. In small 
doses they act like sulphur, and are supposed by many observers to have a 
special influence on suppuration, limiting or preventing it if given in small 
doses frequently repeated. 

The Iodide is believed to possess some of the properties of both its elements. 
It is doubtful whether it is a distinct chemical compound or merely a physical 
mixture. As a parasiticide it is very efficient, and has been found remarkably 
alterative in many local affections of chronic character, but may prove very 
irritant to the skin if improperly prepared. 

The actions of Sulphuric Acid, of Sulphurous Acid and of the Sulphites are respectively 
described under the titles Acidum Sulphtjricum and Acidtjm Sulphurosuh; those of the 
Sulphates under the titles of their respective bases. 



SULPHUR. 469 

Therapeutics. 

Sulphur is chiefly used as a laxative when pultaceous rather than liquid 
stools are required, as in hemorrhoids and anal fissure, also in constipation. 
Scabies has long been treated by its local and internal use, but sulphur alone 
does not kill the itch insect. The older sulphur ointments were made with 
sublimed sulphur, and probably contained a considerable amount of sulphurous 
acid, on which their parasiticide property depended. The later ointments, made 
with purified sulphur, all contain an alkaline ingredient and develop sulphides, 
which are powerful insect poisons. Sulphur fumigations are practically appli- 
cations of volatile sulphurous acid, while most of the sulphur baths and sul- 
phurous mineral waters are solutions of sulphuretted hydrogen or of the alkaline 
sulphides. They are of value in lead poisoning to favor the elimination of that 
metal, in chronic constipation, chronic rheumatism and sciatica and many skin 
diseases, especially chronic psoriasis, eczema, pityriasis and prurigo. The Oint- 
ment and the alkaline ointment are both used in scabies. 

The Iodide has been used internally in scrofula, glanders and cutaneous 
disorders, but it is chiefly employed as an ointment in lupus and parasitic skin 
diseases, especially herpes circinatus. Calx Sulphurata is an efficient depilatory, 
and is used as a paste to remove hair from fields of operation where the razor 
cannot be employed. It is painless, non-irritant, leaves no trace behind, and 
does not prevent the subsequent growth of the hair. Internally, in doses of 
gr. ^ frequently repeated, it has been considered an efficient remedy to prevent 
or limit suppuration, and is used in crops of boils, carbuncles, and tuberculous 
glands. 

Ichthyol was introduced by Dr. Unna, the celebrated dermatologist, as 
an efficient remedy in certain chronic skin diseases, particularly eczema and 
psoriasis. It causes slight irritation and a burning sensation if applied un- 
diluted to the skin ,but in a 50 per cent, ointment it is not irritant, even if 
covered with oiled silk. As a local application its value is due to its large 
proportion of sulphur, which is in a similar condition to that in organic sul- 
phides and mercaptans, and in any pharmaceutical combination would excite 
a dermatitis. Its application in medicine depends chiefly upon its reducing 
property, its antiseptic power and its contractile action upon the vascular system. 
Most of the affections for which it has been recommended are caused by anoma- 
lous circulation, especially capillary dilatation. Used internally, it retards 
the disintegration of albumins and favors their formation and accumulation, 
checking waste and promoting assimilation without irritating the gastrointes- 
tinal mucous membrane or interfering with digestion. It has little apparent toxic 
action on the general system, though instances of poisoning are reported as 
caused by its free use in eczema infantile, and in the curetted uterus. It is an 
intestinal antiseptic, is analgesic and antiphlogistic, and has remarkable power 
over exudations, promoting their absorption and alleviating the pain due to 



I 



470 SUMBUL. 

them, when given internally and applied externally at the same time. For these 
purposes it has been highly praised in gynecology and even in pleurisy. For 
chronic rheumatism a 50 per cent, ointment is used locally and the remedy is 
also given internally. It has done excellent service in erysipelas and in ulcers 
of the leg, locally applied in ointment form with Lanolin. In gynecology it 
is combined with glycerin (1 in 10) ; it is used with turpentine as a liniment 
for rheumatism, or with an equal weight of a mixture of lanolin and olive oil 
and 30 per cent, of chloroform; and against erysipelas as a 10 to 20 per cent, 
collodion, with or without castor oil. Applied as a thick ointment it is very 
serviceable in many skin diseases, especially furunculosis, impetigo contagi- 
osa, folliculitis of the scalp, impetiginous eczema, acne, herpes genitalis and 
sycosis barbae. In variola, a 20 per cent, ointment is successfully used, giv- 
ing prompt relief to the local symptoms, shortening the course of the disease, 
and preventing pitting; and in other eruptive fevers it alleviates itching and 
controls the dermatitis. It is an efficient application in chronic joint affec- 
tions, acute sprains, articular rheumatism, fissures of the nipples and anus, 
and in almost every form of subacute and chronic gout, in lymphatic en- 
largements, and in all diseases depending on hyperemia and capillary dilata- 
tion. For internal administration it should be prescribed in neutral aqueous 
solutions or in capsules, as it is decomposed in acid or alkaline solutions. 

Ichthoform is a harmless intestinal antiseptic and has been used internally 
with much satisfaction in acute gastro-enteritis, chronic gastric catarrh, dysen- 
tery, the diarrhea of tuberculosis and typhoid fever, chronic intestinal catarrh, 
and intestinal fermentation. Locally it is applied with benefit in endometritis, 
ozena, wounds, ulcers, and other lesions for which iodoform is considered ap- 
plicable. 

Thigenol has been employed with excellent results in various types of eczema, 
in seborrhea, and in acne rosacea. It is claimed to be antipruritic and to 
stimulate granulations. 

Thiol causes neither pain, burning, nor other symptoms of irritation, nor 
any bleeding from eroded surfaces. The dry form is used as a dusting powder 
in erysipelas, eczema, erythema, intertrigo, impetigo, pemphigus, periphlebitis, 
subcutaneous hemorrhages, and syphilitic ulcers. It is an efficient application 
in pelvic exudations and endometritis. 

Tumenol is of no service in erysipelas, and is not a parasiticide; but has 
rendered good service in moist eczema, erosions, excoriations, and superficial 
ulceration. The tincture is an efficient application in all forms of pruritus. 

SUMBUL, — is the dried rhizome and root of Ferula Sumbul, nat. ord. Umbelliferae, 
growing in northern Asia. It contains Sumbulic or Angelic and Valeric Acids, also a volatile 
oil, balsamic resins, and a bitter principle. Dose, gr. x~5j [av. gr. xxx.] 

Fluidextractum Sumbul, Fluidextract of Sumbul, — Dose, ttrx-Sj [av. tt£xxx.] 
Extractum Sumbul, Extract of Sumbul, — Dose, gr. j-x [av. gr. iv.] 

Sumbul is an efficient nerve tonic, having qualities closely resembling musk and valerian - 
It is used by the Russian physicians in very many morbid conditions and seems to be a favorite 



TABACUM. 471 

remedy in that country for almost any disease. It is probably of some value in hysteria and 
other nervous derangements of delicate females, and may be used as a substitute for musk in 
typhoid conditions and fevers, asthma, delirium tremens and perhaps in epilepsy. 

TABACUM, Tobacco (Unofficial) ,— is the commercial dried leaf olNicotiana 
Tabacum, an annual plant of the nat. ord. Solanaceae, native of tropical America, 
but cultivated in several parts of the world, especially in Cuba and Virginia. The 
leaves contain a very poisonous, oily fluid alkaloid named Nicotine, C 10 H 14 N 2 , 
which consists of Pyridine, C 5 H 5 N, and a hydrated pyrrhol ring, occurs in the 
plant as a malate, and varies in quantity from 1 to 10 per cent, in different 
specimens. Tobacco contains also a volatilizable, camphoraceous principle 
named Nicotianin, the existence of which is denied by some analysts, besides 
potassium and calcium salts (nitrates and phosphates), silica, gum, resin, and 
other substances. 

The proportion of Nicotine in tobacco is stated at 6 in 10,000 parts (0.06 per cent.) by 
Posselt and Reimann, but other analysts have found 2 per cent, in Havana tobacco and more 
than 8 per cent, in French tobacco. Turkish tobacco is said to contain about 2.5 per cent. 
(Kew Bulletin). The effect of curing undoubtedly produces chemical changes in which 
certain proteins and fat which make the smoke disagreeable, and about 25 per cent, of the 
Nicotine are removed and the aroma developed. 

Tobacco-smoke contains nicotine, pyridine, collidine, picoline, parvoline, etc. Of 
these, Pyridine, C5H5N, predominates when tobacco is smoked in a pipe, but Collidine 
CsHnN, which is far less active, predominates when there is free access of air as in smoking 
cigars. Tobacco-smoke also contains Carbon Monoxide, CO, and Carbon Dioxide, CO2, 
of which Krause determines the average proportion to be 9.3 per cent., and to which he 
credits much of the injurious effects of smoking in young subjects. It also contains irri- 
tant]aldehydes, ammonia, hydrocyanic acid and some volatile oil. 

Unofficial Preparations and Derivatives. 

Enema Tabaci, Enema of Tobacco (B. P. 1867), — gr. xx of the leaf infused in Bviij of 
boiling water for an hour, strained, and the whole administered as one enema. 

Oleum Tabaci, Oil of Tobacco, — is an empyreumatic product and a most virulent poison, 
obtained by distillation at a temperature above that of boiling water. 

Vinum Tabaci, Wine of Tobacco, — B j to the pint. Dose, ttj?v-3J. 

Nicotina, Nicotine, C 10 H U N 2 , — the alkaloid and active principle; a colorless, oily fluid, 
having the odor of tobacco and an acrid taste; readily soluble in water, and forming sol- 
uble salts with acids. Dose, v^^-jq, up to Tp^ij in two hours, in tetanus and in strychnine 
poisoning. 

Nicotinse Bitartras, Nicotine Bitartrate, — occurs in fine, white crystals, having a tendency 
to aggregate, readily soluble in water. This salt is stable and keeps well, even in solution. 
It is recommended as the most suitable form of administering nicotine in tetanus and strychnine 
poisoning. Dose, gr. ^5— iVj u P to a maximum of gr. ij in 2 hours. 

Pyridina, Pyridine, C 5 H 5 N, — is a colorless, liquid, alkaloidal base, formed during the 
dry distillation of nitrogenated organic substances. It has a powerful odor, evaporates in the 
air, and mixes with water in all proportions. Dose, internally TTgv-xv; by inhalation 5j 
allowed to evaporate in an open dish in a small room, in which the patient is exposed for 20 
or 30 minutes thrice daily for the relief of asthma (See). 

Incompatibles are as for Alkaloids (see page 6). Physiologically incompatible are Strych- 
nine, Atropine, Digitalis, Ergot, Alcohol, Ammonia. 

Physiological Action. 

Tobacco is a very depressant nauseant, an emetic by irritant as well as by 
systemic action, and an antispasmodic; also diuretic, diaphoretic, laxative, 



472 TABACUM. 

sedative, and narcotic. It first stimulates briefly and afterwards depresses 
the cerebrum, medulla, cord, the motor nerve endings in the voluntary mus- 
cles, and the secreting nerves of the glands, also the vagus centre and ganglia, 
slowing the pulse-rate, but afterwards paralyzing and causing a high pulse- 
rate. It increases the salivary and intestinal secretions, and produces diure- 
sis, tremor, clonic spasms, and a tetanic stage followed by paresis. It con- 
tracts the pupils, slows and depresses the heart, raises arterial tension at first 
and afterwards lowers it, reduces the body-temperature and causes profuse 
sweating, cold and clammy skin, collapse and death usually by paralysis of 
respiration, sometimes by paralysis of the heart. Its empyreumatic products 
act similarly but less powerfully. Fatal results have followed the inhalation 
of its vapor into the lungs. 

The continued use of Tobacco, by smoking or chewing it. to excess, produces 
granular inflammation of the fauces and pharynx, atrophy of the retina, dys- 
pepsia, lowered sexual power, sudden faints, nervous depression, cardiac irri- 
tability and occasionally angina pectoris. Used by the young it hinders the 
development of the higher nerve centres and impairs the nutrition of the body 
by interfering with the processes of digestion and assimilation. It has been 
credited with causing cancer of the lips and tongue. The so-called " tobacco 
heart" includes many forms of nervous, painful or oppressed cardiac action, 
depending on the age of the subject, the quantity consumed and other cir- 
cumstances. In mild cases an occasional palpitation or flutter is complained 
of; in more severe ones there are considerable cardiac irregularity and rapid- 
ity, and more or less distress experienced; in some there are actual cardiac 
pain, decided irregularity and occasional intermittence of action, and the 
symptoms may simulate those of a case of angina pectoris. There are no 
physical signs as a rule, so that the diagnosis is made by exclusion. The 
pathology is unknown, but probably involves some lesion of the vagus. In 
the young, excessive indulgence in tobacco may lead to cardiac hypertrophy, 
dilatation and even valvular lesions (Osier). A synergistic action has been 
observed by the author between opium and tobacco in many cases, in which 
persons accustomed to tobacco began to use opium or morphine, when the 
slightest use of tobacco made them very sick as though they were novices 
in this respect. 

Nicotine, in even minute doses causes symptoms of intense gastric irritation 
with an extreme degree of collapse. It abolishes the function of the motor 
nerves and paralyzes respiration. Its general action is that of tobacco, but 
it is one of the most powerful and rapidly- acting poisons known, death having 
occurred within three minutes after its ingestion, the patient dropping instantly 
to the floor insensible, with no symptoms except a wild stare and a deep sigh. 
The y 1 - of a grain has caused death in a human being, and -^ is fatal to cats 
and dogs. 



tamarindus — terebinthina. 473 

Therapeutics. 

Tobacco is now but little used in medicine, the dangers attending its employ- 
ment either internally or externally having caused it to be superseded by less 
violently acting agents. 

TAMARINDUS, Tamarind (Unofficial), — is the preserved pulp of the fruit of Tama- 
rindus indica, a large tree of the nat. ord. Leguminosae, native in the East and West Indies. 
It contains citric, tartaric and malic acids, sugar, gum, potassium bitartrate. Dose, 
5J-5J [av. giv.] 

Confectio Sennae, Confection of Senna (Unofficial), — contains Tamarind to the amount 
of 10 per cent. Dose, 5j~ij lav. 3j-] 

Tamarind is a laxative and refrigerant fruit. In infusion it may be used by convalescents 
as a pleasant acidulous drink, or the pulp may be boiled with milk as a whey for the same 
purpose. As a laxative it is usually prescribed in connection with other agents having the 
same action. 

TANACETUM, Tansy (Unofficial), — the leaves and tops of Tanacetum vulgare, a per- 
ennial, herbaceous plant of the nat. ord. Compositae, indigeous in Europe but cultivated in 
gardens and growing wild in old fields. It contains a volatile oil, a bitter principle Tanacetin, 
a tannic acid, etc. A fluidextract may be prepared according to the general rule and admin- 
istered in doses of Ti£x-3j. The dose of the volatile oil (Oleum Tanaceti) is i to 3 drops. An 
infusion (Tansy Tea) may be made in the proportion of 5 j to the pint, and used in doses of 
Sj-ij. 

Tansy is emmenagogue, diuretic and anthelmintic, an aromatic bitter and an irritant nar- 
cotic poison. Fatal results have followed upon overdoses of the oil (Bss-j) or strong decoctions, 
preceded by clonic spasms, disturbed respiration and cessation of the heart's action. It is a 
useful remedy in amenorrhea, but is in popular repute as an abortifacient, a virtue which it 
does not possess except in quantity dangerous to life. 

TARAXACUM, Dandelion, — is the dried rhizome and root of Taraxacum 
officinale, a plant of the nat. ord. Compositae. All parts of the plant contain 
a bitter, milky juice, exuding from any break or wound. Its constituents 
are a bitter amorphous principle named Taraxacin, a crystalline principle 
Taraxacerin, with potassium and calcium salts, Inulin, and resinoid bodies, 
etc. The French name for the plant is Pissenlit. Dose, 5j - 5 j [av. 3ij-] 

Extractum Taraxaci, Extract of Taraxacum. — Dose, gr. v-xxx [av. gr. xv.] 
Fluidextractum Taraxaci, Fluidextract of Taraxacum. — Dose, 3j~5j [av. 3ijss.] 

Taraxacum is a bitter tonic, a diuretic and an aperient. It has been 
supposed to act especially on the liver and is chiefly used in dyspepsia with 
hepatic torpor. As found in the shops it is usually inert. The extract is 
used as an excipient for pills. 

TEREBINTHINA, Turpentine. — A Turpentine means a vegetable exuda- 
tion, liquid or concrete, consisting of resin combined with a peculiar essential 
oil named Oil of Turpentine, C 10 H 16 , and generally procured from various species 
of the nat. ord. Pinaceae. 

Unofficial Turpentines. 

Terebinthina, Turpentine, — a concrete oleoresin from Pinus palustris the 
Yellow Pine, and other species of Pinus, nat. ord. Pinaceae. It occurs in tough, 



474 TEREBINTHINA. 

yellowish masses, brittle when cold, crummy-crystalline interiorly, of terebin- 
thinate odor and taste. Dose, gr. v-xxx as a stimulant, antispasmodic or diu- 
retic; oij _ iv as an anthelmintic. 

Terebinthina Canadensis, Canada Turpentine {Balsam of Fir), B. P., — a 
liquid oleoresin obtained from Abies balsamea, the Silver Fir or Balm of 
Gilead; nat. ord. Coniferae. A yellowish, transparent, viscid liquid, of agree- 
able, terebinthinate odor and a bitterish and slightly acrid taste, slowly dry- 
ing on exposure, forming a transparent mass; completely soluble in ether, 
chloroform or benzol. Dose, gr. x-xxx. 

Pitch and its preparations are described under the title Pix. 

Chian Turpentine, — from the Pistacea Terebinthus, a small larch tree 
growing in the islands of Chio and Cyprus; a thick, tenacious, greenish-yellow 
liquid, concreting on exposure to the air into a translucent solid. Dose, gr. 
iij-v in emulsion. u 

Venice Turpentine, — procured in Switzerland from Larix Europced the 
European Larch; a viscid liquid of the consistence of honey, does not concrete 
on exposure, and is entirely soluble in alcohol. The Venice Turpentine of com- 
merce is usually prepared by dissolving rosin, in oil of turpentine. 

Thus Americanum, Frankincense, — the concrete turpentine scraped off 
the trunks of Pinus australis and Pinus Tceda. An ingredient of the Emplas- 
trum Picis of the Br. Phar. 

Official Preparations of Turpentine. 

Oleum Terebinthinae, Oil of Turpentine, C 10 H 16 , commonly called Spirit or Spirits of 
Turpentine, — is a volatile oil distilled from Turpentine. A thin, colorless liquid, of character- 
istic odor and taste; soluble in 5 volumes of alcohol, mixes with other volatile and fixed oils, 
and dissolves resins, wax, sulphur, phosphorus and iodine. Bromine and powdered Iodine 
act violently on it, and when brought into contact with a mixture of Nitric and Sulphuric 
Acids it takes fire. It is isomeric with a number of volatile oils, and constantly absorbs 
oxygen from the air when exposed, becoming thicker and less active from formation of resin. 
It is a mixture of several hydrocarbons {ter penes'), each having the same formula as itself. 

Oleum Terebinthinae Rectificatum, Rectified Oil of Turpentine, — prepared by shaking 
Oil of Turpentine with an equal volume of solution of Sodium Hydroxide, distilling three- 
fourths, and separating. This preparation should always be dispensed when Oil of Turpen- 
tine is required for internal use. Dose, as a stimulant or diuretic, ttjjv-xxv [av. tt^v], in emul- 
sion 3 to 6 times daily; — as a cathartic or anthelmintic §ss or more, combined with other 
cathartics. A little glycerin and oil of gaultheria will disguise the taste. 

Emulsum Olei Terebinthinae, Emulsion of Oil of Turpentine, — has of the rectified Oil 
15, Expressed Oil of Almond 5, Syrup 25, Acacia 15, Waterjto 100. Dose, njjx— 5 ij [av. 5ssj\ 

Linimentum Terebinthinae, Turpentine Liniment, — has 35 parts of the Oil of Turpen- 
tine with 65 of Rosin Cerate. 

Linimentum Terebinthinae Aceticum, Liniment of Turpentine and Acetic Acid (B. P.), 
— has of Glacial Acetic Acid n, Liniment of Camphor 4.4.5 and rectified oil of turpentine] 
q. s. 100. An imitation of St. John Long's celebrated liniment. 

Official Derivatives. 

Resina, Rosin,— is the residue left after distilling off the volatile oil from Turpentine. It 
is a transparent, amber-colored substance, hard and brittle, with a glossy and shallow con- 
choidal fracture and a faintly terebinthinate odor and taste; soluble in alcohol, ether, fixed 
or volatile oils, and in its own weight of oil of turpentine. Chemically it is considered the 



TEREBINTHINA. 475 

anhydride of Abietic Acid, C 44 H 64 5 , into which acid it is converted by agitation with warm 
diluted alcohol. Silvic, Pinic, and Palmaric Acids are decomposition products, not con- 
stituents of rosin as was formerly taught. Dose, gr. j-vj [av. gr. iv]. 

For the definition of a Resin see page 9, also the tile Resinae in Part II. Other official 
resins are, Resina Jalapae, Resina Podophylli and Resina Scammonii, which are severally de- 
scribed under the titles of the plants forming their respective sources. 

Ceratum Resinae, Rosin Cerate, (Basilicon Ointment), — has of Rosin 35, Yellow Wax 15, 
Lard 50. It forms 65 per cent, of Turpentine Liniment. 

Ceratum Resinae Compositum, Compound Rosin Cerate (Unofficial), — has of Rosin 22I, 
Yellow Wax 22I, Suet 30, Turpentine n|, Linseed Oil 13I per cent. 

Terebenum, Terebene, — is a liquid consisting of dipentene and other hydrocarbons, 
obtained by the action of concentrated sulphuric acid on oil of turpentine, and subsequent 
rectification with steam. It is soluble in 3 of alcohol, slightly soluble in water. Dose, 
TTgij^xv [av. Tj#iv], on sugar, or suspended in §ss of water, by the aid of light magnesium 
carbonate gr. xx. 

Terpini Hydras, Terpin Hydrate, C 10 H 18 (OH) 2 .H 2 O, — is the hydrate of the diatomic 
alcohol Terpin (Terebinthene), obtained by distilling oil of Turpentine with an alkali. Col- 
orless, lustrous, rhombic prisms, nearly odorless, of slightly aromatic and somewhat bitter 
taste; soluble in 13 of alcohol and in about 200 of water at 25 C, in 34 of boiling water and 
in 3 of boiling alcohol. Dose, gr. j-v [av. gr. iv.] 

Unofficial Derivatives. 

Terpinol, — an oily body obtained from the preceding by the action of an acid thereon. 
Dose, gr. ij-v. 

Sanitas Disinfecting Fluid, — is an aqueous solution of turpentine which has been oxi- 
dized by exposure to the air. It contains Hydrogen Dioxide, Thymol, Camphor and Cam- 
phoric Acid, the latter in such small proportion, however, that its action cannot be expected. 
This proprietary preparation has many advantages. It is a good oxidizing agent and anti- 
septic, is not poisonous and does not stain the linen; qualities which recommend it as a disin- 
fectant and for use in surgical operations. 

Retinol, Resinol, Codol, — is obtained as a product of the destructive distillation of resin, 
and occurs as a yellowish, fluorescent, oily liquid. It is used as a solvent for aristol, iodol, 
camphor, creosote, phenol, phosphorus, cocaine, codeine, and other alkaloids. The term 
Resinol is used as a trade name for a secret prepatory preparation, which is advertised as a 
remedy for all varieties of skin disease. Heidingsfeld states that it is irritant, causes derma- 
titis, and has dangerous narcotic properties. 

Official Analogues of Turpentine. 

These include Juniperus Juniper, Sabina Savin, and Pix Liquida Tar, which are 
described under their respective titles. 

Unofficial Analogues of Turpentine. 

Oleum Succini, Oil of Amber, — a volatile oil obtained from the destructive distillation of 
Amber (Succinum), a fossil resin thought to be the exudation of Pinites succinifer an extinct, 
coniferous tree. Dose, gtt. v-x. See under Succinum. 

Oleum Thujae, Oil of Thuja, — a volatile oil which is given in doses of njy-v. A satu- 
rated tincture may be used in drachm doses. Obtained from Thuja occidentalis, the Arbor 
Vitae, a coniferous tree. See under Thuja. 

Incompatibles. 

Incompatible with Oil of Turpentine are: Bromine, Chlorine, Iodine, Water. With 
Rosin are: Caustic Alkalies, Menthol, Phenol, Salol, Thymol, Urethane. With Terebene are: 
Chlorine, Bromine, Iodine, Water. 

Physiological Action. 

Turpentines are stimulant, diuretic, anthelmintic, and hemostatic; in large 
doses laxative and irritant, and externally used are rubefacient and antiseptic. 
Their virtues depend entirely on the volatile oil. 



476 TEREBINTHINA. 

Oil of Turpentine in small doses causes a sense of heat at the epigastrium, 
burning in the mouth and salivation by reflex action. In moderate doses it at 
first stimulates the vaso-motor nervous system, afterwards paralyzing it, and 
thus causing a rise and then a fall of the arterial tension. It lowers the functions 
of the brain, spinal cord and medulla in the order stated, causing diminution 
of voluntary movement and reflex action, dilatation of the vessels, lowered 
blood-pressure and slowed respiration, the latter often becoming spasmodic. 
The pulse is sometimes slowed, sometimes quickened. Large doses produce 
gastro-enteritis, with vomiting and diarrhea, suppression of urine, pain in the 
lumbar regions, burning in the urethra, hematuria and strangury. The mus- 
cular power is diminished, coordination impaired and a state of intoxication 
induced. In toxic dose it acts as a narcotic poison and causes complete mus- 
cular relaxation, profound insensibility with abolished reflexes, dilated pupils, 
cyanosed face, labored and stertorous breathing and death by paralysis of respi- 
ration. It is excreted by the various organs of excretion, all of which are highly 
irritated, .the kidneys suffering particularly. Its vapor inhaled produces nasal 
and renal irritation, frontal headache, also frequently strangury and hematuria. 
Locally to the skin it is rubefacient and even vesicant if applied for any length 
of time or if evaporation be prevented. 

Therapeutics. 

Oil of Turpentine is employed externally as a rubefacient and counter- 
irritant in many conditions producing pain and inflammation. Cloths wrung 
out of hot water and then sprinkled with the oil (turpentine stupes) are useful 
applications in sciatica and other neuralgia?, lumbago, chronic rheumatism, 
chronic bronchitis, peritonitis with tympanites, pleurisy, and renal colic. It is 
one of the most efficient agents in hospital gangrene, applied in full strength 
to the part affected. The liniment is in constant use for sprains, neuralgia 
and other slight local affections. 

Internally it is best employed in ulceration and hemorrhage of the intestines 
and in passive hemorrhages from other organs. Active bleeding with a plethoric 
condition and hematuria are states in which it is contraindicated. It is often 
used with ether (i to 3) in biliary and flatulent colic as an anodyne and anti- 
spasmodic. As a vermifuge against tape-worm it must be employed in large 
doses (gss-ij) with castor oil to promote its rapid passage through the intestinal 
canal. It is well employed as a stimulant to the heart and vaso-motor system 
in puerperal fever, yellow fever, traumatic erysipelas, pneumonia, and capil- 
lary bronchitis. It is useful in chronic bronchial catarrh, chronic cystitis, suba- 
cute gonorrhea and similar affections of mucous surfaces generally. Inhalations 
of the vapor or atomized oil are beneficial in chronic affections of the larynx 
and bronchi. The pure vapor is a good irritant inhalation to provoke coughing 
and thereby cause the expulsion of morbid products in cases of bronchitis and 



THEOB ROM AXIS OLEUM THUJA. 477 

pneumonia when expectoration is arrested by exhaustion and remedies by the 
mouth have no effect. It is too irritant for ordinary inhalation but may be 
diluted with steam from an atomizer. 

Terebene has been extensively used by Murrell, with excellent results, as 
a remedy for obstinate winter-cough and emphysema of the lungs, in flatulence 
and flatulent dyspepsia, in cystitis and gleet, and as a spray in phthisis and 
post-nasal catarrh, also with cocaine in solution as a spray for coryza and hay- 
fever. Other observers, of several years' experience with this remedy, praise 
it highly as an inhalant remedy in phthisis, bronchiectasis, chronic bronchitis 
and other pulmonary affections characterized by profuse, purulent expectoration. 
Rieu employs it in bronchitis and bronchorrhea, in doses internally of gr. xv-xxx 
per diem, but says that it does not affect the muco-purulent expectoration of 
phthisis. It probably has no superior efficacy to creosote or Venice turpentine, 
except that it is without much odor and has no taste. 

Terpin Hydrate is praised in chronic and recurrent bronchitis, night-cough 
from habit, catarrhs and kindred affections. In fact, all acute and many chronic 
affections of the respiratory passages form the proper field for the therapeutical 
action of this preparation. 

Rosin is used to give consistence and adhesiveness to plasters and cerates, 
and generally acts as a mild local stimulant, but the writer has seen persons 
with so susceptible a skin that the ordinary adhesive plaster would produce on 
them a high degree of cutaneous irritation. It is never employed internally, 
but in chronic bronchial catarrh the fumes from boiling rosin are inhaled with 
considerable advantage. Rosin Cerate is one of the most commonly used appli- 
cations to promote the healing of indolent ulcers, also to blistered surfaces, 
burns, scalds and chilblains. 

THEOBROMATIS OLEUM, Oil of Theobroma {Cacao-butter),— is a fixed oil ex- 
pressed from the roasted seeds of Theobroma Cacao, the Chocolate-tree, nat. ord. Sterculiaceae, 
growing in Mexico, the West Indies and South America. The oil is a yellowish-white solid, 
of faint odor, bland taste and neutral reaction. The seeds are oval, about the size of almonds, 
and consist of shells and kernels, in both of which is found the alkaloid Theobromine, C 7 H 8 N 4 2 , 
which closely resembles Caffeine, the latter being its methyl derivative. Chocolate is prepared 
by roasting the seeds, removing the shells, then crushing or grinding the kernels to' a smooth 
paste, which is cast in molds. 

Oil of Theobroma consists chiefly of Stearin with a little Olein. Its action is demulcent, 
and it does not become rancid on exposure to the air. Its chief use is as a basis for making 
suppositories. A Cerate is prepared by melting together Cacao-butter 35, White Wax 35, 
Oil of Almond 30, adding a drop of Oil of Rose and coloring with a minute quantity of Car- 
mine previously triturated with a drop of Water of Ammonia. This is known as Red Lip- 
salve. 

Theobromine has the same action and uses as Caffeine. See under Caffeina, page 182, 
for this principle and for Diuretin. 

THUJA, Arbor Vitae (Unofficial), — the fresh tops of Thuja occidentalis, a tree of the 
nat ord. Coniferae, incorrectly called White Cedar, growing in swampy ground in Canada 
and in the northern United States. They contain a volatile oil, tannin, wax, resin, etc.; 
also Pinipicrin, a bitter principle, and Thujin,^ a yellow, astringent and crystallizable color- 
ing principle, separable into glucose and Thujetin. 

The dose of a saturated, fresh tincture or fluidextract is 5j> 3 to 6 times daily. The 
Volatile Oil may be given in doses of irpj-v. 

Thuja resembles Savin in action very closely. It is stimulant, irritant and astringent, 



478 THYMI OLEUM. 

also aromatic, diuretic and emmenagogue. The oil is a gastro-intestinal irritant and pro- 
duces epileptiform convulsions in warm-blooded animals but paralysis in cold-blooded ones. 
It lowers the temperature and is anthelmintic. Thuja is indirectly an abortifacient when 
given in doses sufficient to cause violent gastro-enteritis. It is reported to have produced 
an acute urethritis resembling gonorrhea. 

Thuja in decoction has been usefully employed in coughs and amenorrhea. It has been 
given as an alterative blennorrhetic in chronic catarrh and bronchorrhea. It is highly 
praised by Phillips for the cure of warts with narrow base and pendulous body, a strong 
tincture being applied locally and given internally at the same time in 5-minim doses twice 
daily. Piffard speaks strongly in its favor as a valuable agent for non-syphilitic warts 
(condylomata acuminata) of the penis and vulva, for papillomatous growths in general and 
for gleet dependent on granular urethritis. It has been used in chronic gonorrhea and 
prostatitis with asserted success, and the oil has been employed as a vermifuge. 

THYMI OLEUM, Oil of Thyme,— is a volatile oil distilled from the 
leaves and flowering tops of Thymus vulgaris, the Garden Thyme, a common 
shrub of the nat. ord. Labiatse, indigenous to France but cultivated in our gar- 
dens. This oil is a pale yellow or colorless, thin liquid, having a strong odor 
of thyme, a warm, pungent and afterwards cooling taste and a neutral reaction; 
readily soluble in alcohol. It contains not less than 20 per cent, by volume 
of phenols. It consists of two portions, the more volatile being a mixture 
of the hydrocarbons Cymene and Thymene, the less volatile being chiefly 
Thymol, which is official. Dose, Tflj-v [av. TTLiij .] 

Thymol, C 10 H 14 O, — is a phenol contained in Oil of Thyme and in the 
volatile oils of several other plants. It occurs in large, colorless, rhombic 
prisms, of aromatic odor, pungent taste and neutral reaction; soluble in 1010 
of water, in 900 of boiling water, in 1 of alcohol, freely in fats and oils, solutions 
of chloral and alkalies, ether or chloroform. It liquefies when triturated with 
an equal quantity of camphor, menthol, or chloral. Dose, gr. ss-iij [av. gr. ij]; 
for uncinariasis, gr. xv-3j [av. gr. xv.] 

Thymolis Iodidum, Thymol Iodide (Aristol), — is official, and is described under Iodum, 
page 303. 

Thymol Solution, — for antiseptic spray, 1 part in 1000. 

Thymol Ointments, — vary in strength from 5 to 30 grains to the § . 

Thymol Inhalation, — Thymol gr. xx, Alcohol 5hj, Magnesium Carbonate gr. x, Water 
to §iij. A teaspoonful to a pint of water at 150 F. for each inhalation. 

Volkmann's Antiseptic Fluid, — has of Thymol 1, Alcohol 10, Glycerin 20 and Water 
100 parts. 

Thymotal, Thymol Carbonate — is an efficient vermicide, and is particularly useful in 
ankylostomiasis. Dose, gr. ij-x. 

Incompatibles. 

Incompatible with Thymol are Acetanilid, Antipyrine, Butyl-chloral Hydrate, Cam- 
phor, Chloral Hydrate, Gold salts, Menthol, Phenol, Pyrocatechin, Quinine Sulphate, 
Rosin, Salol, Spirit of Nitrous Ether, Urethane. 

Physiological Action and Therapeutics. 

Oil of Thyme has the same properties as the oils of other mints, and contain- 
ing a large quantity of Thymol it is similar to the latter in action. 

Thymol in its action stands between phenol and oil of turpentine. Like 



TIGLII OLEUM. 479 

the former it is a powerful antiseptic and disinfectant, also a local irritant and 
anesthetic to the skin and mucous membranes, paralyzing the end-organs of 
the sensory nerves. When absorbed it paralyzes the nerve-centres in the spinal 
cord and in the medulla, lessening reflex action, slowing respiration, lowering 
the temperature and the arterial tension, and in poisonous doses causing weak- 
ness, coma and death. Internally administered in doses of 20 to 30 grains per 
diem it produces a sensation of epigastric heat, sweating, singing in the ears, 
deafness, a sense of constriction in the forehead and increase of the urinary 
discharge, which assumes a dark greenish hue. It is eliminated by the respira- 
tory and urinary organs, which it irritates considerably during the process of 
its excretion. As an antiseptic it is much more powerful and permanent than 
phenol, and much less poisonous, but its insolubility in water prevents its general 
use for this purpose. 

Thymol is chiefly employed as a gargle, spray or inhalation in laryngitis 
and diphtheria; as an ointment in ringworm, eczema and psoriasis, and as an 
injection in ozena. A solution of 1 part in 1000 is the strength usually pre- 
scribed. Its fragrant odor renders it a very agreeable antiseptic application 
for ulcerated conditions of the mouth and fauces, but makes it very attractive 
to flies, which fact together with its high price will prevent it becoming a 
favorite in hospital practice. A solution, used as a mouth-wash, is very effi- 
cient in removing the odor of tobacco from the breath. Thymol is almost 
specific against the intestinal parasite ankylostomum duodenale (uncinaria 
Americana) for which it is given in three or four doses of 10 to 30 grains, 
well triturated, in capsules; care being taken that no oil or alcoholic drink is 
ingested afterwards, in order to avoid the absorption of thymol and conse- 
quent poisoning thereby. 

TIGLII OLEUM, Croton Oil,— is a fixed oil expressed from the seeds 
of Croton Tiglium y a small tree of the nat. ord. Euphorbiaceae, a native of India. 
The oil is of pale or brownish-yellow color, somewhat viscid and slightly 
fluorescent, of fatty odor, acrid taste and slightly acid reaction; soluble in 60 
of alcohol, freely in ether, chloroform, or carbon disulphide. Its composition 
is very complex and has not been thoroughly made out, but it is known to con- 
tain the glycerides of several fatty acids, also a peculiar acid named Crotonic 
Acid, which is the active principle. Dose, 1Tt§-ij [av. TTlj] in pill, emulsion 
or tincture. 

Corson's Paint (Unofficial),— has of Croton Oil 5ij, Ether 5iv, Compound Tincture 
of Iodine to make 5ij; and is used as a counterirritant by painting over the part once daily. 

Linimentum Crotonis, Liniment of Croton Oil (B. P.), — contains 12 parts of the oil in 44 
each of Alcohol (90 per cent.) and Oil of Cajuput. It is a useful pustulant application, being 
more manageable than the oil itself. 

Physiological Action and Therapeutics. 

Externally Croton Oil is highly irritant, producing a pustular eruption 
which heals by scabbing and may leave unsightly cicatrices. Internally it is 



i 



I 



480 TRAGACANTHA ULMUS 

a powerful drastic cathartic, producing in one or two hours copious watery 
stools, in overdoses causing great congestion of the intestinal canal and perhaps 
death from gastro-enteritis. Vomiting usually occurs after large doses, so that 
the irritant hyper-catharsis is not always observed. It is absorbed into the 
blood, and produces glandular hyperemia as well as direct inflammation of the 
intestinal mucous membrane, together with increased peristaltic action. Its 
cathartic power is increased by the addition of an alkali, and is manifested, 
though in less degree, when applied to the integument. 

Croton Oil is used as a hydragogue cathartic when a speedy and complete 
evacuation of the bowels, diminution of arterial pressure and prompt derivative 
action are desired, as in apoplexy, impaction of the intestines, dropsy, lead 
constipation, and paralysis. It is contraindicated when either debility, organic 
obstruction or an inflammatory condition of the stomach and bowels exists. The 
smallness of the dose makes it a very easily administered and manageable purga- 
tive. An inconsiderable fraction of a drop, absorbed by a pellet of sugar or 
bread, may be given in repeated doses until the desired effect is obtained. It 
has been used as a vermifuge against tapeworm. Externally it is employed as a 
counter-irritant in ovaritis, bronchitis, pleurisy, rheumatism, neuralgia, glandu- 
lar swellings and in laryngeal, and pulmonary diseases. 

TRAGACANTHA, Tragacanth, — is a gummy exudation from Astragalus gummifer and 
from other species of Astragalus, shrubs of the nat. ord. Leguminosae, growing chiefly in Asia 
Minor and Persia. It occurs in shell-like, curved or contorted bands, swelling with water to a 
gelatinous mass, which is tinged blue by test-solution of iodine, and consists of a mixture of 
Arabin, or gum-arabic, which is soluble in water, and Bassorin, a gum which is insoluble in 
water but swells up in it, also a little starch. 

Mucilago Tragacanthae, Mucilage of Tragacanth, — Tragacanth 6, Glycerin 18, Water 
to 100. Dose, §ss or more [av. 5iv]. 

Incompatibles are Alcohol, Copper Sulphate, Ferrous Sulphate, Lead Acetate both basic 
and neutral. 

Tragacanth is demulcent, but in large quantities may cause indigestion. It is chiefly 
employed to suspend resins and heavy powders in emulsion. The mucilage may be used as a 
vehicle for active agents in gargles for pharyngitis, and to cause cohesion in the preparation 
of pills and troches. It is a constituent of 4 of the 5 official troches, and is a better agent 
than acacia for making emulsions of cod-liver oil. 

TRITICUM, Couch-grass, — is the dried rhizome and roots of Agropyron repens (gath- 
ered in the spring), the Couch-grass, a perennial plant of the nat. ord. Gramineae, abounding 
in meadows and cultivated grounds, where it ranks as a weed though of the same genus as 
wheat. It contains much sugar and a gum-like principle, Triticin. Dose, 3j~oJ [av. 
5ij] in infusion or decoction. 

Fluidextractum Tritici, Fluidextract of Triticum. — Dose, 5j~5 j [av. 5ijss], well diluted. 

Couch-grass is demulcent, emollient and a feeble diuretic. It is chiefly used in cystitis 
and irritable bladder. The infusion is a popular fever-drink in Europe, and has had a con- 
siderable reputation in dysuria. 

TJLMUS, Elm {Slippery Elm), — is the dried inner bark of Ulmus fulva, an indigenous 
tree of the nat. ord. Ulmaceae. It contains a large quantity of mucilage which it readily 
parts with to water. 

Mucilago Ulmi, Mucilage of Elm (Unofficial), — Elm 6, Water to 100, digested for an 
hour and strained. Dose, ad libitum [av. 5iv.] Should be freshly made when wanted. 

Slippery-elm Bark is demulcent, slightly astringent and somewhat tonic. It is used inter- 
nally in diarrhea, dysentery and affections of the urinary passages, and externally in the form 
of poultice as an emollient application in cases of inflammation. It is employed for the dilata- 
tion of fistulae, strictures, and the os uteri. 



UVA URSI— VALERIANA. 48 1 

XJVA URSI, — the dried leaves of Arctostaphylos Uva-ursi, the Bearberry, 
a low, evergreen shrub of the nat. ord. Ericaceae, inhabiting the northern lati- 
tudes and high mountains of Europe, Asia and America. They contain tannic 
and gallic acids and 3 principles, Arbutin, a bitter glucoside, neutral, crystalline, 
resolvable into glucose and hydroquinone ; Ericolin, bitter and amorphous; 
Ursone, resinous, neutral, crystalline and tasteless. The Calif ornian Manzanita 
(Arctostaphylos glauca) is an allied plant and contains arbutin and tannin. Dose 
of the powdered leaves, gr. x-3j [av. gr. xxx], in infusion or decoction. 

Fluidextractum Uvae Ursi, Fluidextract of Uva Ursi. — Dose, ttjjx-3j [av. ttjxxx.] 
Infusum Uvae Ursi, Infusion of Uva Ursi (B. P.), — Dose, gss-j. 

Arbutinum, Arbutin, C 12 N 16 7 (Unofficial), — occurs in colorless, odorless, bitter crystals, 
soluble in 8 of water and in 16 of alcohol. Dose, gr. iij-vij. 

Incompatibles are as for Glucosides and Tannic Acid (see pages 8 and 65). 

Uva Ursi is astringent, tonic and feebly diuretic. Used in large quantity 
it produces vomiting and purging and is alleged to have oxytocic power. Ar- 
butin is an efficient diuretic, and is decomposed in the body, yielding hydro- 
quinone, which is a powerful poison, and must be formed in the kidneys, as 
through appearing in the urine after arbutin is taken, it does not cause toxic 
effects under such circumstances, but powerfully disinfects the urine and 
the mucous membrane of the urinary passages. It imparts a greenish-brown 
color to the urine. 

Uva Ursi was formerly used in calculous affections and chronic disorders 
of the urinary passages. It has some reputation as an antilithic, and is useful 
in gravel, chronic nephritis, cystitis and urethritis. It relieves incontinence 
of urine, dysuria and strangury, and has proved serviceable even in uterine 
hemorrhages. The fluidextract is an excellent remedy for correcting the ardor 
urinae of acute gonorrhea. Arbutin has been successfully employed in cardiac 
dropsy as a diuretic, also in urethritis. 

VALERIANA, Valerian, — is the dried rhizome and roots of Valeriana 
officinalis, a large, herbaceous plant of the nat. ord. Valerianaceae, having small, 
white, or rose-colored flowers, a native of Europe, but cultivated in Vermont 
and New York. It contains a Volatile Oil, from which are (developed by oxida- 
tion Valerene, C 10 H 16 , a terpene; Valerol or Baldrian Camphor, C 12 H 20 O; and 
Valeric Acid, C 5 H 10 O 2 , which occurs also in many other plants and in cod-liver 
oil. The valeric acid of pharmacy is obtained as a product of the oxidation 
of amylic alcohol, and from it are formed the various valerates. It is not thera- 
peutically identical with the natural acid. Dose of the powdered root, gr. 
x-xlv [av. gr. xxx.] 

Preparations of Valerian. 

Tinctura Valerianae, Tincture of Valerian, — strength 20 per cent. Dose, 3ss-ij [av. 5j] 
Tinctura Valerianae Ammoniata, Ammoniated Tincture of Valerian, — has of Valerian 
ao, Aromatic Spirit of Ammonia to 100. Dose, njy-xlv [av. ttrxxx.] 

3i 



482 VALERIANA. 

Oleum Valerianae, Oil of Valerian (Unofficial), — the volatile oil, a greenish or yellowish 
thin liquid, having the odor of Valerian, an aromatic taste and a slightly acid reaction, readily 
soluble in alcohol. Dose, Ti#j-v. 

Valyl is the trade name of Valeryl-diethyl-amide, which possesses all the pharmacological 
properties of valerian. Dose, gr. ij-vi or more in capsules 2 or 3 times daily, after meals, or in 
milk or soup, but not on an empty stomach. 

Validol, Menihyl Valerate, — a menthyl ester of Valeric acid with 30 per cent, of free 
menthol. Dose, ttjjx-xv on sugar or in a little sweet wine. 

Validol Camphoratum, — a 10 per cent, solution of camphor in Validol, combining the 
actions of Validol and Camphor. Dose tt^x-xv on sugar or in sweetened wine. 

Brovalol, — is the trade name of the bromo-isovaleric acid ester of borneol, and contain- 
ing 25.2 per cent, bromine. It combines the action of valerian with the sedative of the 
bromine. 

Preparations of Valerianic Acid. 

Valerates of Ammonium and Zinc are official and are described under the titles of their 
respective bases. They are made with the artificial valeric acid and do not represent the 
action of the plant but rather that of the bases from which they are prepared. 

Incompatibles. 
Incompatible with Valerian preparations are: Cinchona infusion, Iron and Silver salts. 

Physiological Action and Therapeutics. 

Valerian is antispasmodic and a gentle stimulant to the nervous and circu- 
latory systems. It is sedative to reflex excitability. Its taste and odor are 
very disagreeable but cats are extravagantly fond of it. In these animals it 
excites the sexual appetite, probably from a resemblance between its odor 
and theirs when under venereal excitement; and after a time it produces in 
them violent spasms and convulsions. In full doses it increases the action 
of the heart and raises the temperature, in most persons producing exhilara- 
tion, in some a slight mental disturbance, with formication of the hands and 
feet. Long used it induces a condition of melancholia. Large doses cause 
hiccough, diarrhea, nausea and vomiting, frequent micturition with tenesmus, 
mental disturbance even to delirium, reduced motility and sensibility and 
lessened reflex excitability. The Oil in large doses is paralyzant to the brain 
and the spinal cord, lowers the blood-pressure and slows the pulse. 

The Valerates follow their bases in general action but are supposed to possess 
some of the sedative qualities of their acid constituent. 

Valerian was formerly employed in epilepsy but was probably useful only 
in the hysterical form of that disease. It is a valuable remedy in all forms of 
hysteria and various forms of "nervousness," especially in young and deli- 
cate women. Its value in these conditions is believed to be dependent upon 
a psychic stimulation from its disagreeable odor. It is useful in the flatulence 
of infants and in that of hypochondriacal and hysterical subjects. The 
natural valerian preparations have lost much of their reputation as nerve 
tonics, because of their unreliability, due to the varying quantity of the 
active principle, which is changeable and prone to decomposition in drying 
and storing. Ammonium Valerate is used in the same class of disorders as 



VANILLA — VERATRUM VIRIDE. 4^3 

is valerian. It is often a good remedy for nervous headache, administered 
in io-grain doses in an elixir. Zinc Valerate has been supposed to combine 
the antispasmodic power of valerian with the nerve-tonic effect of a zinc 
salt. It has been used in cholera, epilepsy and neuralgia, frequently with 
considerable success. 

The valeric esters, Valyl, Validol, Validol Camphoratum, Brovalol, etc., 
are used for the same purposes as Valerian and in the light of our recent 
knowledge depend for their actual value largely on suggestion (N. N. R.). 

VANILLA (Unofficial), — is the fruit of Vanilla planifolia, a perennial climbing plant of 
the nat. ord. Orchidaceae, native of the West Indies and tropical America, but cultivated in 
Java, etc. Its characteristic odorous principle is Vanillin, the methyl-ether of protocate- 
chuic aldehyde, which oxidizes slowly in damp air to Vanillic Acid, and may be resolved 
into methyl chloride and protocatechuic acid. Vanillin may be made synthetically from 
Coniferin or from Eugenol. Dose, indefinite [av. gr. xv.] 

Tinctura Vanillae, Tincture of Vanilla (Unofficial), — 10 per cent. Dose, a few drops, 
according to the strength of flavor desired. 

Vanillinum, Vanillin, C 8 H 8 3 , — may be made artificially; occurs in fine, white needles, 
soluble in about ioo of water, easily soluble in alcohol. Dose, gr. |-j [av. gr. ss]. 

Vanilla is an aromatic stimulant, with considerable influence on the nervous system. It 
is chiefly employed as a perfume and for flavoring purposes but has been used with benefit in 
hysteria and low fevers. 

VERATRUM VIRIDE, Veratrum viride,— is the dried rhizome and roots 
of Veratrum viride, American Hellebore, a plant of the nat. ord. Liliaceae. It 
contains the alkaloids Jervine, Pseudo-jervine, Rubijervine and Veratrine {Ceva- 
dine). Veratrum album found in Europe and Asia contains also Protover ci- 
trine, Protoveratridine and other alkaloids. Dose, gr. j-iij [av. gr. ij.] 

Asagrcea officinalis, V eratrum Sabadilla, Cevadilla, — the source of the official 
Veratrine, a mixture of alkaloids, is a bulbous plant of the nat. ord. Liliaceae, 
indigenous to Mexico and Central America. It contains Veratrine (Cevadine) 
its active principle, and Cevadilline, Sabadine, Sabadinine and Veratridine. 

The nomenclature of the Veratrum alkaloids is confusing, having undergone many 
changes. That of Cushny (1906) is followed in this volume. H. C. Wood (1870) studied the 
action of Jervine and Rubijervine (Veratroidine) . Wright and Luff (1879) claimed that the 
two varieties of the plant aie practically identical in composition, except that Veratrine (Ceva- 
dine) is present in V. viride, but not in V. album. Salzberger (1890) found Protoveratrine, 
which was studied by Eden (1892). Cushny (1906) ascribes the activity of V. viride to 
Veratrine, and recognizes the other constituents named in the preceding paragraph. H. C. 
Wood (1908) recognizes Protoveratrine (the most important), Jervine, Rubijervine, and Pseudo- 
jervine, as the active principles. The substance officially termed Veratrine is not the alkaloid 
so named, but a mixture of alkaloids. 

Preparations. 

Fluidextractum Veratri Viridis, Fluidextract of Veratrum viride, — Dose, Trgj-iv [av. 
TTjrjss.] The fluid extract is preferred to the tincture, and should be given hypodermically, 
nj?xx-xxx in puerperal convulsions — (Reamy). 

Tinctura Veratri Viridis, Tincture of Veratrum viride, — 10 per cent. Dose, tt^x-xxx 
[av. njjviij.] 

Norwood's Tincture of Veratrum Viride (Unofficial), — had formerly a very high reputa- 
tion for efficiency. Dose, TTjnss or gtt. iij every 3 hours, except in puerperal convulsions, in 
which ttjjv (gtt. x) should be given hypodermically. Each dose should be accompanied 
by Tijmj of Laudanum or gr. -^ of Morphine to prevent nausea, vomiting, diarrhea and 
sweating. 



4 8 4 VERATRUM V1R1DE. 

Veratrina, Veratrine, — is a mixture of alkaloids obtained from the seeds of Asargrcea 
officinalis (see p. 485). A white, or grayish-white, amorphous powder, highly irritant to the 
nostrils, of very acrid taste, producing tingling and numbness of the tongue and constriction 
of the fauces; slightly soluble in cold water, soluble in 2.8 of alcohol, in 4.2 of ether, in 0.7 



of chloroform, in 96 of glycerin and in 56 of olive oil. Dose, gr. -gm^ 

Unguentum Veratrinae, Veratrine Ointment (Unofficial), — Veratrine 4, Expressed Oil of 
Almond 6, Benzoinated Lard 90. For local use. 

Oleatum Veratrinae, Oleate of Veratrine (Unofficial), — Veratrine 2, Oleic Acid 50, Olive 
Oil to 100. For local use. 

Incompatibles are as for alkaloids (see page 6). 

Physiological Action. 

Heretofore Veratrum Viride has been classed with Aconite as a powerful 
cardiac depressant and vasodilator, but recent experiments by H. C. Wood, 
Jr., indicate that its power of slowing the pulse and thereby lowering the blood 
pressure is wholly due to its action in stimulating the central cardio-inhibitory 
mechanism, and that the drug is really a cardiac stimulant, and does not dilate 
the vessels, as was formerly held. It differs from aconite in affecting respiration 
to a much less degree, in being a systemic emeto-cathartic, in paralyzing the 
motor system centrally, impairing the reflexes but leaving sensation unimpaired, 
and in having little or no diaphoretic or diuretic action in ordinary doses. It 
causes great muscular depression but is seldom fatal; when death results 
it occurs by paralysis of respiration. In small doses it reduces the force of the 
pulse, but does not at first affect its rate. If continued for some time, the pulse 
becomes slow, soft and compressible; rising on the least exertion to be rapid and 
feeble. There is great muscular weakness, and frequently nausea and vomit- 
ing. Large doses increase these symptoms, the pulse becoming very rapid and 
so small as to be almost imperceptible; the skin is cold and clammy, and con- 
stant vomiting, extreme debility, giddiness, impaired vision, and partial un- 
consciousness ensue; and if the quantity has been large enough the respiration 
and heart are paralyzed. 

The general action of Veratrum Album is similar to that of its congener, 
but it is much more irritant to the gastro-intestinal mucous membrane, causing 
violent vomiting and purging, intense abdominal and esophageal pain, greatly 
reduced temperature and pulse, collapse and death from cardaic and respiratory 
paralysis. 

The action of the alkaloid Veratrine on the central nervous system and sen- 
sory nerve terminations resembles that of Aconitine very closely. Locally 
applied it causes the same prickling, warm sensation, followed after a time by 
a feeling of numbness and cold in the part. In contact with the mucous mem- 
brane of the nose and throat it gives rise to violent sneezing and coughing. In- 
ternally administered the characteristic prickling burning sensation is soon felt 
in the mouth and throat, followed by a sense of heat in the stomach, salivation, 
nausea and vomiting. The prickling sensation spreads to the skin all over the 
body, and profuse perspiration often occurs. The pulse becomes slow and 



VERATRUM VIRIDE. 4^5 

irregular, the respiration slow and labored. In veratrine poisoning the bowels 
are more affected than with aconitine, severe colic and violent catharsis being 
usually experienced. Fibrillary contractions of the muscles and convulsions 
are commonly observed, and collapse occurs, followed by coma, and finally by 
failure of the respiration. 

Veratrine stimulates the central nervous system and the sensory nerve ter- 
minations, but by large doses this stimulation gives way to paralysis. Applied 
directly in solution to the peripheral nerves it abolishes their irritability. At 
first it slows the heart by stimulating the cardiac inhibitory centre, and contracts 
the bloodvessels by stimulation of the vaso-motor centre, but later both blood 
pressure and body temperature are lowered, and finally the respiratory centres 
are paralyzed. It stimulates the cerebral motor centres, causing convulsions, 
but does not affect consciousness or the pupils. 

Protoveratrine is much more poisonous than veratrine, but acts on the same 
general lines as aconitine. It does not paralyze the motor nerve terminations 
even when applied to them in quantity. It shortens the contraction period of 
muscular tissue instead of prolonging it as veratrine does, and it increases the 
muscular force temporarily but induces its early exhaustion. H. C. Wood, Jr. 
considers it likely that the action of V. viride is due to Protoveratrine, perhaps 
modified by the Jervine and other alkaloids present. Jervine, Sabadine and 
Sabadinine are similar in action to veratrine, but are much less toxic. Ceva- 
dilline has not been examined; the others are said to be inert. 

The official Veratrine is an acrid and intensely irritant powder, consisting 
of a mixture of alkaloids. It causes violent sneezing, a burning sensation, and 
free salivation. It affects the heart and circulation similarly to the other Vera- 
triae, and in addition seems to be a direct poison to muscular tissue and to cause 
violent convulsions before the muscular paralysis sets in. 

Therapeutics. 

Veratrum is inferior to Aconite in most of the fevers and inflammations, by 
reason of its lacking power over excretion. It renders good service in the early 
stages of many parenchymatous and serous inflammations when occurring in 
sthenic subjects. In the past it was much used in pneumonia with the object 
of dilating the vessels and thereby relieving congestion, but as it does not so 
act this use of the drug is now deemed irrational. It is highly esteemed in 
puerperal fever and in simple hypertrophy, irritable heart and other cardiac 
disorders. It has been used with remarkably good results in acute mania and 
puerperal convulsions, and is of service in aneurism to depress the circulation 
to the lowest point, but in this case the recumbent position must be strictly 
observed in order to secure safety. It should always be administered in 
small doses and its effects carefully watched. In puerperal eclampsia large 
doses have been administered without danger and with decided benefit. 



I 



486 VERBASCUM VIOLA TRICOLOR. 

Veratrine is chiefly used externally. The ointment or oleate is applied with 
benefit in many cases of superficial neuralgia, myalgia and headaches, a small 
quantity being rubbed in over the seat of the pain. It may be absorbed through 
an abrasion of the cuticle and give rise to dangerous symptoms. Internally it 
has been employed as a cardiac sedative in fevers and inflammation, also in 
acute articular rheumatism, dropsies, dysmenorrhea and various nervous affec- 
tions, but its uncertainty of action, and the dangerous depression which it may 
produce, have caused it to lose favor as an internal remedy. 

VERBASCUM, Mullein (Unofficial),— the leaves of Verbascum Thaspus, the Mullein- 
weed, a plant of the nat. ord. Scrophulariaceae, having large woolly leaves and yellow flowers 
in dense spikes. Its chief constituent is mucilage, but the flowers contain an oil in very small 
quantity. An infusion of §iv of fresh leaves to the pint of milk is the form in which it has 
generally been given; a pint to be taken thrice daily. 

Mullein is emollient and demulcent, perhaps also slightly anodyne. It has long been a 
popular Irish remedy in pulmonary affections. Under its use the expectoration is rendered 
more easy, cough is palliated and the general condition improved. It is recommended in 
cystitis, irritable bladder, and diarrhea, and is employed as an enema in dysentery and as a 
poultice for hemorrhoids. The dried leaves may be smoked with benefit in aphonia from 
aryngeal irritation. 

VIBURNUM OPULUS (Cramp Bark) (Unofficial),— is the dried bark of Viburnum 
Opulus, a shrub of the nat. ord. Caprifoliaceae. Dose, gr. x-xlv [av. gr. xxx-1 

Fluidextractum Viburni Opuli, Fluidextract of Viburnum Opulus (Unofficial). Dose, 

TTJ7X-Xlv [av. 1TJ7XXX.] 

Viburnum Opulus was formerly valued by many practitioners as a remedy for uterine 
and abdominal pains. It has fallen largely into disuse, having been replaced by more 
active and certain measures. The so-called Viburnum Compound of Dr. Hayden is stated 
by its manufacturers to consist of "the active principles of the Viburnum Opulus, Dioscorea 
Villosa, Scutellaria Lateriflora, and a combination of aromatics, prepared by a process 
peculiar to ourselves." This they call publishing the formula of the preparation. 

VIBURNUM PRUNIFOLIUM (Black Haw),— is the dried bark of the root of Vibur- 
num Prunifolium, or of Viburnum Lentago, indigenous shrubs of the nat. ord. Caprifoliaceae. 
It contains tannic, oxalic, citric and malic acids, sulphates and chlorides; also two resins, one 
named Viburnin, and Viburnic Acid which is identical with Valeric Acid. Dose, gr. x-xlv 
[av. gr. xxx.} 

Extractum Viburni Prunifolii, Extract of Viburnum Prunifolium, — Dose, gr. ij-x [av. 
gr. viij.] 

Fluidextractum Viburni Prunifolii, Fluidextract of Viburnum Prunifolium. — Dose, 

TTJiX-xlv [av. TTgXXX.] 

Viburnum Prunifolium is considered to possess nervine, antispasmodic, astringent, diu- 
retic and tonic properties, and to be especially useful in preventing abortion, in the nervous 
diseases of pregnancy, and in spasmodic dysmenorrhea. It may be administered with can- 
nabis, morphine, nerve-sedatives or simple aromatics. No exact observations have been 
made regarding its action, and its therapeutical claims are denied by many who have used 
it. It often excites nausea and vomiting. 

VIOLA TRICOLOR, Pansy (Unofficial),— is the wild-grown, flowering herb of Viola 
tricolor, the Heart's-ease Pansy, a plant of the nat. ord. Violaceae, native in Europe, but nat- 
uralized in the southern United States. It contains an active alkaloid, Violine, allied in 
many respects to Emetine, and poisonous. Dose, gr. x-3j, in decoction. 

Viola is mucilaginous, emollient, expectorant and slightly laxative. Its active principle 
is emeto-cathartic, but exists in very small quantity. A decoction of the fresh herb in milk, 
with a poultice of the same, was formerly recommended highly in crusta lactea and impetigo. 
It is used with benefit in some forms of eczema, especially in that of the head and face, and 
has had some reputation in bronchitis. 



VISCUM ZEA. 487 

VISCUM, Mistletoe (Unofficial), — occurs in two species, Viscum album, the European 
Mistletoe, a small, parasitic, evergreen shrub, of the nat. ord. Loranthaceae, growing chiefly 
on deciduous-leaved trees, and Viscum flavescens, the American species, growing on oats, 
elms, etc. They contain mucilage, starch, fixed oil, resin, salts, and Viscin, or Bird-lime, 
which occurs also in Ilex aquifolium, Gentiana lutea and other plants. Dose, gr. x-3j in 
decoction, or n^v-xxx of a ten per cent, tincture. 

The berries of the mistletoes have produced emeto-catharsis, with great thirst, tenesmus, 
bloody stools, convulsions and even death in young children. The leaves and twigs have been 
used in epilepsy, hysteria, chorea, asthma and other nervous affections. The American 
plant is asserted to possess qualities similar to those of Digitalis and to incite uterine contrac- 
tions. It has been used in cardiac affections, dropsies, uterine hemorrhages and amenorrhea, 
also as an abortifacient. 

XANTHOXYLUM, Xanthoxylum (Prickly Ash),— is the dried bark of 
Xanthoxylum americanum the northern species, or of Fagara Clava-Herculis 
the southern species, of an indigenous shrub of the nat. ord. Rutaceae. It con- 
tains an acrid, green oil, tannic acid in small quantity, two resins, and the alka- 
loid Xanthoxyline, which is probably identical with Berberine. Dose of the 
powdered bark, gr. x-xlv [av. gr. xxx]. 

Fluidextractum Xanthoxyli, Fluidextract of Xanthoxylum. — Dose, ttjjx-xIv [av. ttj?xxx. 
Decoctum Xanthoxyli, Decoction of Xanthoxylum (Unofficial), — 5j to the quart. Dose 
a pint during 24 hours in divided doses. 

Physiological Action and Therapeutics. 

Xanthoxylum is a stimulant and aromatic bitter, a local and systemic sialo- 
gogue, also diaphoretic, diuretic and emmenagogue. Its taste is aromatic, soon 
becoming acrid and bitter, causing profuse salivation, tingling in the tongue 
and increased secretion from the stomach, intestines, liver and pancreas. It 
increases the cardiac action and raises the arterial tension, and is classed among 
the vegetable alteratives with mezereum, guaiac and stillingia. 

Xanthoxylum is highly valued in chronic rheumatism, myalgia, lumbago 
and similar disorders, also in jaundice from catarrh of the bile-ducts, in dropsies 
and chronic pharyngitis. In old cases of pharyngitis, the mucous membrane 
being glazed and dry, the decoction may be used as a gargle and Tflx-xxx of 
the fluidextract taken internally thrice daily. The bark, used as a mastica- 
tory, is a popular remedy for toothache and has been beneficial in paralysis 
of the tongue. 

YOHIMBINE (Unofficial), — is an alkaloid obtained from the bark of Corynanthe Yohimbi, 
thejCameroon tree, indigenous to East Africa. It is aphrodisiac and a powerful local 
anesthetic. It is efficient in pure forms of sexual impotence, but not in those due to constitu- 
tional or organic disease, and has slight influence in persons of advanced years. It is contraindi- 
cated in all acute and chronic inflammations and hyperemia of the abdominal and pelvic viscera. 
As an anesthetic it acts efficiently when applied directly to a nerve or to the mucous membrane, 
but produces local hyperemia instead of the anemia caused by cocaine. It is readily decom- 
posed by light, hence its solutions should be kept in amber-colored bottles and in a dark place. 
Dose, gr. ^-\, or irgy-viij of a 2 per cent, solution, gradually increased to Trjjxvj. 

ZEA, Zea (Corn Silk), — is the fresh styles and stigmas of Zea Mays, the 
Maize or Indian Corn, nat. ord. Gramineae. It contains Maizenic Acid, a fixed 



1 



488 ZINCUM. 

oil, resins and salts. Dose of a fluidextract, 3HJ; of an infusion (i to 8), 
oiv-viij, almost ad libitum. There are no official preparations. 

Zea is a mild diuretic when given in full doses at short intervals. It is 
by some observers considered demulcent and anodyne, and is generally be- 
lieved to have a specific or alterative influence over many disorders of the 
genito-urinary passages and the urinary bladder. It has been used with success 
for incontinence of urine, uric and phosphatic gravel, gout, rheumatism, ure- 
thritis, pyelitis, acute and chronic cystitis, cardiac dropsy and obstructive val- 
vular disease of the heart. 

ZINCUM, Zinc, Zn, — is metallic Zinc, in the form of thin sheets or irregular, 
granulated pieces, a bluish-white metal, having a sp. gr. ranging from 6.9, 
when it is cast, to 7.2, when it is rolled. It occurs native as Blende a sulphide, 
Calamine a carbonate, Zincite a red oxide, Franklinite a mixture of the oxide 
with that of iron and manganese; also as a silicate. The metal is soluble in 
the weakest acids and therefore should never be used for culinary vessels. 
Its salts are all more or less actively poisonous. Metallic Zinc is official but 
is not employed as a medicine. 

Zinc Salts and their Preparations. 

Zinci Acetas, Zinc Acetate, Zn(C 2 H 3 2 ) 2 + 2H 2 0, — soft, white, micaceous or pearly, 
six-sided tablets or scales, somewhat efflorescent in dry air, of faintly acetous odor, sharp 
metallic taste and a slightly acid reaction; soluble in 2.3 of water and in 30 of alcohol at 
25 C. in 1.6 of boiling water and in 1 of boiling alcohol. Used locally as an astringent in 
solution of gr. j or ij to the 5, or internally in doses of gr. ^-iij [av. gr. ij]. 

Zinci Carbonas Prsecipitatus, Precipitated Zinc Carbonate, — a white, impalpable 
powder, permanent in the air, odorless and tasteless, insoluble in water or alcohol, but soluble 
in acids with copious effervescence. Used locally as a protective. 

Zinci Chloridum, Zinc Chloride, ZnCl 2 , — a white, granular powder, or porcelain-like 
masses, odorless, of intensely caustic properties; very soluble in water and in alcohol; very 
deliquescent. Is tonic and escharotic. For internal use a solution in Spirit of Ether is the 
most convenient form, strength 3j to the §, of which four to eight minims may be given 
twice daily in water. Strength of injections and collyria, gr. j-ij to the §. 

Liquor Zinci Chloridi, Solution of Zinc Chloride, — is an aqueous solution, containing 
about 50 per cent. (48.5 to 52 per cent.) of the salt. A clear, colorless, odorless liquid, of a 
very astringent, sweetish taste and an acid reaction. A powerful disinfectant for sinks, 
drains, etc. Used also as an injection in gonorrhea, leucorrhea, etc., in dilute solution, \ 
to 1 per cent. Burnett's Disinfecting Fluid is similar to the above but slightly stronger. 

Zinci Iodidum, Zinc Iodide, Znl 2 (Unofficial) , — a white, granular powder, very deliques- 
cent, of sharp, saline and metallic taste and acid reaction; very soluble in water and in 
alcohol. Dose, gr. ss-ij [av. gr. j], in syrup. 

Zinci Oxidum, Zinc Oxide, ZnO, — an amorphous, white powder, odorless and tasteless; 
insoluble in water or alcohol; soluble without effervescence in dilute acids also in ammonia 
water. Dose, gr. j-x in pill. 

Unguentum Zinci Oxidi, Ointment of Zinc Oxide, — has of Zinc Oxide 20, Benzoinated 
Lard 80. 

Zinci Phenolsulphonas, Zinc Phenolsulphonate, {Zinc Sulpho-carbolate), — colorless, 
transparent, rhombic prisms, very soluble in water and in alcohol. Dose, gr. j-v [av. gr. ij]. 

Zinc Stearas, Zinc Stearate, — a very fine, white, unctuous powder, insoluble in water? 
alcohol or ether. Used locally as a dressing powder and a vehicle for dry antiseptics. 

Unguentum Zinci Stearatis, Ointment of Zinc Stearate (Unofficial), — strength 50 per cent, 
made with White Petrolatum. 



ZINCUM. 489 

Zinci Sulphas, Zinc Sulphate, ZnS0 4 + 7H 2 0, — colorless, rhombic crystals, of astringent 
metallic taste, and acid reaction; soluble in 0.6 of water, insoluble in alcohol. Dose, as 
emetic, gr. x-xx [a v. gr. xv]; as a tonic and astringent, gr. t*o~iJ m pill. 

Zinci Valeras, Zinc Valerate, {Zinc Valerianate), — white, pearly scales, having the odor 
of valeric acid, and a sweetish, metallic taste; soluble in about 70 of water and in about 22 of 
alcohol. Dose, gr. |-gr. iv [av. gr. ij], in pill. 

Zinci Permanganas, Zinc Permanganate, Zn(Mn0 4 )2+6H 2 (Unofficial), — resembles 
the potassium salt in its oxidizing properties. It is astringent and antiseptic. Used in 
solutions of 1 to 5000 to 1 to 3000. 

Zinol (Unofficial), — is the trade name of a preparation composed of Zinc Acetate 1, Al- 
bumin Naphtho-sulphonate 4 parts, which is used in aqueous solution, gr. j-iij to the § , as an 
injection for gonorrhea; also in 1 J to 3 per 1000 solutions for vaginal catarrh of gonorrheal 
origin, and as a dressing for bed-sores and suppurating wounds. It is astringent and bacteri- 
cidal. 

Incompatibles. 

Incompatible with Zinc Salts are: Acacia, Alkalies, Arsenates, Carbonates, Cyanides, 
Lead Acetate with Zinc Sulphate in solution, Lime-water, Milk, Oxalates, Phosphates, Sul- 
phates, Sulphides, Vegetable astringent decoctions and infusions. 

Physiological Action. 

Zinc Salts are astringents, but milder ones than the salts of lead. Its soluble 
compounds (the chloride, iodide, sulphate and acetate) are corrosive poisons, 
causing violent gastro-enteritis and in some cases profound nervous depression. 
The Chloride is a powerful and painful escharotic or rather mummifier of the 
tissues, having great affinity for water, coagulating albumin and shrivelling the 
vessels. It is not a very active disinfectant. The Sulphate is an escharotic 
and a specific emetic, acting promptly by direct irritation of the stomach, without 
much depression or after-nausea. In small doses it is tonic and astringent, 
in larger ones it would be a severe irritant but for its causing prompt emesis. 
The Acetate resembles the sulphate in action. The Oxide used externally is 
a mild, soothing astringent; used internally it enters the blood as a lactate or 
chloride, acting as a mild astringent and a nervous sedative. Being almost 
insoluble in the stomach, it has but feeble diffusive power and consequently 
but slight activity. The Carbonate resembles the oxide in action. The Iodide 
locally is a powerful escharotic and has been supposed to possess some alterative 
power when given internally, in addition to its astringent qualities as a zinc 
salt. The Stearate is feebly antiseptic but strongly astringent. The Valerate 
acts as a nervous sedative, but its properties are in all probability due to its 
zinc base and not to the acid combined with it. 

The continued use of Zinc salts produces symptoms similar to those of 
chronic lead-poisoning, but of much less gravity. These salts manifest less 
tendency to accumulate in the system than other metallic salts and are excreted 
much more rapidly. Elimination takes place chiefly by the liver and intestinal 
glands. 

! Therapeutics. 

Zinc salts are chiefly employed in weak solution as mild astringent applica- 
tions in catarrhs of mucous membranes, as conjunctivitis and urethritis, also 



49° ZINCUM. 

as unguents and lotions in skin diseases, particularly eczema, impetigo, herpes 
and erythema. The Chloride is made into a paste with flour and glycerin for 
the destruction of lupus, epithelioma and other morbid growths. It is a 
commonly used disinfectant and deodorant, and in weak solution (rr^iij-v of 
the liquor to §j of water) makes a good lotion for putrid ulcers. A solution of 
gr. j-iij to the o is an excellent injection for gonorrhea, and one of gr. ij to the 
o is one of the best applications for purulent ophthalmia in the infant or adult. 
The Iodide is not employed as an escharotic, nor has it ever been a favorite 
remedy for internal use. It is chiefly employed in solution as an application 
to enlarged tonsils, and as an ointment (i part to 8 of lard) for the reduction 
of glandular enlargements. The Sulphate is used locally as an astringent to 
mucous surfaces generally, internally as an emetic in narcotic poisoning and 
croup, and in small doses as a tonic and antispasmodic in convulsive diseases, 
as chorea, hysteria, epilepsy, angina pectoris and asthma. In diarrheas and 
dysentery it is a good astringent and is frequently combined with opium and 
ipecac. In weak solution, gr. j-ij to the 5 , it is the standard astringent injection 
for gonorrhea after the subsidence of the acute stage. The Acetate is used for 
the same purposes as the sulphate, but is usually preferred for collyria. The 
Oxide may be employed as a dusting powder in intertrigo, also as an ointment 
in eczema and excoriated surfaces generally. In combination with bismuth 
and pepsin it is an excellent remedy for the summer diarrhea of children, and 
with aromatic powder and morphine it is very efficient in gastralgia. It is a 
good remedy in 3 -grain doses for the night-sweats of phthisis, and has been 
successfully employed in epilepsy and neuralgia, in whooping-cough, hysteria 
and nervous headache, and in bronchorrhea to check the profuse secretion. It 
is much employed as an ingredient of cosmetics. The Carbonate is by some 
preferred to the oxide for local use in skin diseases. Calamine Ointment, which 
is a mixture of the impure carbonate (calamine) with the oxide and an unguent 
basis, was until recently a favorite application as a soothing protective to abra- 
sions and inflammations of the integument. The Phenolsuphonate is used as 
an astringent and antiseptic for indolent or foul ulcers, and in solutions some- 
what stronger than those of the sulphate locally for subacute inflammations 
of mucous membranes. Internally it has been used with great satisfaction as 
a remedy for cholera infantum. The Valerate is employed in chorea, epilepsy, 
neuralgia, and various anomalous nervous affections, such as the nervous head- 
ache of hysterical women, nervous coughs and aphonia due to uterine and 
ovarian irritation. The Stearate is an excellent dusting and insufflating powder, 
much used in rhinological practice and in the treatment of gonorrhea. It may 
be mixed with boric acid, europhen, menthol, chrysarobin, salicylic acid, and 
other antiseptics, for use in intertrigo, burns, eczema, coryza, hay fever and 
many other local affections. 



ZINGIBER. 491 

ZINGIBER, Ginger, — is the dried rhizome of Zingiber officinale, a plant 
of the nat. ord. Zingiberaceae, having dingy-yellow flowers on a leafless flower- 
stalk and long, lanceolate leaves on a separate stem. The plant is a native 
of India, but is cultivated in Jamaica, Sierra Leone, and other tropical coun- 
tries. The rhizome occurs in irregularly branched pieces, laterally compressed, 
of agreeably aromatic odor, and pungent aromatic taste. Green Ginger is the 
fresh rhizome, Black Ginger is the dried rhizome with its epidermis on; White 
or Jamaica Ginger is the dried rhizome deprived of its epidermis. It is most 
active when fresh, becoming inert by the action of age and exposure. Its 
active principles are a soft, acrid and aromatic Resin, and a yellow, pungent 
Volatile Oil. Dose, gr. x-xxx [av. gr. xv.] 

Preparations. 

Fluidextractum Zingiberis, Fluidextract of Ginger, — alcoholic. Dose, ttjjx-xxx [av. 
itjjxv.] Essence of Ginger is an unofficial alcoholic preparation of various strengths, gener- 
ally about 1 in 2, sometimes 1 in 1 as the fluidextract. 

Tinctura Zingiberis, Tincture of Ginger, — 20 per cent. Dose, tt#x-3j [av. ttjjxxx.] 

Syrupus Zingiberis, Syrup of Ginger, — has of the Fluidextract 3 per cent, in sugar and 
water. Dose, 3j-§j[av. 3iv.] 

Oleoresina Zingiberis, Oleoresin of Ginger, — is extracted by ether and contains all 
the virtues of the root. Dose, gr. ss-j [av. gr. ss.] 

Trochisci Zingiberis, Troches of Ginger (Unofficial), — each troche contains about 2 
minims of the Tincture, also Tragacanth, Sugar, and Syrup of Ginger. Dose, j-v troches. 

Ginger is a constituent of Pulvis Aromaticum and Pulvis Rhei Compositus. The tinc- 
ture is used in preparing Aromatic Sulphuric Acid. 

Physiological Action and Therapeutics. 

Ginger is sialogogue when chewed, sternutatory when inhaled, and exter- 
nally a rubefacient. Internally it is a grateful stimulant and carminative, 
produces a sensation of warmth at the epigastrium, promotes the expulsion of 
flatus, and reflexly stimulates the heart and the central nervous system. In 
large doses it is a gastro-intestinal irritant. It is used in domestic medicine as 
a stimulant carminative in colic, also in hot water for the cramps of suppressed 
menstruation due to exposure to cold. It may be employed with advantage in 
flatulence and atonic dyspepsia, in the latter being usually combined with other 
remedies. Though decidedly constipating by itself the Oleoresin is frequently 
used in purgative pills, to prevent griping; also as a stimulant ingredient of 
tonic pills. The troches are employed to increase the secretion of saliva, also 
in relaxed conditions of the throat; and the syrup is a favorite flavoring ingredi- 
ent for prescriptions. Preserved Ginger is a favorite condiment, and carbonated 
water flavored with ginger is a common beverage under the name "ginger ale." 

Ginger Beer is a favorite temperance beverage, but most of the preparations sold under 
its name are simply carbonated water flavored with ginger. The following recipe is fur- 
nished by Dr. William Hardman, of Blackpool, England, in whose family it has been used 
for over fifty years, and the excellence of which he guarantees. 



492 ZINGIBER. 

Take i£ oz. of the best ginger well bruised, i oz. of cream of tartar, and i£ lb. of cane 
loaf sugar. Put all the ingredients into an earthen vessel and pour on a gallon of boiling 
water; when nearly cold add a gill of yeast, cover over with a blanket and let it stand in a 
warm place until next morning. Then skim it and run it through a filtering bag, bottle it, 
cork well with good corks and tie down the corks with string. In three days it will be fit for 
use. The bottles must be clean and sweet. A little lemon juice is considered an improve- 
ment by some. (Lincet.) 



PART II. 

PHARMACY AND PRESCRIPTION WRITING 



Pharmacy (<f>dpfiaKov, a drug or medicament), — may be denned as the art 
of selecting and preserving medicines, and preparing them for administration. 
It may be divided into — 

Official or Galenical Pharmacy, — dealing with the processes and preparations 
of the Pharmacopoeia; and — 

Extemporaneous or Magistral Pharmacy, — which includes the operations 
of compounding and dispensing remedies as directed in the extemporaneous 
prescriptions of physicians. 

Pharmacopoeias and Dispensatories. 

A Pharmacopoeia is an official list of the drugs and their preparations 
recognized by the medical profession of a certain country. In other countries 
the Pharmacopoeia is published under government auspices; in the United States 
its publication is left to the medical and pharmaceutical professions and it is 
revised every ten years by a convention called for that purpose ; but it is one of 
the standards recognized by law for the purposes of the pure food and drug 
act. The official Pharmacopoeias in the English languages, with the dates of 
their latest revision or additions, are as follows, viz. — 

The Pharmacopoeia of the United States of America, 9th Decennial Revision, 
1 9 10; official from September 1, 19 16. 

The British Pharmacopoeia, 19 14. 

Besides the above there are — The Pharmacopcea Germanica; the Pharmacopee Francaise 
(Codex Medicamentarius) ; the Austrian, Pharmacopcea Austriaca; Russian, Ph. Rossica; 
the Swedish, Ph. Suecica, the Norwegian, Ph. Norvegica; the Danish, Ph. Danica; the Belgian, 
Ph. Belgica; the Swiss, Ph. Helvetica; the Spanish, Farmacopea Espafiola; the Portuguese, 
Ph. Portugueza; the Indian, Ph. of India; the Hungarian, Ph. Hungarica; the Netherlands', 
Ph. Neerlandica; the Roumanian, Ph. Romafia; the Finnish, Ph. Finnica; the Chilian, Farm- 
acopea Chilena; the Greek, Ph. Hellenica; the Japanese, Ph. Japonica; the Mexican, Neuva 
Farmacopea Mexicana; the Croatia-Slavonian, Ph. Croatico-Slavonica; and the Italian, 
Farmacopea Italiana. 

A Dispensatory is a commentary on one or more pharmacopoeias, giving 
the physical and medicinal history of drugs and preparations, with their doses, 
physiological action and therapeutics, and includes similar information about 
many drugs which are not official in any pharmacopoeia but are of occasional 

' . 493 



494 WEIGHTS AND MEASURES. 

use or general interest. A dispensatory is a private publication, of authority 
according to the reputation of its author. The principal treatises are Amer- 
ican publications, and are veritable drug-encyclopaedias, so elaborately do 
they deal with every subject embraced therein. Those of acknowledged 
value are — 

The Dispensatory of the United States of America, by Dr. Geo. B. Wood and Dr. 
Franklin Bache. 19th edition, revised and largely rewritten, by Professors H. C. Wood, J. P. 
Remington, and S. P. Sadder. Philadelphia, J. B. Lippincott & Co. 1907. 20th edition 
is in press. 

The National Standard Dispensatory, by Drs. Hare, Caspari and Rusby. Philadel- 
phia, Lea Bros. & Co. 191 6. 

The American Dispensatory, by Felter & Lloyd, Cincinnati, is the recognized authority 
of the "eclectic" practitioners. 19th edition, 1903. 

New and Nonofficial Remedies, 1916. This book contains a list of the medicinal 
substances which have been examined by the Council on Pharmacy and Chemistry of the 
American Medical Association prior to January 1, 1916, and appearing to comply with the 
rules of the Council were accepted for inclusion in this book. 

A Companion to the British Pharmacopoeia, by Peter Squire; 19th edition, London, 
1916; is the nearest English approach to the American dispensatories, and is the standard 
text-book on the general materia medica in Great Britain. Although a very good book it does 
n ot compare as a work of reference with either of the two great American Dispensatories first 
above named. 



WEIGHTS AND MEASURES. 

The working formulae of the U. S. Pharmacopoeia af 1880 were constructed 
on the system of parts by weight for all articles, whether solids or fluids, except 
in the case of nuidextracts, for which the metric weights and measures were 
employed. On this system it really made no difference what unit of weight 
was adopted in official pharmacy. The pharmacopoeia of 191 o in most cases 
employs definite weights for solids, and measures for liquids, in terms of the 
metric system. In certain cases, where weighing is decidedly more convenient 
or where the product is adjusted to a percentage by weight which would be 
rendered uncertain if the ingredients were taken by measure, liquids are ordered 
to be weighed. In some cases (Aqua Destillata, Aqua Aurantii Florum), the 
quantities are directed simply by volume. In most cases, therefore, solids are 
officially directed to be weighed by grammes, and liquids to be measured by 
milliliters* (mils). At the same time, however, the weights and measures 
generally used by physicians in prescribing and by pharmacists in dispensing 
medicines are, and will doubtless continue to be, in the United States those 
of the Apothecaries' or Troy System of weights, having 480 grains to the 
ounce and 5760 grains to the pound; and the Apothecaries' Measure. The 
drachm (60 grains), and the scruple (20 grains), are intermediate units of 
weight which are still used but are becoming obsolete. 

The units of the Apothecaries' Measure are the minim (Til), which in water 
* Synonymous to cubic centimeter which is no longer used in U. S. P. IX Rev., 191 6, 
or B. P., 1914. 



WEIGHTS AND MEASURES. 



495 



at its maximum density equals gr. 0.95; the fluidrachm (60 minims) and the 
fluidounce (8 fluidrachms or 480 minims). The signs used to denote these 
units are Tit minim, 9 scruple, 3 drachm, § ounce, and in the case of liquids 
an f to denote fluid is often placed before the sign, thus f 5 for fluidrachm, f § 
for fluidounce. The relations between these units of weight and measure in 
water at 4 C. or 39.2 F. are as follows: — 



Measure. Weight. 


Weight. Measure. 


Tijjj, One minim = 0.95 grains, 
f 5j, One fluidrachm = 57.0 " 
f §j, One fluidounce = 456.4 " 


grain j = 1.05 minims. 

5j = 63.3 " 
§j = 504.8 



The Apothecaries' grain is identical in value with the Troy grain, the American commercial 
grain and the grain of the British Imperial system. The U. S. liquid gallon is the volme of 
58418.144 grains of water at the temperature of its maximum density, weighed in vacuo; and 
the fluidounce of water weighs 456.392 grains, under similar conditions. 

Table of Troy or Apothecaries' Weight. 



Pound. 


Ounce. 


Drachm. 




Scruple. 




Grain. 


Libra. 


Uncia. 


Drachma. 




Scrupulum. 




Granum. 


lb 


5 


3 




s 




gr. 


1 


= 12 


96 


= 


288 


= 


5760 




1 


8 


= 


24 


= 


480 






1 


= 


3 

1 


= 


60 
20 




Table of Apothecaries' 


Fluid Measure. 






Gallon. 


Pint. 


Fluidounce. 




Fluidrachm. 




Minim. 


Congius. 


Octarius. 


Fluiduncia. 




Fluidrachma. 




Minimum. 


c. 


O. 


f5 




f3 




m 


I - 


8 


■ - : 128 


= 


1024 


= 


61440 




1 


16 


= 


128 


= 


7680 






1- 




8 

1 


= 


480 
60 



The British Pharmacopoeia recognizes only the Imperial Standard or 
Avoirdupois Weight, having 43 7 \ grains to the ounce, 16 ounces to the pound 
(instead of 12), and 7000 grains to the pound; and the Imperial Measure, 
having 20 ounces to the pint (instead of 16, as with us). 

Table of British Pharmacopoeial Weight. 

Troy grain, Avoirdupois ounce and pound. 

Grain. 
Granum. 

gr- 

= 7000 

437 £ 

The Troy ounce contains 42J grains more than the avoirdupois ounce, but the Troy pound 
contains 1240 grains less than the avoirdupois pound. The grain is the only unit common to 
both. 

Table of British Pharmacopoeial Measure. 

Gallon. 
Congius. 

c. 

I 



Pound. 




Ounce. 


Libra. 




Uncia. 


lb 




oz. 


1 


= 


16 

I 



Pint. 


Fluidounce. 




Fluidrachm. 




Minim. 


Octarius. 


Fluiduncia. 




Fluidrachma. 




Minimum. 


O. 


floz. 


= 


fldr. 


= 


min. 


8 


= 160 


= 


1280 


= 


76800 


1 


= 20 


= 


160 


= 


9600 




T 


= 


8 


= 


480 








1 


= 


60 



496 WEIGHTS AND MEASURES. 

The Metric, or Decimal System of Weights and Measures, is now offi- 
cial in the United States, having been adopted throughout the last three revisions 
of the U. S. Pharmacopoeia. It is in general use on the continent of Europe 
and is employed by French and German physicians in this country. Its three 
standard units are as follows, — 

A Meter, the standard unit of linear measure and also of the whole system, is the ten- 
millionth part of the quadrant or fourth part of the terrestrial meridian, the quadrant being 
the distance from the equator to the pole. One-tenth of a meter is a Decimeter, the cube of 
which contains one Liter of pure water at 4 C, the temperature of its maximum density, 
which liter of water weighs one Kilogramme, or 1000 grammes. 

A Liter, the unit of volume, is the volume of one cubic decimeter (1000 cubic centimeters) 
of pure water at 4 C, which volume of water weighs one Kilogramme (1000 grammes). 
One-thousandth of a liter is a Milliliter (or cubic centimeter), which volume of pure water at 
its maximum density weighs one Gramme. 

A Gramme, the unit of weight, is the one-thousandth part of a kilogramme, and is there- 
fore the weight of one-thousandth of a liter (a milliliter*) of water at 4 C, the temperature 
of its maximum density. Its tenth is the Decigramme, its hundredth is the Centigramme, 
and its thousandth part is the Milligramme. 

The original and French spelling is metre, litre, gramme; the Anglicized form is meter, 
liter, gram. The U. S. Pharmacopoeia sanctions a combination of both, thus — meter, liter, 
gramme. 

The metric terms used in pharmacy are few, and are generally confined 
to the gramme, milligramme, and milliliter* (fluid-gramme); but the system 
embraces many other terms of increase and decrease of the units, as set forth 
in the following table, viz. — 



1 0000. 


Myriameter. 


IOOOO. 


Myrialiter. 


1 0000. 


Myriagramme. 


1000. 


Kilometer. 


1000. 


Kiloliter. 


1000. 


Kilogramme. 


100. 


Hectometer. 


100. 


Hectoliter. 


100. 


Hectogramme. 


10. 


Dekameter. 


10 


Dekaliter. 


10. 


Dekagramme. 


I. 


Meter. 


I. 


Liter. 


1. 


Gramme. 


.1 


Decimeter. 


.1 


Deciliter. 


.1 


Decigramme. 


.01 


Centimeter. 


.01 


Centiliter. 


.01 


Centigramme. 


.001 


Millimeter. 


.001 


Milliliter* (Mil). 


.001 


Milligramme. 



The figures are the numerals employed to represent the various terms of increase or de- 
crease, thus — 1000. represents a kilometer, a kiloliter, or a kilogramme; and .001 represents 
a millimeter, a milliliter, or a milligramme; therefore the unit should be added in each case 
to show which series it belongs to, thus — 1000. Meter, .001 Gramme. 

•There is only one relation between the terms of these three series, which relation may be 
expressed by either of the following formulae, viz. — 

A Decimeter cubed contains a Liter, which weighs a Kilogramme. 

A Centimeter cubed contains a Milliliter * which weighs a Gramme. 

If the three series were arranged so as to bring these three related terms on one line, the 
table would be deceptive, as no corresponding relation exists between the other terms which 
would also be on the same lines. 

Relations between the Metric Weights and Measures and those of the Apoth- 
ecaries' system are as follows, — 

1 meter =39.3704 inches. 1 grain = 0.0648 gramme. 

1 liter = 2.1134 pints. 1 minim = 0.0616 cubic centimeter. 

1 gramme =15.4323 grains. 1 fluidounce =29.5737 cubic centimeters. 

The Metric System is making way but slowly in this country, although its 

* Cubic centimeter referred to in previous revisions has been replaced by the term 
milliliter in U. S. P. IX. 



WEIGHTS AND MEASURES. 497 

progress is aided by every process of forcing which scientific bodies can bring 
into action, and it remains to be seen how much its adoption by the U. S. Phar- 
macopoeia will influence the medical profession in its behalf. With all the 
influence brought to bear in its favor it certainly has not yet been adopted by 
any considerable proportion of native-born and home-educated physicians and 
pharmaceutists. One of its greatest difficulties for the physician is the absence 
of any correspondence or relation between the unit of weight (gramme) and 
the unit of measure (liter), and the consequent want of fluid denominations 
below the milliliter, corresponding with the decigramme, centigramme and 
milligramme of the weight scale. Its chief disadvantage is one which is 
inherent to any decimal system, — that the number ten cannot be divided more 
than once without producing a fraction. This is partly compensated for by 
the practice of dividing five into the three parts 2, 2 and 1, and on this principle 
metric weights are usually constructed. Our five-cent nickel coin is exactly 
2 centimeters in diameter, and weighs 5 grammes. 

Approximate or Domestic Measures become necessary in apportioning 
doses for a patient, when liquid medicines are used. Of these the measure 
most commonly employed is the teaspoonf ul, which is generally taken as equiva- 
lent to a fluidrachm, though as now manufactured the teaspoon usually contains 
about 75 minims, or 25 per cent, more than the theoretical quantity. The 
dessertspoonful is about equal to two teaspoonsful, and the tablespoonful to 
about 4 teaspoonsful or f 5ss, while the wineglass is supposed to contain about 
f §ij. The use of graduated medicine glasses is strongly recommended instead 
of these approximate measures. They may be obtained at a trifling cost in 
any well-stocked drug store. 

Drops (Guttae) are very variable in size, though generally supposed to equal 
minims; the variations in their relative dimensions being due to the viscidity 
of the liquid, the shape and surface of the orifice from which they escape and 
sundry other circumstances. The Syrups and Mucilages produce large drops, 
while Bromine, Chloroform and other heavy mobile liquids produce very small 
ones. These differences are well illustrated in the following table, which gives 
the number of drops in a fluidrachm of several liquids of certain classes, arranged 
in the order of their increase. A more complete table is given in the Appendix. 

Syrupus Acaciae, 44 Oleum Ricini, 77 

Syrupus Scillae, 75. Oleum Copaibae, 123. 

Aqua, 60. Oleum Juniperi, 148. 

Liquor Potassii Hydroxidi, 62. Spiritus Camphorse, 143. 

Liquor Hydrargyri Nitratis, 131. Spiritus Chloroformi, 150. 

Acetum Opii, 90. Fluidextr. Digitalis, 134. 

Vinum Opii, 100. Fluidextr. Ipecac, 120. 

Tinctura Opii Deodorati, no. Fluidextr. Cinchonas, 138. 

Tinctura Opii Camph., 130. Fluidextr. Zingiberis, 142. 

Tinctura Opii, 130. Fluidextr. Buchu, 150. 

Tinctura Iodi, 148. Fluidextr. Hyoscyami, 160. 

Tinctura Aconiti, 146. JEiher, 176. 

Alcohol Dilutum, 137. Bromum, 250. 

Alcohol, 146. Chloroformum, 250. 

32 



498 PRESCRIPTIONS. 

Specific Gravity is the relative weight of equal bulks of different bodies. 
The' specific gravity of water at a certain temperature 25 C. (77°F.) is taken 
as 1, and that of all other substances is expressed in terms of this unit. The 
Pharmacopoeia gives very complete tables of percentages and specific gravities 
of Alcohol, Ammonia Water, Acetic, Hydrochloric, Nitric, Sulphuric and Phos- 
phoric Acids. The specific gravity of any substance is expressed by the quotient 
obtained by dividing the weight of a given measure of the substance by the 
weight of an equal measure of water. In pharmacy the specific gravity of solids 
is not of any importance, but that of liquids is a matter of constant value, and 
is determined in most cases by means of a specific gravity bottle or by a hydrome- 
ter, instruments which are described in any standard work on chemistry 
or physics. Modifications of the hydrometer with scales adapted to particular 
work are the urinometer, saccharometer, lactometer, etc. 

Specific Volume is the relative bulks of equal weights of different bodies. 
In pharmacy it means the volume of the weight of a liquid compared with the 
volume of an equal weight of water at 25 C. The specific volume of a body 
is therefore inversely as its specific gravity, and is expressed by the quotient 

obtained by dividing unity by the specific gravity. = sp. vol. and there- 
fore sp. gr.Xsp. vol. =1. 



PRESCRIPTIONS. 



Extemporaneous Prescriptions are formulae written on the instant {ex- 
tempore) to meet the requirements of individual cases. 

A prescription should begin with the name of the person for whom it is 
designed and the date on which it is written. Then follows the Latin word 
Recipe, usually abbreviated to the sign 1$, and signifying "Take;" next, the 
names and quantities of the ingredients to be used, which are also expressed 
in Latin; then the directions to the compounder, followed by the directions to 
the patient, the last being now usually expressed in English; and finally the 
signature and address of the prescriber. 

A prescription then has four component parts, as follows: the — 

Superscription, — consisting of the name of the party for whom it is designed, the date and 

the sign 1$ signifying "Take thou." 
Inscription, — the body of the prescription, consisting of one or more of the following sub- 
divisions: the — 

Basis, — or chief, active ingredient. 
Adjuvant, — to assist the action of the basis. 

Corrective, — to correct some injurious quality of the other ingredients. 
Vehicle or Excipient, — giving the prescription a suitable form. 
Subscription, — the directions for the compounder, usually expressed in contracted Latin. 
Signature, — the instructions for the guidance of the one administering the medicine, expressed 
in English, followed by the signature of the prescriber. 



PRESCRIPTIONS. 499 

Registry Number, — the number issued by the collector of internal revenue under the 
Federal Anti-Narcotic Act is^ very desirably printed on the prescription blank so 
that it is not thoughtlessly omitted when prescribing drugs coming under provisions of 
this Law. 

A prescription may, however, contain the base alone, or the base with the 
adjuvant, or the base with a simple vehicle or diluent. A single ingredient 
may serve a double or a triple office, as the Syrupus Rhei Aromaticus with 
Quinine, in which case the syrup serves as an adjuvant to increase the action 
of the quinine, as an excipient to cover the taste, and as a vehicle to facilitate 
the administration of the dose directed. Again, the basis may need no aid in 
doing its work and may require no corrective of its action nor any special vehicle. 
On the other hand, there is no limit to the number of ingredients which may 
be used, provided that the prescriber has a clear idea of something to be accom- 
plished by each one, and that there is no chemical or medicinal incompatibility 
between them. In olden times prescriptions were very complex and contained 
a great many curious and incongruous ingredients. As Dr. Piffard has well 
said, "the tendency of the present age is toward mono- rather than poly-phai- 
macy, and prescriptions with the orthodox adjuvans and corrigens are less fre- 
quently seen than formerly." 

Procedure in Writing a Prescription. 

In writing an extemporaneous prescription, the first step is to write the 
patient's name and address, the date and the sign 1$. Then the title of each 
ingredient should be written in Latin and in the genitive case, except that when 
a certain number only of an ingredient is ordered the name of the ingredient 
should be in the accusative case, for example, " Vitellumunum, — one yolk-of-egg." 
Next, the quantity of each ingredient sufficient for one dose should be men- 
tally determined and multiplied by the number of doses which the mixture 
is to contain, and the result set down in signs and Roman numerals. The 
directions to the pharmacist and patient being added and the prescriber's name 
or initials affixed, the prescription is completed; but when very active agents 
are used, it is a good plan to go over the calculations a second time before let- 
ting the prescription leave the hands of the person most responsible for the 
result. For pills or powders the same process should be employed, slightly 
varied according to the requirements of each case. Frequently the ingredients 
and quantities for but one pill, powder or suppository are named, with instruc- 
tions to make a certain number after the formula. When an unusually large 
dose of any poisonous drug is prescribed, it is customary to underline the quan- 
tity, so as to call the attention of the compounder to the fact that the prescriber 
is aware that the dose is above the average. 

An Example will perhaps make the foregoing more comprehensible, and 
at the same time serve to indicate the style of writing usually employed. The 
following formula represents the preparation known as Black Draught, but 



5oo 



PRESCRIPTIONS. 



(Basis.) 

(Adjuvant.) 

(Corrective.) 

(Vehicle.) 



Inscription. 



Subscription. 



Signature. 



officially styled the Compound Infusion of Senna; approximate weights and 
measures being substituted for the pharmacopceial metric weights. 

For Mrs. Gray. December i, 1916. \ C tt™™«,««™^„ 

Recipe, Take,— / Superscription. 

f Sennae semiunciam, 

Of Senna, half an ounce; 
Magnesii Sulphatis, 

Of Magnesium Sulphate, 
ManncB, ana unciam unam, 

Of Manna, of each an ounce, 
Foeniculi, drachmam unam, 
Of Fennel, one drachm, 
Aqua Bullientis, fluiduncias octo, 

Of Boiling Water eight fluid-ounces. 
Macera per horam in vase clauso, deinde cola. 

Macerate for an hour in a closed vessel, then strain. 
Signetur, Let it be entitled, — A wineglassful every four hours until 
it operates. 

J. F. Wood, M. D. 

Abbreviated in the style usual among physicians, the above prescription 

would read as follows,- — 

For Mrs. Gray. December 1, 1916. 

1$. Sennce, § ss. 

Magnesii Sulphat., 

Mannce, aa 3 j. 

Fwniculi, 5 j. 

Aquae Bull., f § viij. 

Mac. per hor. in vase clauso, deinde cola. 
Sig. — A wineglassful every four hours, until it operates. 

Wood. 

As the result of the above is nearly identical with the official preparation, we 
might write the same prescription more simply, as follows, — 

]$. Infusi Senna Compos., B viij. 
with the proper superscription and signature; this being the manner of pre- 
scribing the official preparations. 

It will be noticed that in the above analysis the term basis covers two ingre- 
dients; but it is obvious that either of them might be considered the principal 
agent, and the other one classed as an adjuvant. 

"These four parts of a formula are intended to accomplish the object of 
Asclepiades, curare cito } tute et jucunde; in other words, to enable the basis to 
cure quickly, safely and pleasantly." (Pareira.) 

Another Example will illustrate the mental operations which should always 
be followed by a prescriber; for no matter how good a memory he may have, 
he will some day make a grievous mistake if he follows the practice of writing 
prescriptions from memory. Furthermore, the unscientific character of the 
latter habit will, when appreciated, prevent any educated physician from in- 
dulging in it. Every prescription should be written with a definite purpose in 
view, consequently the mind of the prescriber should weigh each step carefully 
and should avoid all slavish subjection to ready-made formulas. 



PRESCRIPTIONS. 501 

Suppose, then, that we wish to order for Miss Graham an emulsion of Castor 
Oil, flavored and sweetened so as to make it less disagreeable to the taste than 
it naturally is. If the ingredients were simply mixed together, as in the previous 
example, the result would be an unsightly preparation, consisting of sweetened 
and flavored water with the oil floating on top. So we require that the process 
of emulsification be first accomplished, by which the oil is minutely subdivided 
and suspended in the water by the aid of the emulsifier, which may be any 
viscid excipient, as gum, soap, or yolk-of-egg. Taking the last-named for the 
emulsifying agent, we would begin by writing down in order the following terms 
as stated below in italics, viz.: — 

For Miss Graham. December 1, 1916. 

^. (Take thou—) 

Olei Ricini, (of Oil of Castor), 
Vitellum (Yolk-of-egg), 
Tere bene simul; dein adde — (Rub well together; then add — ) 

Having gone so far, we begin to think of an agreeable vehicle, and choosing 

from the many syrups at our disposal that of Ginger, and from the flavored 

waters that of Cinnamon, we write further for these as the ingredients to be 

added, thus — 

Syrupi Zingiber is (of Syrup of Ginger), 
Aquce Cinnamomi (of Cinnamon Water). 

The ingredients are now all entered upon the prescription, but their respec- 
tive quantities have not yet been decided upon. We proceed then by first taking 
into consideration the total quantity of the medicament required, — which, in this 
case, as the preparation is intended to purge the patient, need not embrace more 
than one or two doses. As it is well to provide for a repetition of the dose, 
in case the medicine should not act sufficiently, we will decide upon two doses 
in all. Now, the average adult dose of Castor-oil is about a tablespoonful or 
half-an-ounce, and as we want two such doses we insert the sign and numerals 
f 5j, or simply §j, opposite the title of the oil which is written in the genitive 
case. But to emulsify it properly we need about one-half as much of the emul- 
sifying agent, and we may express this by writing foi half-an-ounce of yolk- 
of-egg, or for the yolk of one egg, or for one yolk-of-egg, which weighs about 
half-an-ounce. This would be expressed in Latin by either of the following 
methods, — 

Vitelli semi-unciam (5ss). One-half -ounce of Yolk-of-egg. 
Vitellum ovi unius (j). The Yolk of one egg. 
Vitellum unum (j). One Yolk-of-egg. 

As the word Vitellus means Yolk-of-egg, we may omit the word Ovi, and 
accepting the latter as the best style, insert the numeral j opposite the word 
Vitellum, which is properly in the accusative case. The whole quantity so far 
specified is one ounce and a half, and if we add two and a half ounces of diluent 
we shall have a four-ounce mixture, or the full of a regular-sized bottle as found 
in the shops. There being considerable viscidity already present in the emul- 



502 PRESCRIPTIONS. 

sion we do not need much syrup, so we assign to the Syrup of Ginger the odd 
half-ounce, leaving two ounces of the Water to make up the total bulk of four 
fluid-ounces. 

The prescription now only requires for its completion that the subscription 
and signature be added. We proceed to admonish the dispenser by telling him 
to mix the ingredients together, writing therefore the word Misce, or the abbre- 
viation M commonly used therefor; and to further point out the nature of 
the preparation we add, Let be made an emulsion, or in Latin, Fiat emulsum, — 
the passive verb taking as predicate-nominative the thing into which the making 
is to be. The final direction Label or Write thus, is expressed by the term Sig- 
netur, Let it be entitled, followed by the instructions for the patient or the person 
who is to administer the medicine, which should be in English though 
they may be written in Latin. Our completed prescription will stand thus, — 

For Miss Graham. December i, 191 6. 

T$. Olei Ricini, § j. 

Vitellum, j. 

Tere bene simul, dein adde — 

Syrupi Zingiberis, § ss. 

Aqua, Cinnamomi, § ij. 

M. Fiat emulsum. 

Sig. — " One-half at once, to be repeated next day if required." 
L. D. Jones, M. D. 

The last entry of the inscription might be written — Aquce Cinnamomi, quan- 
tum sufficiat ad §iv, meaning "of Cinnamon- Water as much as may be necessary 
to [bring the whole quantity to] four ounces, " usually expressed in contracted 
style, thus — 

Aq. Cinnamomi, q. s. ad §iv. 

This style is preferred when any of the quantities are approximations, and 
the final item cannot be exactly stated to secure a certain total. In the fore- 
going case, the one yolk-of-egg might measure a little more than the half -ounce 
assigned to it; but by using the q. s. ad style at the end, we make sure of getting 
a total of exactly four fluid-ounces. 

The Use of Latin in Prescriptions. 

The use of the Latin language in writing prescriptions is criticised by 
a certain class of patients who like to know what they are taking, or wish 
to exercise their judgment upon the prescription of a physician in whose 
learning and skill they professed to have confidence when they consulted 
him. This feeling crops out frequently in our State legislatures, where bills 
are periodically introduced making it a crime for a physician to write a 
prescription in any other than the vernacular tongue. It is well for the student 
to know the reasons for maintaining the use of a dead language in the ordinary 
affairs of life. These reasons are as follows: — 

The names of plants vary in every modern language, and even in the same 



PRESCRIPTIONS. 503 

language several different plants not infrequently receive the same common 
name. For example, — the name "Starwort" is given to Aletris farinosa and 
Helonias dioica; " Colic-root" is one of the names of Aletris farinosa, also of 
Dioscoreavillosa and Liatris spicata; "Mandrake" is applied to Podophyllum and 
Mandragora; " Winter-green " to Chimaphila and Gaultheria; and " Snake-root " 
to five different plants, — Asarum, Cimicifuga, Eryngium, Senega and Serpen- 
taria. There are many other instances of this diverse nomenclature in English, 
and as each plant has a different name in French, another in German, and still 
another in Italian, Spanish, Dutch, etc., the confusion, in so polyglot a country 
as this, would cause innumerable errors if any but a generally understood lan- 
guage were used in prescriptions. Latin is such a language, it is the accepted 
language of science throughout the world, the Latin names of plants are definite 
and cannot be confounded, and a prescription written in Latin by a physician 
of any nationality, in any part of the civilized world, can be readily understood 
and correctly compounded by a pharmacist in any other civilized country. 

Another reason, formerly more potent than at present, is the protection to the 
patient which the secrecy of a Latin prescription affords. A prescription 
ordering mercury and potassium iodide in plain language would be an awkward 
thing to send by one's child or servant to be put up, or to have ordered by tele- 
phone to be sent to Mrs. C. B. of a certain number and street. Again, there 
exists in many cases a strong prejudice against certain names of drugs, usually 
borne of ignorance but none the less potent, and in such it becomes necessary 
for the patient's good to conceal from him the name of the medicine he is taking. 
In this age of free education in all branches and the consequent smattering of 
everything possessed by almost everybody, the use of Latin does not afford 
the necessary secrecy, and the physician who does not dispense his medicines 
is often compelled to resort to private formulae deposited by him with a certain 
druggist. In France it is a criminal offense to make known or expose the con- 
tents or nature of a prescription to any person other than the party for whom 
it was written, the law recognizing the fact that prescriptions may betray secrets 
which should be carefully guarded. 

There is no royal road to prescription- writing; practice, care and knowledge 
of the whole subject are necessary to enable one to turn out habitually those 
elegant prescriptions which are properly termed "magistral," being the work 
of a magister or master of his business. A fair knowledge of the Latin language 
is a sine qua non to every professional man but especially to the physician. It 
is pitiable to see a Doctor write ignorantly of even the genitive case endings 
of the drug-names which he uses. The teaching of Latin is not within the 
scope of this work, and this part of the subject will be concluded with the advice 
to the physician who is ignorant of that language to write his prescriptions 
wholly in English if he cannot write them in decent Latin. A very full table 
of the Latin words, phrases and contractions used in prescription-writing, also 
a table of genitive case endings, will be found in the Appendix. 



504 prescriptions. 

Principles of Combination. 

The principles of combination are so well laid down by Dr. H. C. Wood 
that his words are appended verbatim, as follows: — 

The art of combining medicines is not a difficult one ; but in practice certain 
principles should not be lost sight of. Chief of these are, to prescribe as few 
remedies as possible, and to use no powerful drug without a very distinct idea of 
what it is intended to do. Whenever it is desired to give a powerful remedy in 
increasing doses until its physiological effect is produced, it should always 
be given by itself. Thus, it may be necessary to give Arsenic so as to impress 
the system, at the same time that Iron is indicated; but the two remedies should 
be given separately, so that the dose of either can be increased or diminished 
independently of the other. The principles of combination formulated below 
were long ago enunciated by Dr. Paris, but are today as imperative as ever. 
Medicines are combined — 

First. To augment, correct, or modify the action of a medicine. Thus, 
purgatives act much more kindly when a number of them are united together. 
The chief reason of this probably is, that as different remedies affect different 
portions of the gut, the whole intestine is best reached by a union of the diverse 
substances. It may take an intense irritation of the mucous membrane to purge 
as actively as does a mild irritation of both the mucous membrane and the 
muscular coat. 

There are powerful medicines which act similarly upon some parts of the organism but 
dissimilarly upon other parts. By combining such remedies powerful effects can be obtained 
at the points where the two lines of action cross each other, without influencing to a great ex- 
tent other portions of the system. Thus, Chloral produces sleep by its action upon the brain, 
and also has a distinct influence upon the heart but none upon the intestinal tract. Morphine 
acts upon the brain and does not seriously influence the heart, but has a powerful effect upon 
the intestinal tract. By combining Chloral and Morphine we get an overwhelming conjoined 
influence upon the brain in producing sleep with the least possible disturbance of the heart 
and of the intestinal tract. 

Secondly. To obtain the joint action of two or more diverse remedies. 
Thus, in a cough mixture Morphine may be included to quiet the cough, whilst 
Ipecacuanha and Squill (in accordance with the first principle) are added to 
affect the mucous membrane. The application of this principle requires caution, 
or the practitioner will be led into that chief abomination — polypharmacy. It 
is worse than futile to attempt to prescribe for every symptom. The under- 
lying cause of the disorder or the understratum of bodily condition must be 
sought out and prescribed for simply. 

Thirdly. To obtain a special combination, which is really a new remedy 
or which experience has shown acts almost as a new remedy. Thus, when 
to Iodide of Potassium in solution Corrosive Sublimate is added, a new chemical 
compound is formed, which experience has shown to be of great value in syphi- 
litic diseases. Griffith's antihectic mixture is another instance of the use of 
chemical changes, the Proto-carbonate of Iron being formed out of the Sulphate 



PRESCRIPTIONS. 505 

of the metal and the Carbonate of Potassium. In the famous Dover's powder 
no chemical change occurs, but the ordinary action of Opium upon the skin is so 
enhanced that the combination may be looked upon almost as a new remedy. 
Fourthly. To afford a suitable form. Thus, Acacia is added to make an 
emulsion or Confection of Rose to make a pill. In the choice of excipients 
care should be exercised to select a substance free from medical properties, 
having no chemical incompatibility with the medicinal agent, and of suitable 
physical character. Bread crumbs often make a good basis for pills, but with 
Nitrate of Silver they are chemically incompatible. 

When writing a prescription, the utmost care should be taken to use such excipients that 
the combination should not only be attractive to the eye, but also as little repulsive to the 
palate as may be. Whenever possible, the pill-form or capsule should be employed with 
bitter or disagreeable medicines. The pill may be readily coated with silver-foil; tonic pills 
may be coated with Iron by shaking or rolling them in Ferri Pulvis while soft and sticky. 
Sugar-coated pills and "compressed pills" are apt to get so hard and insoluble that their 
use requires caution. In regard to mixtures, flavoring oils should be freely used, and 
the power of Glycerin to conceal the disagreeable taste of many substances should be 
remembered. 



Metric Prescriptions. 

Metric prescriptions are written or compounded with sufficient accuracy 
by considering a Milligramme as equal to the -gVtb. of a Troy grain, a Gramme 
as equivalent to 15 Troy grains, and a Milliliter (cubic centimeter, fluid 
gramme) as equal to 15 minims or Jth of a fluidrachm. All other metric 
terms, units and prefixes may be wholly ignored by the physician and the 
pharmacist. In fact the terms centigramme and decigramme are rarely used 
at all, the former being generally expressed by 10 milligrammes and the latter 
by 100 milligrammes. The term gramme when abbreviated is printed and 
written Cm., the term milligramme, Mg., and the term milliliter, mil (formerly 
cubic centimeter, Cc); always beginning with a capital. In expressing 
quantities by metric weight or measure in writing the common or Arabic 
numerals are used, and are always placed before the term or abbreviation 
designating the unit, thus — 2.50 Gm., 30 Cc. When apothecaries' weight 
is employed the numerals are placed after the sign or symbol designating the 
unit, and in Roman characters, thus — gr. x, 3ij, 5J SS > 5 V J> always using a 
small g in gr. The decimal point after the figure representing the number 
of grammes or cubic centimeters should be replaced by a line, in order to 
avoid such errors as might arise from the misplacement of a point, the drop- 
ping of ink, or the intrusion of a fly-speck, which might cause serious results 
in many cases. The simplest rule for writing a prescription in metric terms 
by one who is not practiced in the use of the system is the following : — 

Write as though prescribing but one dose of each ingredient in grains or 
minims and decimals thereof ; then substitute the term grammes or cubic centimeters 
for grains or minims, and the prescription is correct for 15 doses in metric terms. 



506 PRESCRIPTIONS. 

Of course, when writing for a mixture or solution, the proper quantity of 
vehicle must be added to complete the one dose, and must also be expressed 
first in grains or minims. For example, — 

One dose. 15 doses metric. 

J$. Quininae Sulphatis gr. j, 1 

Strychninae Sulph, gr. -fa or 0.016, 016 

Fluidextr. Glycyrrhizae, Ti^iv, 4 

Syrupi, ttjjIx, 60 

This gives a two-ounce mixture approximately, of which the dose would be a teaspoonful. 

One dose. 15 doses metric. 

]$. Quininae Sulphatis, gr. j, 1 

Massae Ferri Carb., gr. ij, 2 

Extr. Nucis Vomicae, gr. £ or 0.25, 25 

Ft. pil. no. xv. Sig. — One pill thrice daily after meals. 

The above rule will answer for all liquids except those which are very heavy, 
as Syrups and Chloroform, or very light, as Ether. Measures may be entirely 
discarded, and all fluid quantities expressed in grammes. The average drop 
of water may be considered equivalent to 0.05 mils (50 milligrammes), the 
average teaspoonful to 5 mils, the tablespoonful to 20 mils, the Troy § to 
30 grammes, the fluidounce to 30 mils, and 8 fluidounces to 250 mils. 

In prescribing Syrups or Chloroform, each Troy fluidounce should be reck- 
oned at something more than 30 grammes — say 40; and if this be done, the 
difficulty of converting one scale into the other will be obviated. The following 
table shows the actual weight in grammes of one or more fluidounces of the 
substances named: — 

Water. Tinctures. Syrup. Chloroform. Ether. 

Fluid oz. (Grammes.) (Grammes.) (Grammes.) (Grammes.) (Grammes.) 

5 i. = 29.52 28.00 38.00 43-7© 22.14 

§ ii. = 59-04 56.00 76.00 84.40 44.28 

5 iv. — 118.08 112.00 152.00 174.80 88.56 

§ viii. = 236.16 224.00 304.00 349-6o 177.12 

Tables of equivalents between apothecaries' and metric weights and measures 

will be found in the Appendix, and on the inside of the cover of this book. 

Abbreviations. 

Abbreviations though very commonly used by physicians in prescribing, 
are a source of much annoyance to the compounder, and frequently one of great 
danger to the patient. Physicians who never knew anything of the Latin gram- 
mar, or those who have forgotten its rules, are very apt to use abbreviations 
to conceal their ignorance of case-endings. Many others use them through 
sheer laziness and some from force of habit. The educated and conscientious 
man will take pride in turning out a full and clear prescription, free from cabal- 
istic letters and all elements of uncertainty. In the Appendix will be found 
a list of the Latin terms used in prescriptions, with the abbreviations in vogue 
and the English meanings. The U. S. P. Rev. IX has provided official 
abbreviations for the various preparations contained therein which facilitates 
greatly the prescribing of official substances. Ambiguous contractions may 



PRESCRIPTIONS. 



507 



result fatally to the patient, as is readily seen by studying the following list, 
which gives a few examples of the dangers of careless abbreviation: — 



Aconit. 



Amman. 



Acid. Hydroc. — may mean 

Aconitine. 
Aconitum. 
Ammonia. 
Ammoniacum. 



Acidum Hydrochloricum. 
Acidum Hydrocyanicum. 



a rhi I Aqua Chlori. 

Aq. umor., 1 A( ^ ua ChloroformL 

Aa Fontis I Mi ^ ht easil y be read 

Aqua Fortis. 

Chlorine. 
Chlor., \ Chloral. 

Chloroform. 

Calomel. 
Hyd. Chlor., -j Corrosive Sublimate. 

Hydrated Chloral. 



Hydr.,. 



Sod. Sulph. 



Sulph., , 



Zinci Phos., 



Hydrargyrum. 

Hydras. 

Hydriodas. 

Hy drochloridum . 

Hydrocyanidum. 

Sodium Sulphate. 

Sodium Sulphite. 

Sodium Sulphide. 
' Sulphur. 

Sulphide. 

Sulphate. 

Sulphite. 
f Zinc Phosphate. 
\ Zinc Phosphide. 



Renewal of Prescriptions. 



It is advisable to have printed upon the prescription blank the words 
Non Repetatur so that the prescription cannot be renewed except by the 
physician's order. Frequently patients continue the prescription without 
consulting the physician as to the wisdom thereof. Ofttimes the prescrip- 
tion is passed on to another person thinking it may benefit him. The in- 
calculable harm resulting therefrom can thus be controlled. It is also to be 
remembered that prescriptions containing opium, coca, their salts, derivatives 
or preparations cannot be renewed even by order of the physician, unless 
another prescription is written. 

Federal Anti-Narcotic Act. 

The Federal Anti-Narcotic Act approved by Congress of the United 
States, Dec. 17, 1914, effective Mar. 1, 1915, relates to the production, im- 
portation, manufacture, compounding, sale, dispensing or giving away 
opium or coca leaves, their salts, derivatives or preparations. This law aims 
to prevent the illegitimate traffic and improper use and prescribing of narcotic 
drugs. The provisions of this law require every physician who has in his 
possession or prescribes any opium or coca leaves, their salts, derivatives or 
preparations to register with the collector of internal revenue of the district, 
pay a special tax of $1.00 per year and receive a registration number which 
must be used by the physician in prescribing or dealing in these drugs. 
Failure to comply with the provisions of this law, renders the physician 
liable to a heavy fine and imprisonment. Read in detail a copy of this 
law and its regulation (page 921). 

Prescription Blanks. 

After many years' experience in prescribing on blanks furnished by drug- 
gists, the writer has come to the conclusion that it is better taste for the 



508 INCOMPATIBILITY. 

physician to have his own blanks, without the address of any drug-store 
thereon. Many physicians have prescription blank books so arranged that 
a carbon copy of each prescription written is retained. A careful prescriber 
always reads a formula twice before letting it go out of his hands. The 
blank used by the writer measures 4 J inches by 3 J, joined by a perforated 
edge to a stub 3I inches by 2J inches. On the main blank the physician's 
name and address are printed, together with his office-hours, and a place for 
number and date, also the sign 1^., and a line for signature. It is well to 
have the registry number under the Anti-Narcotic Act printed on each blank. 
For convenience the physician indicates or has printed on the prescription 
blank, "Copy Formula on Container." 



INCOMPATIBILITY. 



Incompatibility may be Chemical, Pharmaceutical or Therapeutical, accord- 
ing as the prescribed combination results in chemical decomposition, physical 
disassociation or antagonistic action. In the first case the incompatibility 
may be unintentional or intentional on the part of the prescriber, for in many 
cases the result of the chemical action affords the substance desired. 

Instances of intentional incompatibility are the mixtures of Calomel or Corrosive Sub- 
limate with Limewater, producing the Black and Yellow Oxides of Mercury respectively 
and commonly known as Black Wash and Yellow Wash. Such a combination should not be 
filtered (as a novice might suppose), but should be dispensed with a Shake-label, in order that 
the precipitate may be uniformly distributed before using. 

Chemical Incompatibility generally results from neglect on the part of 
the prescriber of the most common chemical reactions, such as that — 

Acids tend to combine with bases and to form salts. 

Weak acids or bases are displaced from their combinations by stronger ones, 
so that salts in solution when brought together generally exchange their radicles, 
especially if by doing so an insoluble compound can be formed. 

A salt in solution is easily decomposed by a strong alkali if the salt is one 
having a weak or volatile base. 

A substance in solution may be decomposed by another without precipitation, 
the product being soluble in the solution. 

Alkaloidal salts are precipitated from their solutions by the addition of fixed 
alkalies, their salts, or salts which produce insoluble compounds. Oxides of the 
fixed alkalies decompose salts of the metals proper and those of the alkaloids, 
precipitating their bases; but the base may be soluble in excess of the alkali. 

Tannic and Gallic Acids and vegetable substances containing them pre- 
cipitate albumin, alkaloids and most of the metallic oxides, and form inky solu- 
tions when brought into contact with the persalts of Iron. Tannic Acid pre- 
cipitates gelatin. 

Glucosides are incompatible with free Acids and with Emulsin. 



INCOMPATIBILITY. 



509 



Examples of the neglect of these principles are seen in the prescribing of Quinine Sulphate 
in mixture with Potassium Acetate, resulting in a voluminous precipitate of Quinine Acetate 
which cannot be poured from the bottle; — Vinegars or Syrups containing Acetic Acid (Syr. 
Allii, Syr. Scillae) added to a solution of alkaline carbonates, causing decomposition ot the latter 
with evolution of CO,; — the addition of Liquor Potassii Hydroxidi to a solution of Ammonia- 
alum, setting free gaseous ammonia; the mixing of Strychnine Sulphate and Potassium Bromide 
in solution, causing the decomposition of the alkaloid sulphate and precipitation of strychnine; 
— preparations of Cinchona with salts of Iron, forming an inky tannate of iron; — Elixir of 
Chloral with Alkalies, causing the elimination of chloroform and its subsequent evaporation. 

Insoluble Salts. — The following more or less insoluble salts will be formed 
whenever the materials of which they are composed are brought together in 
solutions: — the Hydroxides, Carbonates, Phosphates, Borates, Arsenates and 
Tannates of most earthy and heavy metals and alkaloids, and the metallic Sul- 
phides; the Sulphates of Calcium and of Lead, and the subsalts of Mercury; 
the Chlorides, Iodides, and Bromides of Bismuth, Silver, Lead and Mercury; 
the Iodides of Quinine, of Morphine, and of many other alkaloids. 

Instances are — Limewater or Aromatic Spirit of Ammonia with Tincture of Chloride of 
Iron or solutions of Mercury salts, or neutral solutions of Quinine or Morphine salts. 

Ammonium, Potassium, and Sodium Carbonates or Bicarbonates with Limewater. 

Solutions of Magnesium Sulphate, Alum, Zinc Acetate or Sulphate, with solutions of 
salts of Iron, Manganese, Bismuth, Antimony, Lead, and most alkaloids. 

Ammonium or Sodium Phosphates with solutions of Iron Salts, with Limewater, solution 
of Magnesium Sulphate, of Alum, etc. 

Liquor Potassii Arsenitis with Limewater, with solutions of basic salts of Iron, and with 
solutions of neutral salts of Quinine and Morphine, etc. 

Solutions, Decoctions, Tinctures, and Extracts containing Tannic Acid with solutions of 
salts of Iron, Mercury, Antimony, Lead, also with solutions containing albuminous substances 
and Gelatin. 

Limewater with solutions of Quinine Sulphate or Morphine Sulphate. 

Solutions of Lead Acetate with Zinc Sulphate or Alum. 

Sodium Chloride with Silver Nitrate. 

Morphine Hydrochloride with Lead Acetate. 

Alkaline Iodides or Bromides with Bismuth Carbonate or Subnitrate, with Lead Acetate, 
with Subchloride of Mercury, or with neutral solutions of Quinine, Morphine and Strychnine 
salts. 

Table of Precipitant Solutions. 

The following table shows the most important instances of solutions which mutually 
precipitate each other, the letter P meaning "forms a precipitate with" — 



Solutions of 


w 
.£ 

# o 

h 

£ So 

< 


c 
.2 • 

|S 

■«og 

.2 c 

3 


1 
"o 


1 

'(n 

2 « 

| W 

tj 
"o 
w 


a 

*c3 
. 

«« w 

n 

.2 

"0 


a 

M 
rt ,n 

§~ 

«« d 
OCO 

SB 
3 



CO 


c 
8 

< 

CO 

a 


*o 

CO 


.5 

"«3 

O 

"o 

c 

.2 

"0 


Alkalies, 


P 
P 
P 


P 
P 
P 


p 
p 
p 
p 
p 
p 
p 
p 
p 
p 
p 
p 


p 
p 
p 
p 
p 
p 
p 
p 
p 
p 
p 
p 


P 


p 






Tannic Acid, 


p 


p 


Carbonic Acid and Carbonates, 

Sulphuric Acid and Sulphates, 


P 
P 
P 


p 






Phosphoric Acid and Phosphates, 

Boric Acid and Borates, 


P 
P 


P 
P 


p 










Hydrochloric Acid and Chlorides, 










Hydrobromic Acids and Bromides, .... 














Hydriodic Acid and Iodides, 


P 


P 
P 










Sulphides, 










Arsenical Preparations, 












Albumin, 

























5IO INCOMPATIBILITY. 

Explosive Compounds result from the admixture of powerful oxidizing 
agents with substances which are readily oxidizable. The most important 
members of these two classes are as follows: — 

Oxidizers. Oxidizable (Combustible). 

Chlorine and its Oxides. Phosphorus. Hypophosphites. 

Free Hydrochloric Acid. Sulphur. Sulphides. 

Nitro-hydochloric Acid. Glycerin. Sugar. Alcohols. 

Chlorates. Hypochlorites. Oils. Ethers. Tannin. 

Chromates. Chromic Trioxide. Cork. Charcoal. Creosote. 

Permanganates. Dry Organic Substances. 

Nitric Acid. Nitrates. Powdered Iron and Zinc. 

Bromine. Bromates. Arsenic Trioxide. 

Iodine. Iodates. Cyanides. 

Silver Oxide. Oxalates. 

Peroxides (Dioxides). Ferrous, Mercurous and Stannous salts. 

Explosions have resulted from mixing Fluidextract of Uva Ursi with certain samples of 
Spirit of Nitre, Chromic Trioxide with Glycerin, Potassium Permanganate with Glycerin, Nitric 
Acid with Glycerin, Silver Nitrate with Creosote, Silver Oxide in pill with Extract of Gentian, 
Potassium Chlorate with Glycerin and Tincture of Ferric Chloride. Calcium Chloride tritu- 
rated with Sulphur in a mortar has exploded, so also has Calcium or Sodium Hypophosphite 
when triturated alone. Tincture of Iodine with Ammonia forms the Iodide of Nitrogen, which 
is highly explosive, especially if triturated in the presence of water. Catechu and Potassium 
Chlorate in a dentifrice have exploded in the mouth from the friction produced by a dry tooth- 
brush. Lozenges of Potassium Chlorate, carried in the pocket with a box of safety matches, 
have exploded by rubbing against the composition on the outside of the box, causing 
an extensive burn of the thigh. 

Hydrogen Dioxide is peculiar in that it acts both as an oxidizer and as an oxidizable agent. 
It reduces oxidizing agents and is itself reduced at the same time, hence it is incompatible with 
all the substances mentioned above. Nitrites may act in the same way under favorable 
circumstances. 

Poisonous Compounds may be formed by the admixture of many sub- 
stances in solution, such as — 

Potassium Chlorate with Potassium Iodide, in solution together do not react 
at ordinary temperatures, but in the system they evolve a poisonous agent, 
probably Potassium Iodate. 

Potassium Chlorate with Syrup of Ferrous Iodide, liberates Iodine from the 
iodide in the warm stomach, causing severe gastric irritation, perhaps gastritis 
of dangerous degree. 

Dilute Hydrocyanic Acid or Potassium Cyanide with Calomel, forms the 
Bichloride and Bicyanide of Mercury, both virulent poisons; — with metallic 
hydroxides, carbonates, sub-nitrates or sub-chlorides, cyanides of the metals are 
formed which are even more poisonous than the acid itself in its usual 
diluted form. 

Pharmaceutical Incompatibility differs from chemical incompatibility 
in the absence of chemical action, and generally occurs when one substance is 
added to another which, through differences in solubility, cause a precipitation 
of solid matter or a separation of part of the liquid. The separated constituents 
may be active and hence important, or inert and therefore unimportant. 

Instances of this are — the addition of an acid to a Quinine and Licorice mixture, result- 
ing in precipitation of the Glycyrrhizin (relied on to cover the taste of the Quinine) by the acid; 
or the use of Quinine, Tincture of Ferric Chloride and Licorice together; or the prescribing of 



INCOMPATIBILITY. 511 

solutions of Chloral and Potassium Bromide with an alcoholic preparation, the Chloral sepa- 
rating to the top as an alcoholate, and therefore dangerously in excess for the first few doses; or 
the neglect to prescribe Acacia or some other emulsifier in mixtures of an alcoholic fluidextract 
of a resinous body with an aqueous preparation, which would result in the separation of the 
resin to the surface and an overdose with the first teaspoonful. 

When a fluidextract is diluted with a liquid differing in composition from 
those used in the fluidextracts, the gum, albumin, resin and mucilage are often 
separated. In such a case as Fluidextract of Cannabis the active resin would 
be thrown out of its alcoholic solution and floating on top might cause serious 
symptoms; but in many other instances the precipitate would be inert and 
nitration would be in order. Water is the solvent for albuminous, gelatin- 
ous, gummy and saccharine bodies and for a large number of inorganic salts; 
while Alcohol is the solvent for volatile oils and resins, gum-resins, resinoids, 
balsams and all drugs containing these as their active principles. The solvent 
power of either Alcohol or Water for their particular substances decreases in 
proportion to the amount of the other added. 

Instances of Pharmaceutical Incompatibility. 

Resinous Tinctures or Fluidextracts with aqueous solutions. 
Tincture of Guaiac with Spirit of Nitrous Ether. 
Compound Infusion of Gentian with Infusion of Wild Cherry. 
Compound Infusion of Cinchona with Compound Infusion of Gentian. 
Essential Oils with aqueous liquids in quantities exceeding 1 drop to oj- 
Fixed Oils and Copaiba with aqueous liquids (except excipients). 
Tinctures made with Alcohol with those made with Diluted Alcohol. 
Alcoholic Tinctures and Fluidextracts with aqueous preparations. 
Spirit of Nitrous Ether with strong mucilages. 
Infusions generally with metallic salts. 

Therapeutical Incompatibility arises when two agents are administered 
together which oppose each other in their action on the human system,~as 
for instance Belladonna in any form with Physostigma. But in many cases 
physiological antagonists are designedly prescribed together, one as a guard 
against the excessive action of the other, as the hypodermic administration of 
Morphine and Atropine. The antagonists to each of the active medicinal 
agents may be found in Part III, under the title Poisoning. They are sum- 
marized in the table of antagonistic poisons on page 19. 

Dangers of Incompatibility may in great measure be avoided by the use 
of the utmost simplicity in prescribing. The subject can only be glanced at 
within these pages, but the following simple rules may help the burdened memory 
of the student and practitioner. 

Never use more than one remedy at a time, if one will serve the purpose 
for which you are prescribing. 

Never use Strong Mineral Acids with other agents, unless you know exactly 
what reaction will ensue. They decompose salts of the weaker acids, and form 
ethers when combined with alcohol. Never combine Free A cids with hydroxides 
or carbonates. 

Select the simplest solvent, diluent or excipient you know of, remembering 



512 INCOMPATIBILITY. 

that the solvent power of alcohol and of water for their respective substances 
decreases in proportion to the quantity of the other added. 

Generally, do not combine two or more soluble salts; for such salts in solu- 
tion, when brought together, usually exchange their radicles thereby forming 
an insoluble compound. 

Never prescribe a drug with any of its Tests or Antidotes. 

Never prescribe a Glucoside, as Santonin, Colocynthin, in combination with 
Free Acids or with a substance containing Emulsin, as these agents will de- 
compose it. 

Aconite should be ordered in water alone, Corrosive Mercuric Chloride by 
itself in water or in simple syrup. The latter drug is incompatible with almost 
everything, even the compound syrup of sarsaparilla being said to decom- 
pose it. 

Potassium Iodide decomposes most of the metallic salts, and is one of the 
drugs which are best administered alone. 

The following-named substances are incompatible with so many others 
that they should always be prescribed alone; they are best given in simple 
solution: — 

Alum. Morphine Acetate. 
Dilute Hydrocyanic Acid. / Morphine Hydrochloride. 

Dilute Nitro-hydrochloric Acid. Quinine Sulphate. 

Sulphuric Acid. Liquor Calcis. 

Mercuric Chloride (Corr. Sub.). Liquor Potassii Hydroxidi. 

Iodine and Iodides. Liquor Potassii Arsenitis. 

Syrup of Ferrous Iodide. Liquor Ferri Nitratis. 

Potassium Permanganate. Tinct. Ferri Chloridi. 

Potassium Acetate. Zinc Acetate. 

Potassium Bromide. Iron and Quinine Citrate. 

Tartar Emetic. Free Chlorine in Solution. 

Tincture of Guaiac. Tannic and Gallic Acids. 

Silver Nitrate and Lead Acetate and Subacetate, though incompatible with 
almost everything, may be combined with Opium, the latter forming therewith 
a compound which though insoluble is therapeutically active as an astringent 
and anodyne lotion. Silver Nitrate with Creosote forms an explosive compound. 

Tannic and Gallic Acids, and substances containing them (as the astringent 
bitters), precipitate albumin, alkaloids and most soluble metallic salts. They 
may be prescribed with the proto-salts of Iron, but not with its per-salts. Ca- 
lumba is the best vegetable tonic to use with ferric salts, as it contains neither 
tannic nor gallic acid. Tannic Acid precipitates gelatin. 

Iodine and the soluble Iodides are incompatible with the alkaloids and sub- 
stances containing them, also with most metallic salts. 

Alkalies neutralize free acids, and precipitate the alkaloids and the soluble 
non-alkaline metallic salts. Oxides of the Alkalies decompose salts of the metals 
proper and salts of the alkaloids, precipitating their bases; but the base may 
be soluble in an excess of the alkali. 

Resinous Tinctures or Fluidextracts (e. g., Tinct. Cannabis), when com- 



EXTEMPORANEOUS PHARMACY. 513 

bined with aqueous solutions should always have Acacia or some other 
emulsifying agent added, to prevent the separation of the resin, which otherwise 
will be deposited on the sides of the bottle or will float on top of the mixture. 
Tincture of Digitalis should not be mixed with aqueous or syrupy solutions 
for in such cases precipitation or decomposition of the active principles may 
occur. This tincture is injured by admixture and is best administered on 
sugar or dropped on a piece of bread. 



EXTEMPORANEOUS PHARMACY. 



This is the most important division of Pharmacy, embracing as it does the 
preparation and dispensing of those medicines which are designed for immediate 
use and are compounded on the prescriptions of physicians. Hence it com- 
prises the chief portion of the daily work of the pharmacist, and can be learned 
only at the dispensing counter under the personal supervision of a competent 
master. In the following pages are given the most important of the general 
directions pertaining to this subject, with the object, so far as the limits of the 
book will admit, of enabling the young medical practitioner to familiarize him- 
self with the compounding and dispensing of drugs. 

Compounding means the mixing or preparing of the drugs ordered in a 
prescription, and comprises all the operations of official pharmacy together with 
many other manipulations which will be described in their appropriate places. 

Dispensing is the operation of putting up and issuing the drugs ordered 
in a prescription, and may apply to the already compounded preparations of 
official pharmacy as well as to those prepared extemporaneously. 

Filling a Prescription means a combination of operations which requires 
great care, undivided attention, and a special practical apprenticeship at the 
dispensing desk. In the following discussion of extemporaneous preparations 
such hints are incorporated as are particularly applicable to the compounding 
of each article under consideration; and they may be prefaced by a few general 
suggestions which will serve to point out the most approved method of dealing 
with this important part of the druggist's work. 

The prescription should first be slowly read over in a critical spirit, but no 
word or action of unfavorable criticism should reach the ears or eyes of the 
messenger. To shrug the shoulders when scanning the items, to laugh or even 
smile at the phraseology, to question the person offering it as to whom it is 
for, or for what complaint it is given, are instances of such flagrant treason to 
the prescriber as would justify the most complete professional ostracism of the 
offender. The compounder has no business whatever with the propriety of the 
prescription for its purpose. It might have been given as a placebo for reasons 
eminently wise and judicious; or if not so constituted it has at least been ordered 
33 



1 



514 EXTEMPORANEOUS PHARMACY. 

by one who is in possession of facts about which the druggist knows nothing, 
even if by education and experience the latter were competent to judge in the 
matter, which he seldom is. His criticism should be directed only to the dosage 
and the pharmaceutical compatibility of the ingredients. Even in the latter 
case he must remember that incompatibles are often prescribed with the view 
of forming another agent by the chemical reaction produced. If he thinks that 
there is any mistake, or that the quantities ordered are in any degree poisonous, 
it is his duty to make an excuse for delay to the messenger and at once com- 
municate with the physician. This course, in these days of telephones, is 
nearly always practicable. 

After reading the prescription, it is well to first number it and then write 
the label. This gives time for the label to dry, and avoids the use of blotting 
paper, which often mars the writing and renders the directions illegible. 

A clearly defined method should then be decided on by which to compound 
the prescription. Directions for such plans of procedure will be found in the 
succeeding pages under the titles of the various preparations. Next, the ingre- 
dients should be carefully weighed or measured out, each one being checked 
off so as to avoid the danger of its being duplicated. In many cases the ex- 
cipient is not specified, its choice being left to the druggist; but in all such a 
note should be made on the prescription to show the article used, in order that 
in the event of a renewal being ordered there may be no perceptible difference. 
No alteration or addition should be made which would in any degree affect 
the medicinal action of the prescription or interfere with the intention of the 
prescriber. 

The labelling of the package and the numbering and filing of the prescription 
are matters of mechanical detail which are best learned at the counter. Various 
devices for simplifying these operations are in vogue and may be seen in any 
well-appointed drug-store. Poisonous articles sold by druggists should always 
be labelled Poison, and the transaction entered in a book usually required by law 
to be kept for that purpose; but in the case of prescriptions the word "Poison" 
should not appear on the package or label unless so directed by the prescriber. 

Stock Solutions of the salts most frequently prescribed are kept in many 
establishments for convenience in dispensing. The following are examples : — 

Alum,— gijss in a quart of distilled water. Of this solution each fluidounce represents 
5ss of the salt. 

Potassium Bicarbonate, — §j in f§iv of distilled water; of which oss contains 5j of 
the salt. 

Potassium Chlorate, — i in 24 of distilled water, will not crytallize as the temperature 
changes. 

Potassium Bromide, — 1 in 6 of distilled water, makes a very convenient solution for dis- 
pensing purposes, each 3 containing 10 grains of the salt. 

Hydrated Chloral, — 1 in 1 of distilled water, of which each minim contains one grain of 
Hydrated Chloral; or 1 in 6 of distilled water, of which each 3 contains 10 grains. 

Morphine Sulphate, — gr. xvj in oj of distilled water, with a grain of Salicylic Acid or 3 
drops of Phenol to prevent change. Of this solution, known as Magendie's, each minim con- 



OFFICIAL PHARMACY. 515 

tains gr. fa of the salt, and tt^x contain gr. $. A safer solution, as it requires less mental cal- 
culation, is one of one-half the above strength, viz. — gr. viij in § j, of which each fiuidrachm 
contains gr. j of Morphine Sulphate. 

Phenol, — oj in f §iv of glycerin, makes a convenient solution which will mix with water 
in all proportions, ngivss represents gr. j of Phenol. 

Tannic Acid, — oj in foiv of glycerin, dissolved by the aid of a gentle heat, njjiv; 
represent gr. j of Tannic Acid. 

Rules for the Pharmaceutical Student. The following rules are quoted 
from the Chemist's and Druggist's Diary, and are well worth remembering by 
the student: — 

Read a prescription through rapidly and in a manner suggesting no suspicion or doubt. 

Write directions invariably before dispensing. Avoid thus the use of blotting-paper; 
a good dispenser uses almost none. [Small typewriters are obtainable and when used 
result in very neat labels for prescriptions. Ed.] 

If a mixture contains readily soluble ingredients, never use a mortar. 

Avoid effecting solution by heat, for feat of recrystallization. 

With syrups and also ingredients not water, arrange in dispensing to rinse out the measure 
and leave it clean; a skilled dispenser shows very little traces of his work. 

Carefully clean and put away weights and scales after each operation. 

Hold the scales firmly by the left hand, never lift them high above the counter and judge 
of the weight as much by the indicator as by the position of the scale. 

Select glass pans for scales, preferably of heavy make, and discard flimsy brass material, 
which corrodes speedily and becomes inaccurate. 

Learn to judge of the quantity to be weighed with tolerable accuracy; train the eye as 
well as the hand. 

If in doubt, always begin with that about which you have no doubt. 

Be rapid in manipulation. Finish wrapping, tying, or sealing quickly. Slow dispensing 
is bad dispensing, and arises either from deficient practice or want of knowledge. 

Never hesitate when in doubt to ask advice from a fear of compromising your own dignity. 



OFFICIAL PHARMACY. 



Official Operations are those processes which are directed in the pharma- 
copoeia to be used in the preparation of medicines. Many of them are processes 
which are common to both chemistry and pharmacy, as precipitation and crys- 
tallization, — while others are peculiar to pharmacy, as percolation and tritura- 
tion. The most important of the pharmaceutical operations are briefly de- 
scribed below; for full details of the various apparatus used the student is re- 
ferred to the more exhaustive treatises on Pharmacy. 

PHARMACEUTICAL OPERATIONS. 

Carbonization is the heating of organic substances without exposure to the 
air until the volatile constituents are driven off, and the residue assumes the 
characteristic appearance of carbon. 

Clarification is the separation from liquids of solid matter which prevents 
their being transparent, without using filters or strainers. It may be effected 
by heat (as in the case of Mel Depuratum), by adding a lighter liquid, by adding 
albumin, gelatin, milk, or paper-pulp, by fermentation, or by the subsidence 
of the particles in the form of a sediment through long standing. 



5l6 PHARMACEUTICAL OPERATIONS. 

Colation or Straining is usually a very simple operation, so familiar to 
every one of ordinary experience as to be scarcely worth describing. The 
strainers are made of cotton flannel, fine muslin, gauze, woolen felt and other 
fabrics. 

Comminution is the process by which the aggregation of the particles of 
a solid body is overcome, and the body is reduced to pieces of varying sizes. 
Its object is to increase the area of the surface exposed to the action of solvents, 
and it includes the operations of cutting, rasping, grating, crushing, stamping, 
grinding, pulverizing, triturating, levigating, elutriating, and granulating. Ap- 
paratus of various kinds, as cutters, mortars and pestles, mills, etc., are used 
for the comminution, while spatulas are employed to loosen the particles, and 
sieves to sift the coarser from the finer. These last-named contrivances are of 
five sizes, designated by the number of their meshes to the inch, 80, 60, 50, 40, 
and 20 respectively permitting the passage of powders termed very fine, fine, 
moderately fine, moderately coarse and coarse. 

Crystallization is the process which bodies undergo in passing from the 
liquid or the gaseous state to the geometrical forms called crystals. Six systems 
of crystals are recognized by crystallography, which has assumed the dignity 
of a separate science. Bodies which are not capable of crystallization are 
termed amorphous. Every crystallizable body assumes its own peculiar form, 
or some other form derived from or related to it. The process of crystallization 
is effected (1) by fusion and partial cooling, as in the cases of some metals and 
Sulphur; (2) by sublimation, as Benzoic Acid, and Mercuric Chloride; (3) by 
deposition from hot saturated solutions while cooling; .(4) by deposition from 
a solution during evaporation; (5) by deposition caused by passing a galvanic 
current through the solution; (6) by precipitation as in the case of Mercuric 
Iodide; (7) by the addition to the solution of a substance having a strong affinity 
for water, as the adding of Calcium Chloride to an aqueous solution of sodium 
chloride, or Alcohol to a solution of potassium nitrate or to an aqueous syrup. 
In a few cases amorphous solids may crystallize without undergoing liquefaction, 
as Sulphur, Barley-sugar and Iron wire. The methods most frequently em- 
ployed are those by deposition from supersaturated solutions, and by deposition 
during evaporation. The more slowly the process is carried on the larger and 
more regular will be the crystals. The process is facilitated by use of foreign 
bodies as nuclei around which the crystals are deposited; a familiar instance 
being the thread in the centre of a mass of rock-candy. 

The Water of Crystallization is the H 2 with which most substances combine in the 
act of crystallization, and the number of molecules thereof differs for each body and for the 
same body frequently under different conditions. Exsiccation is the removal of this combined 
water by heat, the crystals assuming thereby the form of a dry powder. _ Efflorescence is a similar 
process occurring spontaneously on exposure of the crystals to the air, the effloresced portion 
appearing as a dry powder on the surface of the crystals. Deliquescence, on the other hand, is 
the act of absorbing water from the atmosphere, a property possessed by some substances which 
are therefore said to be hygroscopic. 



PHARMACEUTICAL OPERATIONS. 517 

Decantation is the pouring or drawing off a supernatant liquid into another 
vessel. If done by pouring, a guiding-rod for the liquid to run on is an effective 
adjuvant; if by drawing, the siphon in some form is usually employed. 

Decoloration, or the removal of coloring-matter from liquids or from solids 
in solution, is effected by the use of animal charcoal, which in small operations 
may be arranged in a funnel or a percolator, and the liquid placed thereon. It 
should not be forgotten that charcoal absorbs many other principles besides 
coloring-matter, especially alkaloids, bitter and astringent principles, so that 
the process of decoloration may be one of serious injury to the efficiency of the 
preparation. 

Deflagration is the heating of an inorganic substance with another which 
yields oxygen (usually a nitrate or a chlorate), the result being the decomposi- 
tion of the body with violent and sudden combustion. 

Desiccation is the process of removing moisture from solids, and has for 
its object either the preservation of the substance, the reduction of its bulk or 
the facilitation of its comminution. The operation should be conducted at as 
low a temperature as possible. Roots, leaves and seeds are generally dried by 
being placed in trays of wire network and exposed to a uniform temperature 
in a room heated by steam. A better method is to suspend organic substances 
from the ceiling of an attic during warm weather; a slow process, but one which 
does not result in much loss of active volatile principles. Crystals and pre- 
cipitates require a higher temperature and are usually dried on a water-bath. 
When the water of crystallization is to be expelled, as in desiccating alum and 
ferrous sulphate, a temperature of about 400 F. is required. In absorbing 
water from alcohol Potassium Carbonate and slaked Lime heated are employed, 
and in several instances Sulphuric Acid is the desiccator used. 

Dialysis is a process by which crystallizable substances are separated from 
non-crystallizable ones, by suspending a solution containing both upon a porous 
diaphragm having its under surface in contact with water. The crystalloids 
pass through the diaphragm, while the non-crystalline remain above it, and 
are termed colloids. Examples of the latter class are gelatin, gum, glue, starch, 
dextrin, albumin and extractive matters, which are generally the inert and 
valueless constituents of vegetable drugs. Parchment-paper and bladders are 
used for the diaphragm; the whole apparatus being termed the dialyzer, while 
the water into which the crystalloids pass is called the diffusate. 

The unofficial preparation known as Dialyzed Iron (Ferrum Dialysatum) is a colloidal 
substance obtained by treating Ferric Chloride in solution with Ammonia, whereby ferric 
hydroxide is precipitated and then dissolved by agitation. The mixture being placed on a 
dialyzer, the crystalloids formed (ammonium chloride and ferric chloride), together with any 
free acid present, pass into the diffusate, leaving the neutral colloidal liquid (solution of ferric 
oxychloride) above on the septum. 

Distillation consists of two processes, the evaporation of a liquid, and the 



Sl8 PHARMACEUTICAL OPERATIONS. 

condensation of the vapor into a liquid in a separate vessel. The agent used 
in the first part of the operation is heat, in the second part cold. Its object 
is to separate mixed volatile and fixed substances, or to combine volatile sub- 
stances which cannot otherwise be mixed, as in the preparation of some of the 
Waters. The apparatus used is of great variety, from the simple retort and 
receiver to elaborate and costly stills. 

, Destructive or Dry Distillation is a process of decomposing an organic substance by 
heat into volatile products, which are collected in a separate vessel, the residue being said to be 
carbonized. It is employed only by large manufacturers, for the preparation of Acetic and 
Succinic Acids, Oil of Amber, Wood Tar, etc. 

Fractional Distillation is the separation by distillation of substances which are volatile 
at different temperatures, each being separately driven over and received in a vessel by itself. 
Different degrees of heat are successively employed in accordance with the volatilizing points 
of the substances to be obtained. 

Expression is the forcible separation of liquids from solids, by subjecting 
them to pressure. Hand-pressure through straining-cloths may be employed, 
but mechanical presses are more efficient and are coming into general use. 
Oils obtained in this manner are called expressed or fixed oils, to distinguish 
them from the volatile oils obtained by distillation. 

Exsiccation or Calcination is the process of depriving a solid of its moisture 
or other volatile constituents by the application of heat without fusion. The 
term Exsiccation is usually applied to the vaporization of the water of crystal- 
lization from a crystalline body; Calcination to such operations as the expulsion 
of carbon dioxide and water from carbonates, as in the manufacture of lime, 
and magnesia. 

Filtration is a process of straining through a medium so fine as to deliver 
the filtrate in transparent condition. The filters are made of paper usually, 
though charcoal, asbestos, sand and other articles are sometimes employed, 
being supported in a funnel of glass or other material held by the ring of a retort- 
Stand. The best filtering-paper is made in Sweden by Munktell, and is white; 
but a good paper for ordinary use is the Prat Dumas White, which should be 
employed for filtering alkaline or alkaloidal solutions. The gray French papers 
answer well enough for fluidextracts, tinctures or colored liquids, but should never 
be used for solutions containing free alkali. 

Filtering-paper is folded by doubling a sheet upon itself, and then folding it again directly 
in the middle. When opened four distinct sections appear, one of which is separated from the 
other three, and the filter thus formed is placed in a funnel. This arrangement is known as a 
plain filter, which by repeated creasing is converted into the plaited filter; the latter being the 
form generally used in pharmaceutical operations of small extent. In large laboratories 
special processes are employed with apparatus of more or less complexity for hot nitration, 
rapid filtration, etc. , 

Fusion is the process of liquefying solids by the application of high heat 
without the use of a solvent. It is employed in making ointments and plasters, 
in purifying resins, and for the purpose of decomposition. The degree of heat 
required varies from a temperature of oo° F., sufficient to melt lard in an open 
vessel, to one of 8oo° F., employed in fusing Zinc in an earthen crucible; and 



PHARMACEUTICAL OPERATIONS. 519 

may be regulated by the aid of the water-, steam- or sand-bath. The two former 
appliances limit the degree of heat applied, while the sand-bath prevents sudden 
changes in the temperature. Oil-baths and glycerin-baths are employed in 
fractional distillation. 

Granulation is a process of reducing a coarsely crystalline substance to a 
granular powder, by dissolving it in water and evaporating the solution with 
constant stirring until the product becomes perfectly dry. Many salts are thus 
treated for convenience in dispensing, as the bromide, the iodide, the carbonate 
and the citrate of potassium. Ferrous Sulphate, though generally dispensed 
in the exsiccated powder, may be granulated into minute crystals by filtering 
an aqueous solution of it into alcohol. 

Ignition in pharmacy means the process of strongly heating solids or semi- 
solid substances, the residue left being the product desired. It is used in the 
quantitative tests for phosphoric acid, ammonium phosphate and purified anti- 
mony sulphide. 

Incineration is the heating of organic substances with access of air until 
the carbon is consumed, the ash being the product desired. 

Maceration is one of the processes of extracting the soluble principles from 
drugs, and consists in steeping the comminuted substance in a suitable liquid 
called the menstruum, generally alcohol, for a period varying from 2 to 14 days, 
during which it is occasionally agitated. The liquid is then poured off, the 
residue is expressed, and the mixed liquors are filtered. Several of the official 
tinctures are prepared by this method, and many others by maceration first 
and percolation afterwards. A few active principles may be extracted by water 
alone, (e. g. morphine), and in some cases the addition of acids or alkalies to 
the water will effect the chemical solution of many ingredients which are in- 
soluble in plain water. As a rule however Alcohol is the most generally appli- 
cable of all simple solvents, but from its hardening the cell-membranes instead 
of softening them it prevents the osmosis of their contents. Drugs subjected 
to alcoholic or other menstrua should have their cells thoroughly broken or torn, 
so that the solvent may be brought into actual contact with the principles con- 
tained in them. The degree of disintegration required depends upon the size 
of the cells, ducts, tubes, intercellular spaces, etc., in which the active principles 
are enclosed. A very finely powdered state is open to objection from the pack- 
ing of the particles together into an almost impenetrable mass when treated by the 
solvent. The average size of vegetable cells is about -g-^-g- of an inch, while 
resin cells and other cavities are larger, averaging about t %q inch. The Phar- 
macopoeia prescribes in each instance the degree of fineness of the powdered 
drug employed in making certain of its preparations, or its bruising, slicing, etc., 
when such operations will answer. [Compare the article on Comminution.] 
, Percolation or Displacement is a process of obtaining the soluble con- 



I 



520 PHARMACEUTICAL OPERATIONS. 

stituents of a powdered substance by the descent of a solvent through it. 
Though an ancient process for the making of lye from wood-ashes (lixiviation), 
it has only within the last fifty years been adopted as an official process in 
pharmacy, but it is gradually taking the place of maceration as a means of extract- 
ing the soluble principles of drugs. The vessel used to hold the powdered drug is 
called the percolator, of which there are many forms employed by the manu- 
facturers. The liquid used as a solvent is called the menstruum, and when coming 
from the percolator it is termed the percolate. The U. S. Pharmacopoeia gives 
very full directions concerning this process. 

Precipitation is the process of separating solids from their solutions, and 
is usually effected by chemical reaction, though it may be accomplished by 
other methods, as by adding a second liquid in which the substance is insoluble, 
by heating albuminous solutions, or by exposing solutions of silver salts to the 
action of light. The most familiar example of chemical precipitation is the 
addition of a solution of Mercuric Chloride to one of Potassium Iodide, the 
result being a double decomposition of the salts and the formation of Mercuric 
Iodide, which falls to the bottom of the vessel as a brilliant, red, insoluble and 
crystalline powder. The precipitate is the separated substance, which is usually 
thrown down, but it remains suspended in some cases, and in others it rises 
to the top. The precipitant is the substance which is added to produce the 
precipitation. A magma is a thick, tenacious precipitant remaining behind 
after the supernatant liquid is removed by decantation or otherwise. Precipi- 
tates are termed flocculent, gelatinous, curdy, granular, crystalline, etc., according to 
the forms assumed. In small operations they are usually collected on plain 
niters, and washed by the repeated addition of water. 

Separation of liquids which do not mix with each other is a simple mechan- 
ical process performed with pipettes of various forms, or with funnels having 
stop-cocks in their necks. Special forms of receivers are used for the separation 
of volatile oils from the water which may accompany them during distillation. 

Solution is the dissolving of a solid or gaseous substance in a liquid, and 
may be simple when the substance undergoes no alteration, being recovered 
unchanged on evaporation; or chemical when the dissolved body is chemically 
altered by the solvent or some other substance present, and cannot be recovered 
on evaporation. Syrup is an instance of simple solution, the Syrup of Lime one 
of chemical solution. The liquid employed is termed a solvent before the sub- 
stance is added to it, after the operation is completed the combined preparation 
is called a solution. If fully charged with the dissolved substance so that it 
will retain no more, it is known as a saturated solution. One liquid may be dis- 
solved in another, or a gas may be dissolved in a liquid. The solution of solids 
is greatly facilitated by pulverization and by stirring the menstruum. Heat 
generally aids solution, most substances being more soluble in hot liquids than 
in cold ones. A saturated solution of one substance may still be capable of 



PHARMACEUTICAL OPERATIONS. 52 1 

dissolving others. Rapid solution of solids without chemical change causes 
reduction of temperature, while chemical solution produces elevated temperature. 
Circulatory Solution is performed by suspending the substance to be dissolved 
near the surface of the solvent in a gauze bag or on a porous shelf. The portion 
first acted on descends and produces a circulatory movement in the fluid, facili- 
tating the solution of the whole. 

Solvents employed are chiefly Water, Alcohol, Glycerin, Acids, and Oils. Others less 
frequently used are Ether, Chloroform, Benzin and Carbon Disulphide. 

Sublimation is the distillation of a volatile solid, the product being termed 
a sublimate. Its objects are to purify volatile solids from impurities and to 
collect such as result from chemical action at high temperatures. The operation 
is carried on in iron, glass or stoneware retorts, and results in cake sublimates 
or powder sublimates according as the temperature of the condensing surface 
is high or low. 

Testing and Assay are directed by the Pharmacopoeia in certain cases, 
for the purpose of determining the identity and purity of its drugs and their 
preparations. The Pharmacopoeia contains a very complete section on Rea- 
gents, in which full directions are given for the preparation and use of Test 
solutions and Volumetric solutions; also instructions for Gasometric estimations, 
for the determination of the Optical Rotation of organic substances, and for 
Alkaloidal Assay by immiscible solvents. 

Pharmacopoeial testing and the volumetric method of determination are 
necessary to the work of the practical pharmacist, and as the apparatus used is 
simple and the operations are those in the line of his daily work, he should be 
familiar with them. On the other hand the proximate analysis of organic 
substances for their principles, and the ultimate analysis of the same bodies 
for their elements, require a high degree of skill and long experience, and 
should be left to the professional chemist. 

The apparatus used in testing consists of graduated flasks and jars, burettes, 
pipettes, funnels, beakers, test-tubes, capsules, crucibles, reagent-bottles, etc. 
The metric system is directed for all work, and the apparatus employed should 
be graduated accordingly. 

Torrefaction or Roasting is the application of heat, in a less degree than 
for carbonization, to an organic substance for the purpose of modifying some 
of its constituents, as in the roasting of coffee and of rhubarb. The latter sub- 
stance, when subjected to this process, loses its cathartic properties, but retains 
its astringency, and is known as Torrefied Rhubarb. 

Trituration is the comminution of a solid to an extremely fine powder by 
continued rubbing in a wedgewood mortar with an inert and gritty powder, 
Sugar of Milk being the substance directed to be used. The product is called 
a Trituration (see that title under Official Preparations) . The surfaces of 
the mortar and pestle-head should coincide closely, and the thorough comminu- 



I 



522 PHARMACEUTICAL OPEFA.TIONS. 

tion of the trituration is best accomplished by a circular motion of the pestle 
in gradually increasing circles, until the side of the mortar is reached, then 
reversing the motion and gradually lessening the circles until the pestle reaches 
the centre again. The process is greatly facilitated by having the pestle attached 
to a long handle playing in an opening made in a piece of wood nailed at a 
convenient height. A weight may be fixed on top of the handle if a greater 
degree of friction is desired. 

Pulverization by Intervention is only another name for trituration when performed in 
a mortar and with solid bodies, the foreign substance used being subsequently removed. 
Potassium Sulphate may be employed as the medium for the pulverization of Gold and then 
dissolved out by water. Alcohol or Chloroform may be added to Camphor to aid its pulveriza- 
tion, and then removed by evaporation. Phosphorus may be pulverized by placing it in 
water, gently heating the latter until the phosphorus is melted, and agitating the whole while 
cooling. 

Levigation is the trituration of a substance made into paste with water or some other 
liquid, and resembles the old process of grinding oil paints by hand on a slab of stone. The 
process is used for coarse materials, as chalk, where the refuse is rejected, or for such substances 
as red mercuric oxide, and zinc oxide. When performed with a porphyry slab and muller it is 
termed Porphyrization. 

Elutriation is a water-sifting process for separating the coarser particles of insoluble sub 
stances from the finer. The substance is mixed with water and after the larger particles have 
fallen to the bottom, the liquid is decanted into another vessel, in which the light and powdery 
particles are collected. 

Vaporization includes the various operations by which volatile matters are 
separated from fixed substances or from other matters which are less volatile, 
heat at varying temperatures being the agent used. The operations under this 
head are — Evaporation, Distillation, Desiccation, and Sublimation, the last three 
of which have been described. 

Evapopation in pharmacy is the process by which the more volatile con- 
stituents of a liquid are driven off by heat for the purpose of reducing its volume 
or purifying it, as in the preparation of extracts and fluidextracts, and the crys- 
tallization of salts. The vessels used should be shallow so as to expose a large 
surface of the liquid to the atmosphere. The heat used may be regulated by 
a water-bath, a steam-bath or a sand-bath, and ordinarily should be kept below 
but near to the boiling point of the liquid treated. As organic substances are 
usually injured by long heating, small portions only of vegetable preparations 
should be subjected to this process, and the liquid should be frequently stirred 
in order to hasten the operation. In large laboratories vacuum-pans are em- 
ployed to remove the atmospheric pressure, enabling the evaporation to be 
accomplished at a much lower degree of heat than if the liquid were exposed 
to the air. Ebullition (boiling) is a form of evaporation. 

Spontaneous Evaporation is the evaporation of a liquid without the direct application 
of strong heat, but at the temperature of the room or closet used for the purpose. It is especial- 
ly applicable to cases in which the residue is liable to injury or loss from much heat, or to 
secure finer crystals than can be obtained by the quick evaporation of their solution. 

Washing is a simple mechanical process for separating soluble from in- 
soluble matter, by pouring upon it a liquid which will dissolve the soluble por- 
tion. Various methods of doing this are in vogue and are often dignified with 



PHARMACEUTICAL PREPARATIONS. 523 

very high-sounding terms, as Lotion, Affusion, and Ablution. An ordinary 
wash-bottle, with two glass tubes perforating the cork, is a convenient imple- 
ment for directing a continuous stream upon a precipitate, while for continuous 
washing a combination of bottles with a funnel may be used. 



PREPARATIONS. 



Official Preparations may be presented under various methods of classi- 
fication, one of the simplest being that which divides them into liquids and 
solids, the former being subdivided into groups named after their principal 
bases, viz.: — 

Liquid Preparations. 

Acetous Preparations, — the Vinegar, one in number. 

Alcoholic, — Fluidextracts, Tinctures, Spirits, Elixirs, and one Oleoresin, that of Cubeb; 
one Liniment, that of Belladonna. 

Aqueous, — Waters, Solutions, Infusions, Decoctions, Syrups, Honeys, Mucilages, Emul- 
sions, Mixtures; the last five containing sweet or viscid substances. 

Ethereal, — Collodions and Oleoresins . 

Glycerines, — Glycerites, five in number. 

Oleaginous, — Liniments, except that of Belladonna; also the Oleate, one in number. 

Serums, — Two in number. 

Solid Preparations. 

Cerates. Masses. Pills. Powders. Suppositories. Troches. 

Extracts. Ointments. Plasters. Resins. Trituration. 

In the following descriptions of the pharmaceutical groups the composition 
and dosage of the various preparations are omitted, as they are fully detailed 
in the section on Materia Medica, under the title of the principal constituent 
in each case. 

PHARMACEUTICAL PREPARATIONS. 

Pharmaceutical Preparations include the pharmacopceial (official) ones, 
also those of extemporaneous pharmacy (unofficial) . Both classes are described 
together in alphabetical order, for the sake of easy reference. 

Aceta, Vinegars, — are solutions of the active principles of certain drugs in 
diluted Acetic Acid. They are made by maceration and straining, and each 
one contains the soluble principles from 10 per cent, of drug. Acidulous men- 
strua form soluble salts with the alkaloids. 

One Vinegar is official, viz: — 
Acetum Scillae, — used in preparation Syrupus Scillae. 

Aquae, Waters, — are aqueous solutions of volatile substances, which may 
be solids, liquids or gases, dissolved by solution in cold or hot water, by filtration 
through an absorbent powder, by percolation through cotton saturated with the 



524 PHARMACEUTICAL PREPARATIONS. 

substance, or by distillation. All waters deteriorate when long kept, microscopic 

plants being propagated in them from spores derived from the atmosphere. 

They should be prepared only in such quantities as are needed for immediate 

use. The official waters number 19, including three forms of Aqua itself, 

viz. : — 

Aqua. Aqua Chloroformi. 

Aqua Destillata. Aqua Cinnamomi. 

Aqua Destillata Sterilisata. Aqua Creosoti. 

Aqua Ammoniae. Aqua Foeniculi. 

Aqua Ammoniae Fortior. Aqua Hamamelidis. 

Aqua Amygdalae Amarae. Aqua Menthae Piperitae. 

Aqua Anisi. Aqua Menthae Viridis. 

Aqua Aurantii Florum. • Aqua Rosae. 

Aqua Aurantii Florum Fortior. Aqua Rosas Fortior. 
Aqua Camphorae. 

Of the above 5 are prepared by simple solution, 2 by passing gases through water, 5 by 
distillation, and 6 by trituration of the medicament with purified talc, addition of water 
and nitration. 

Aquae Aromaticae, Aromatic Waters, — are aqueous preparations made 
from volatile oils and are intended to be practically saturated aqueous 
solutions of volatile oils free from solid impurities. 

Balnea, Baths (Unofficial). Baths are often medicated, and then become 
medicinal preparations. The ingredients only are ordered in a prescription, 
as in the following examples, each of which is intended for a bath of 20 to 30 
gallons: — 



Balneum Acidi Nitrohydrochlorici. 
J\. Acidi Nitrici, 

Acidi Hydrochlorici, aa 5 j. 

M. Sig. — Use with 30 gallons of hot 
water, as a bath. 



Balneum Sulphuris Compositum. 

1$. Sulphuris Praecip., o ij« 

Sodii Hyposulphitis, % j. 

Acidi Sulphurici Dil., B ss. 

Aquae, O j. 

M. Sig. — For a 30-gallon bath. 



Capsular, Capsules (Unofficial). Gelatin Capsules of various sizes from 
o to 10 are to be obtained in the drug-stores. They are a convenient means 
of. administering oils or nauseous solids, and when filled may be swallowed as 
easily as a large pill. Soluble Elastic Capsules are also prepared, each con- 
taining an ordinary dose of such medicines as castor oil and cod-liver oil. The 
largest of these capsules makes a bolus which may be swallowed with a little 
effort, as it is quite compressible and changes its shape to suit the calibre of 
the passage. The ordinary capsules are easily filled by the aid of a paper 
funnel, and the end of a pen-holder as a packer; but simple devices (capsule- 
fillers) for facilitating the operation may be purchased. 



ty. Pulv. Opii, gr. x. 

Pulv. Camphorae, gr. xx. 

Sacch. Alb., q. s. 
Triturat., et fiant capsulae x. 
Sig. — One at bedtime for chordee; repeat 
in two hours if necessary. 



]$. Copaibae, 5 jss. 

Oleoresinae Cubebae, 3 ss. 

M., et fiant capsulae xij. 

Sig. — Two capsules to be taken three 
times daily, soon after meals, for gonor- 
rhea. 



Cataplasmata, Poultices (Unofficial), — are usually prepared at the resi- 
dence of the patient, the ingredients only being ordered from the druggist. 



PHARMACEUTICAL PREPARATIONS. 525 

They are generally employed as a means of applying heat and moisture to 
a certain portion of the body, but are sometimes medicated with anodyne, 
counter-irritant or disinfectant agents. An excellent method of preparing 
poultices is to make several bags of various sizes, of either of the fabrics 
known as Swiss and Cheese-cloth, filling each bag half full with the linseed 
meal or other agent used, then sewing up the open end. When wanted for 
use one of these bags is submerged in boiling water for a few minutes, and 
on taking it out the meal is found to have swelled so as to fill the bag, which 
should then be squeezed to rid it of superfluous water, laid on the part and 
covered with oiled silk and a bandage. 

The ordinary filthy poultice of flaxseed, slippery elm, bread and milk, has 
no place among the resources of the aseptic surgeon. The common poultice is 
a hot-bed for bacteria, and as such, it should be discarded. In the treatment 
of an ordinary furuncle with poultices, almost every surgeon must have seen 
occasionally the development of innumerable minute daughter-furuncles in the 
surface covered by the poultice. In phlegmonous inflammation of the fingers 
or hand, the prolonged use of the poultice is followed by maceration of the skin, 
extensive edema of the superficial structures, a flabby condition of the granula- 
tion — in fact all the evidences which point to the poultice as a means of favoring 
the extension of the infectious process (Senn). If moist heat is required a 
compress of sterile gauze moistened with warm 1-2000 Bichloride of Mercury 
solution can be applied to the skin covered with wax paper or oiled silk, and 
this kept warm by a hot water bottle. For all ordinary purposes the hot 
water bottle suitably protected furnishes the best method of applying heat 
locally. 

A Sinapism is a poultice or plaster containing Mustard (Sinapis) , used for 
the purpose of counterirritation. If applied too hot and kept on too long the 
skin will become inflamed and ulcerated, and extensive gangrenous sores may 
result. 

No cataplasm is official. Cataplasma Kaolin (U. S. P. VIII) in which 
Kaolin and glycerin were the active agents has been discarded. 

Cerata, Cerates, — are unctuous preparations similar to ointments, but of a 
much finer consistence. They all contain Wax (cera), and do not melt at tem- 
peratures below 104 F. They are intended for external use, and are generally 
spread on lint before being applied. There are 3 official Cerates, including 
Cera turn itself, which is made by fusing together 30 of white wax, 70 of ben- 
zoinated lard, but for use in southern latitudes and during the heated season 
in other localities 5 of the lard (or more if necessary) may be replaced by an 
equal quantity of white wax. The composition of the others may be found 
in the section on MateriaMedica under the appropriate titles, but the figures 
in parentheses below give the percentage of drug to basis in each. 

Cera turn. Ceratum Resinae (35). 

Cefatum Cantharidis (35). 



526 PHARMACEUTICAL PREPARATIONS. 

Chart®, Papers, — consist of strips of paper medicated by impregnation of 
its fibres with medicinal substances or by being coated therewith. Charta 
Sinapis in 8th Rev. U. S. P. is no longer official as such but more correctly 
as Emplastrum Sinapis (U. S. P. IX). The formerly official Charta Potassii 
Nitratis, is unsized paper impregnated with nitre and intended for the in- 
halation of its fumes while burning. 

Collodia, Collodions, — are liquid preparations having for their base a solu- 
tion of Pyroxylin in a mixture of Ether and Alcohol. They are intended for 
external use, being applied to the skin by means of a brush, producing a film on 
the surface after the evaportion of the menstruum. There are 3 official Collo- 
dions, viz.: — 

Collodium. Collodium Flexile. 

Collodium Cantharidatum. 
The Flexible Collodion contains 2 per cent. Camphor and 3 per cent, of Castor Oil. 

Confectiones, Confections (None Official), — consist of medicinal sub- 
stances formed into a mass with Sugar, Honey, Water, etc., with the object 
of rendering them palatable and preserving them from change. Electuaries 
are similar preparations, but this term is now obsolete. There were two 
official Confections in U. S. P. VIII, viz: — 

Confectio Rosae. Confectio Sennae. 

Confections and Electuaries are very seldom prescribed, and this accounts 
for their absence in U. S. P. IX. A few old formulae for such preparations 
are given below as pharmaceutical curios. The first is a meritorious pre- 
scription, the second is said to have been purchased by Lord Anson for the 
sum of £300. 



Electuary for Piles. 
]$. Potassii Bitartratis, 
Potassii Nitratis, 

Pulv. Jalapae, aa S ss. 

Confectionis Sennas, % j. 

Syrupi Zingiberis, q. s. 
M. Fiat electuarium. 
Sig. — A piece the size of a marble to be 
taken thrice daily. 



The Chelsea Pensioner. 

1$. Sulphuris Loti, o ij. 

Potassii Bitart, § j. 

Pulv. Rhei, 3 ij. 

Guaiaci Resinae, 5 j. 

Mellis Depurat., lb j. 

Myristicam Pulv., j. 

M. Fiat electuarium. 
Sig. — A dessertspoonful twice daily, as a 
laxative in chronic rheumatism. 



Confectio Damocratis. 
[Of Historic Interest Only.] 
[An ingredient of Warburg's Tincture.] 
This preparation was official in the London Pharmacopoeia of 1745. It contained 1 grain 
of Opium in §ss, and consisted of 45 ingredients, as follows, viz.: Cinnamon, 14 parts; Myrrh, 
n parts;— White Agaric, Spikenard, Ginger, Spanish Saffron, Treacle, Mustard Seed, Frank- 
incense and Chian Turpentine, of each 10 parts; — Camel's Hay, Costus Arabacus, Zedoary, 
Indian leaf, Mace, French Lavender, Long Pepper, Seeds of Harwort, Juice of ripe Cistus, 
strained Storax, Opponex, strained Galbanum, Balsam of Gilead, Oil of Nutmeg, Russian 
Castor, of each 8 parts; — Water Germunder, Balsam-tree Fruit, Cubeb, White Pepper, Seeds 
of Cretian Carrot, Poley Mont, strained Bdellium, of each 7 parts; — Gentian root, Celtic 
Hard, Leaves of Dittany of Crete, Red Rose, Seeds of Macedonium, Parsley, Sweet Fennel 
Seeds, Seeds of Lesser Cardamom, Gum Arabic, Opium, of each 5 parts;— Sweet Flag, Wild 



PHARMACEUTICAL PREPARATIONS. 527 

Valerian, Anise-seed, Sagapenum, of each 3 parts; — Spigrul, St. John's Wort, Juice of Acacia, 
Catechu, Dried Bellies of Skunk, of each 2\ parts; — the roots finely powdered and the whole 
mixed thoroughly into a paste with Clarified Honey. 

Decocta, Decoctions, — are made by boiling vegetable substances with water. 
As very few drugs contain active ingredients which are not injured by heat, 
these preparations have never obtained favor with scientific physicians. The 
official general formula for Decoctions prescribes that when the strength is not 
directed by the physician, nor specified by the Pharmacopoeia, they shall be 
prepared in the proportion of 5 grammes of the substance with 100 Cc. of water; 
but that the strength of decoctions of energetic or powerful substances should 
be specially prescribed by the physician. 

Elixiria, Elixirs, — are sweetened, aromatic, and spirituous preparations, 
containing active medicinal substances in small quantities. There are 2 official 
Elixirs, viz.: — 

Elixir Aromaticum. Elixir Glycyrrhizae (Elixir Adjuvans, U. S. P. VIII). 

The latter is a mixture of Licorice and Elixir Aromaticum. The first 
named is intended to represent a type of the large class of elixirs employed 
in manufacturing and extemporaneous pharmacy. It is practically an alcohol- 
ized syrup, flavored with Orange, and is designed for use as an excipient for 
extracts, tinctures, salts, etc. The manufacturers have put on the market a 
great variety of elixirs, and most druggists keep a stock of them on hand pre- 
pared in the shop; but they may be ordered by prescription just as any other 
mixture would be. The substances generally used in this form are — 

Arsenic. Hydrated Chloral. Ferric Phosphate. 

Bismuth. Coca. Ferric Pyrophosphate. 

Ammonium Bromide. Gentian. Quinine Phosphate. 

Lithium Bromide. Guarana. Strychnine Phosphate. 

Potassium Bromide. Ammonium Valerate. Pepsin. 

Calisaya Bark. Ferric Chloride. Taraxacum. 

Many of these agents may be combined with one another, as the Elixir of Bismuth and 
Strychnine; Elixir of Calisaya, Iron and Strychnine; Elixir of Gentian with Tincture of Chloride 
of Iron; Elixir of Iron, Quinine and Strychnine Phosphates. 

Emplastra, Plasters, — are solid compounds, insoluble in water, of a tena- 
cious but pliable consistence and intended for external application to limited 
areas of the body surface. They are prepared by incorporating medicinal sub- 
stances with certain bases, which are usually Lead Plaster or Rubber Plaster. 
The heat employed should be low, to avoid decomposing the active agents, and 
should not be continued long enough to drive off any volatile constituents. 
The plaster mass is then spread on chamois skin, kid skin or muslin. The con- 
stituents of the following-named 7 official Plasters may be found in the section on 
Materia Medica, under their appropriate headings. 

Emplastrum Belladonnae. Emplastrum Elasticum. Emplastrum Sinapis (Charta 
Emplastrum Cantharidis. Emplastrum Plumbi. Sinapis, U. S. P. VIII). 

Emplastrum Capsici. Emplastrum Resinae. 

Plasters are rarely prepared extemporaneously, the official and many others 



52 8 PHARMACEUTICAL PREPARATIONS. 

being produced on a large scale by the manufacturers, and are kept in stock 
by all druggists. As a consequence the compounding and spreading of a plaster 
by the pharmaceutist has become a lost art. The official plasters may be ordered 
by prescription in the manner illustrated below. Blisters may be produced by 
the application of any preparation of Cantharides sufficiently strong for the 
purpose. The official Cerate of Cantharides may be spread on adhesive plaster 
making a blistering plaster, or Cantharidal Collodion may be painted over the 
surface. Plasters are usually ordered by the square inch, but a diagram of the 
shape and size may be drawn on paper, and the plaster be directed to conform 
thereto, as in the first following prescription. 



Emplastrum Vesicatorium. 
1$. Cerati Cantharidis, q. s. 

Extende supra Emplastrum Adhaesivum 
hujus formae et magnitudinis. 

Sig. — Blistering Plaster, to be applied over 
the region of the heart. 



Counter-irritant and Anodyne. 
1$. Emplastri Sinapis, 

Emplas. Belladonnae, aa 3" X 6". 
Sig. — Apply the mustard paper first, to 
be followed by the plaster when the surface 
has been well reddened. 



> 



Emulsa, Emulsions, — are aqueous, liquid preparations containing an in- 
soluble medicinal substance, as an oil or a resin, in a state of minute subdivision, 
and suspended by the aid of some viscid excipient, as gum, which may be con- 
tained in the medicinal ingredient itself (e. g., asafcetida), or may be added by 
the pharmaceutist. The official Emulsions are 4 in number, viz. — 

Emulsum Amygdalae. Emulsum Olei Morrhuae. 

Emulsum Asafoetidae. Emulsum Olei Terebinthinae. 

Natural Emulsions comprise two classes of substances, — (1) those emulsions 
which exist ready formed in nature, as milk, yolk of egg, the milk juices of 
plants, etc., and (2) the mixtures formed by rubbing up gum-resins (as ammo- 
niacum, myrrh, asafcetida) with water. Each of these substances contains, 
together with its resin, enough gum to make a perfect emulsion when triturated 
with water. The manufactured emulsions are simply imitations of the natural 
ones, sufficient gum being added in case of a resinous substance to cause its 
suspension in the aqueous diluent. 

Emulsification consists in the division of the oily or resinous substance into 
very minute globules, and the surrounding of each globule with a thin envelope 
of the excipient. If properly done the globules will remain mechanically sus- 
pended in the water, without any tendency towards recombination. Milk is 
the best illustration of a natural emulsion, its butter existing in the aqueous 
portion as very minute globules, each surrounded by a thin film of casein. Yolk 
of Egg is a dense emulsion, consisting of oil suspended in water by means of 
albumin. 

Excipients which may be used for emulsification are the following, arranged 

in the order of their most frequent employment, viz. — 

Mucilage of Acacia, — used for oils and resins. Powdered Acacia is even better, being 
made into a mucilage by the process of emulsification; such a mucilage having the advantage 
of being perfectly fresh when incorporated with the other ingredients. To give good results 
the following proportions in parts by weight should be used, — 



PHARMACEUTICAL PREPARATIONS. 529 

Gum Acacia. Water. 

1 part of Fixed Oil or Copaiba requires, £ J 

1 " " Balsam of Peru " 2 i\ 

1 " " Oil of Turpentine " 1 1 

Mucilage of Tragacanth, — may be used for oils and resins, but it has not proved so 
satisfactory as the preceding. The same may be said of powdered Tragacanth. 

Vitellus, Yolk of Egg, — is an excellent agent for emulsifying oils, but mixtures made with 
it must be used within a few days, as they will not keep long. One yolk will emulsionize an 
ounce of fixed oil, and is about equal to half an ounce of acacia. It is best suited to emulsions 
of cod-liver oil intended for immediate administration. 

Liquor Potassii Hydroxidi, — may be used for oils, the resulting compound being how- 
ever a soap rather than an emulsion. Copaiba is usually emulsified by using both a gum and 
an alkali; a similar process being employed for many of the fixed oils. 

Tincture of Senega, — will emulsify fats and oils very efficiently, even in very small 
quantities, xtyx emulsifying an ounce of fixed oil. 

Tincture of Quillaja (Soap-bark), — is a good emulsifier of oils, and is much used in 
Europe for this purpose. 

Milk, — is used to emulsify Scammony in the Mistura Scammonii, which was formerly 
official in the British Pharmacopoeia. 

Syrups, Confections and Extracts, — may be used in making emulsions, but are rarely 
so employed. 

The method of preparing an emulsion which experience has shown to be 
the best is as follows: — Add the oil, resin, etc., to a proper quantity of the ex- 
cipient and mix both in a mortar. Then add enough water to equal one-half 
the weight of the previous mixture, and triturate the whole rapidly and un- 
ceasingly until the emulsion is homogeneous and of a whitish color. Next, add 
the remainder of the water slowly, with continual stirring; finally incorporating 
the other ingredients, if any. 

Emulsions are sometimes flavored and at the same time colored with such 
a preparation as the Compound Tincture of Cardamom, but they present a 
better appearance when white. Alcoholic preparations should not be added in 
large quantity to emulsions made with acacia or yolk of egg, as alcohol will 
precipitate the emulsifying agent. Volatile Oils require admixture with a fixed 
oil before being made into an emulsion. Soluble salts should never be pre- 
scribed with emulsions of oils. Acids are incompatible with mixtures which 
have been emulisfied by an alkali. Mucilage used for emulsions should always 
be freshly prepared. 

The following examples of prescriptions for emulsions will represent those 
generally met with, but an official formula differing from the first is given in 
the pharmacopoeia. 



Cod-Liver Oil Emulsion. 

]$. Olei Morrhuae, §ij. 

Vini Albi, B jss. 

Acidi Phosphorici Dil., 5iij- 

Syrupi, 3 v. 

Vitellum, 3. 

Aq. Amygd. Amar., q.s. ad. . 5 viij. 
Misce, et flat emulsum 



Alkaline Emulsion of Copaiba. 
R. Copaibae, 

Liq. Potassii Hydroxidi,. .aa 3ij. 
Misce, et adde — 
Pulv. Acacias, 

Pulv. Sacchari, aa 3ij- 

Aq. Menth. Viridis, q. s. ad.. §iv. 
Misce, et fiat emulsum. 



Sig. — Tablespoonful doses as directed. I Sig. — Tablespoonful doses. 

34 



530 PHARMACEUTICAL PREPARATIONS. 

Extracta. Extracts are solid or semisolid preparations obtained by 
evaporating solutions of vegetable principles and may be divided, according 
to their consistency, into Pilular Extracts and Powdered Extracts. 

Pilular extracts are of a soft consistency and contain more or less moisture. 
Unless kept in well-sealed containers they absorb moisture and hence are 
weakened or in dry climates undergo concentration due to evaporation of 
moisture. It will be readily seen the difficulty, unless well preserved, of 
keeping a pilular extract of uniform and fixed strength. Pilular extracts, be- 
cause of their consistency, are adapted for use in pill masses and ointments. 

Powdered extracts differ from pilular extracts in that the moisture has been 
removed, resulting in a finished product which is dry and fine. They should 
be preserved with care and are preferred in making preparations and com- 
pounding prescriptions because they can be more easily and accurately 
weighed and dispensed. The process of manufacture of extracts, although 
differing in details with each drug, on the whole involves the powdered drug, 
being macerated or percolated with a suitable menstruum or solvent which 
will extract the greatest amount of active principle with the least amount of 
inert matter and extractive. The menstrua employed are, alcohol, water, or 
a mixture of the two in varying proportions. Some of the drugs require, for 
the removal of the active substance, the addition of an acid or alkali to the 
solvent. The percolate is then concentrated by evaporation and distillation 
as speedily as possible without subjecting the product to a degree of heat 
which will impair or destroy the activity of the finished product. This is 
best accomplished under reduced atmospheric pressure. 

Twenty-five extracts are official: 14 as powdered extracts; 8 as pilular ex- 
tracts (malt extract, honey-like consistency) ; 2 both in powdered and pilular 
form and one, the commercial extract of licorice, in flattened rolls or in masses. 
The official extracts are named as follows: — ■ 

Extractum Aconiti (P. W.).* Ext. Glycyrrhizae (Commercial ext). 

Ext. Belladonna? Folorium (P. L. & P. W.). Ext. Glycyrrhizas Purum (P. L.). 

Ext. Cannabis (P. L.).f Ext. Hydrastis (P. W.). 

Ext. Cascarae Sagradse (P. W.). Ext. Hyoscyami (P. L.). 

Ext. Cimicifuguae (P. W.). Ext. Malti (Honey-like consistency). 

Ext. Colchi Cormi (P. W.). Ext. Nucis Vomicae (P. W.). 

Ext. Colocynthidis (P. W.). Ext. Opii (P. W.). 

Ext. Colocynthidis Compositum (P. W.). Ext. Physostigmatis (P. W.). 

Ext. Ergotee (P. L.). Ext. Rhei (P. W.). 

Ext. Fellis Bovis (P. W.). Ext. Stramonii (P. W. & P. L.). 

Ext. Gelsemii (P. W.). Ext. Sumbul (P. L.). 

Ext. Gentianae (P. L.). Ext. Taraxaci (P. L.). 

Ext. Viburni Prunifolii (P. W.). 
Alkaloid standards have been adopted by U. S. P. IX, Rev., for Extracts that can be 
reliably assayed. 

Assay processes have been provided for ten drugs. 

The Proximate Principles generally present in extracts, besides the peculiar 
principles of plants, are sugar, tannin, extractive, chlorophyll, coloring-matter 
* P. W— Powdered extract, f P. L.— Pilular extract. 



PHARMACEUTICAL PREPARATIONS. 53 1 

and salts. When an alcoholic solvent is used there are also present resins, fats 
and often a volatile oil, and when the menstruum is not purely alcoholic there 
is more or less of gum and starch. One of these ingredients, named Extractive 
or Apotheme, is a deposit, soluble in water and alcohol, which has the singular 
property of passing into an insoluble substance under the influence of the at- 
mospheric air with heat. It also has a tendency, when precipitated from solu- 
tions, to unite with other principles carrying them down with it. . It is frequently 
present in extracts, hence its name. 

Fluidextracta, Fluidextracts, — are concentrated solutions of vegetable 
drugs, of uniformly definite strength if the crude drugs are so, a cubic centi- 
meter (Tfl, 16.23) m eacn case representing the medicinal powers of one 
gramme (gr. 15.43) of the drug, or approximately a minim of the finished 
preparation representing the active constituents of a grain of the drug. They 
are officially directed to be prepared from one of the processes herewith 
described. 

Type Process A. In this class are included those fluidextracts that are 
made with a menstruum of alcohol or a mixture of alcohol and water by the 
usual process of percolation. 

Type Process B. In this class are included those fluidextracts in which 
glycerin or an acid is used in the extraction and the two menstrua are suc- 
cessively employed. Menstruum I contains the glycerin or acid in a definite 
proportion to the amount of the drug and Menstruum II a mixture of alcohol 
and water intended-for completing the exhaustion of the drug. 

Type Process C. The process of fractional or divided percolation. This 
is especially recommended for drugs containing volatile ingredients or con- 
stituents injured by exposure to heat. This process may likewise be used as 
an alternative process in the formulas in which Type Process A is directed. 

Type Process D. In this class are included those fluidextracts in which 
extraction is effected by infusion and percolation with boiling water, alcohol 
being added to the concentrated liquid as a preservative. 

In the preparation of fluidextracts the directions appear under each fluid- 
extract in the Pharmacopoeia. The Type Processes are described in detail 
in the Pharmacopoeia and must be implicitly followed in order to obtain the 
best results. The process directed in each case is intended to be that which 
will thoroughly extract all the active constituents of the drug and at the same 
time leave the inert soluble matters behind in the rejected portion known as 
the marc. The official fluidextracts number 49 and are named in the follow- 
ing list: 

Assay processes are provided for: Fluidextracts of Aconite, Belladonna Root, Cannabis, 
Cinchona, Colchicum Seed, Digitalis, Guarana, Hydrastis, Hyoscyamus, Ipecac, Nux 
Vomica, Pilocarpine, Squill. 



532 



PHARMACEUTICAL PREPARATIONS. 



Fluidextractum Aconiti. 
Fluidextr. Aromaticum. 
Fluidextr. Aspidospermatis. 
Fluidextr. Aurantii Amari. 
Fluidextr. Belladonnae Radicis. 
Fluidextr. Buchu. 
Fluidextr. Cannabis. 
Fluidextr. Cascara Sagradae. 
Fluidextr. Cascara Sagradae 

Aromaticum. 
Fluidextr. Cimicifugae. 
Fluidextr. Cinchonas. 
Fluidextr. Colchici Seminis. 
Fluidextr. Digitalis. 
Fluidextr. Ergotae. 
Fluidextr. Eriodicfcyi. 
Fluidextr. Eucalpyti. 



Fluidextr. Frangulae. 
Fluidextr. Gelsemii. 
Fluidextr. Gentianae. 
Fluidextr. Glycyrrhizae. 
Fluidextr. Granati. 
Fluidextr. Grindeliae. 
Fluidextr. Guaranae. 
Fluidextr. Hydrastis. 
Fluidextr. Hyoscyami. 
Fluidextr. Ipecacuanhae. 
Fluidextr. Lobeliae. 
Fluidextr. Nucis Vomicae. 
Fluidextr. Pilocarpi. 
Fluidextr. Podophylli. 
Fluidextr. Rhei. 
Fluidextr. Rosae. 
Fluidextr. Sabal. 



Fluidextr. Sarsaparillae. 
Fluidextr. Sarsaparillae Comp. 
Fluidextr. Scillae. 
Fluidextr. Senegae. 
Fluidextr. Sennae. 
Fluidextr. Spigeliae. 
Fluidextr. Staphisagriae. 
Fluidextr. Stillingiae. 
Fluidextr. Sumbul. 
Fluidextr. Taraxaci. 
Fluidextr. Tritici. 
Fluidextr. Uvae Ursi. 
Fluidextr. Veratri Viridis. 
Fluidextr. Viburni Prunifolii. 
Fluidextr. Xanthoxyli. 
Fluidextr. Zingiberis. 



Gargarisma, A Gargle (Unofficial), — is a mixture or solution for appli- 
cation to the pharynx or the mouth (mouth-wash). It should not contain 
any very active drug, which would produce dangerous symptoms if swallowed, 
or any agent which would injure the teeth or the mucous membrane. Gargles 
are ordered and compounded in the same manner as mixtures. They usually 
contain astringent or disinfecting salts (alum, borax, potassium chlorate, zinc 
sulphate), with a vegetable astringent and often honey. The following formulae 
will illustrate prescriptions of this class: — 



B). Tinct. Guaiaci Ammoniatae, 

Tinct. Cinchonae Comp aa 5 ss. 

Mellis, § jss. 

Bene simul agita, et adde — 

Potassii Cbloratis, 3 ijsjs. 

Aquae, q. s., ad 5 viij. 

Fiat gargarisma. Sig. — Gargle. 



1$. Aluminis, 3ij. 

Granati Corticis, 3iv. 

Petal. Rosae Rubr, 5 j. 

Mellis,.... gj. 

Aquae Bullientis, 5vj. 

M. Sig. — Gargle. 

(Goddard.) 



Glycerita, Glycerites, — are mixtures of medicinal substances with Glycerin, 
in which some of them are dissolved. They are very useful preparations for 
dispensing purposes, as they can be readily diluted with water or alcohol without 
precipitation. There are 6 official Glycerites, the figures following their names 
in the list below indicating the percentage of drug in each. The Glycerite of 
Starch contains io per cent, of water, and that of Hydrastis has for its men- 
struum a mixture of glycerin, alcohol and water. 



Glyceritum Acidi Tannici (20). 
Glyceritum Amyli (10). 
Glyceritum Boroglycerini (31). 



Glyceritum Hydrastis (100). 
Glyceritum Phenolis (20). 



Haustus, A Draught (Unofficial), — is an extemporaneous mixture consist- 
ing of a single dose, and usually ordered in a vial containing from one to two 
fluidounces. 

Effervescing Draught is one of the best known. It is prepared by neutralizing a watery 
solution of Potassium Bicarbonate with Lemon-juice or Citric Acid, and may be drank during 
effervescence. When the CO a has escaped it is a solution of Potassium Citrate in water, 
and corresponds to the official Liquor Potassii Citratis. 

Black Draught is another well-known preparation of this class. It is official as Infusum 
Sennae Compositum. 



PHARMACEUTICAL PREPARATIONS. 



533 



Infusa, Infusions, — are prepared by treating vegetable substances with 
boiling water. The drug should be coarsely comminuted, sliced or bruised, 
and treated by maceration with the proper quantity of water, which in the ab- 
sence of specific directions to the contrary should be 5 parts by weight of the 
drug to 100 of water, or 5 grammes in 100 Cc. Infusions should be freshly 
made as required for they are very prone to decomposition. Those official num- 
ber 2 and are named in the following list, the figure after each representing the 
percentage of drug to menstruum, viz. — 

Infusum Digitalis (1$). Infusum Sennae Compositum (6). 

The last-named infusion contains also 12 per cent, each of Manna and Magnesium Sul- 
phate and 2 of Fennel. 

Many dispensing pharmaceutists are in the habit of making infusions from 
concentrated alcoholic tinctures or from fluidextracts. This is a very repre- 
hensible practice, especially in those cases where the active ingredients are of 
a resinous nature and therefore precipitate when the alcoholic solution is added 
to water. v 

Inhalationes, Inhalations, and Vapores, Vapors (both Unofficial), are 
medicines in the form of a vapor, a gas or an atomized spray, to be inhaled by 
the patient for their local action on the respiratory tract. The well-known 
steam-atomizer is the agent by which most of these preparations are administered, 
though many substances may be inhaled from the surface of hot water, from 
a sponge in a bottle surrounded by a hot cloth, or from a heated shovel. They 
are prescribed in the usual manner, as follows: — 



Stimulant Inhalation. 

]$. Olei Cubebae, 5ij. 

Magnesii Carbonat., 3 j- 

Aquae, 5 iij. 

M. Sig. — A teaspoonful in a pint of 
water at 150 F., for each inhalation. 

Oil of Pine. 

1$. Ol. Pini Sylvestris, 5 ij. 

Magnesii Carb, 3j. 

Aquas, 5 iij. 

M. Sig. — A teaspoonful on a pint of hot 
water for each inhalation. 



Phenolized Inhalation. 

1$. Phenolis, ngxlviij. 

Aquas, q s. ad 5ij. 

M. Sig. — Use one-half in the cup of 
steam-atomizer for each inhalation. 



Tar and Turpentine. 
r|. Ol. Picis Liquidas, 

Ol. Terebinth., aa gij. 

M. Sig. — Pour slowly on a hot shovel in 
the sick-room, keeping the vapor confined 
therein. 



The Charta Potassii Nitratis (Nitre-paper), is a preparation intended for use as an inhala- 
tion, its vapors while burning being taken into the lungs. 

Injectiones, Injections (Unofficial), — are liquid preparations intended for 
introduction into the cavities of the body by means of a syringe. When thrown 
into the rectum they are termed Enemata (enemas or clysters), and are usually 
prepared at the bedside. Enemata may be demulcent, laxative, nutritive, stim- 
ulant or vermifuge in character; and always have warm or tepid water as their 
diluent, with which are incorporated such medicaments as may be desired. 
They may consist simply of water as a wash for the cleansing of the bowel. 



534 



PHARMACEUTICAL PREPARATIONS . 



Injections are termed vaginal, urethral, vesical, nasal, hypodermic, etc., accord- 
ing to the locality in which they are employed. A special form of syringe is used 
in each case, the discussion of which belongs rather to the domain of surgery 
than to medicine. Those used for the nasal cavities are often arranged with 
small holes or an atomizing attachment, so as to deliver the injection in the 
form of a fine spray. A Collunarium is a nasal douche or wash. In the Ap- 
pendix will be found a number of formulae for hypodermic injections; a few 
prescriptions for other forms are the following: — 



Demulcent Enema. 

1$. Tincturae Opii, itjjxx. 

Decocti Amyli, §iv-vj. 

M. Fiat enema. 



Injection for Gonorrhea. 
(Injection Brou. ) 

1$. Zinci Sulphatis, gr. viij. 

Plumbi Acetatis, gr. xv. 

Tincturae Opii, 5ij. 

Tinct. Catechu, 5 j\ 

Aquae Rosae, q.s. ad §vj. 

M. Fiat injectio. Sig. — Use with a ure- 
thral syringe. 



3. 



Vermifuge Enema. 

fy. Fluid extr. Quassias, § jss. 

Aquae, § ijss. 

M. Sig. — A tablespoonful with an equal 
quantity of warm water, as an enema, to be 
retained as long as possible. 

Nasal Injection. 

]$. Phenolis, cryst., . gr. xxiv. 

Sodii Boratis, 

Sodii Bicarb., aa 3ij. 

Glycerini, 5 ss. 

Aquae Destil. q.s. ad Oj. 

M. Sig. — To be used twice daily in a nasal 
syringe or sprayer. (Dob ell's Solution). 

Lamellae, Discs, — are small discs of gelatin with some glycerin, and medi- 
cated with a minute quantity of an alkaloid, for use on the ocular conjunctiva. 
In the British Pharmacopoeia four such preparations are official, viz. — 

Lamellae Atropinae, Discs of Atropine, — each disc contains 3 oVo grain of Atropine Sul- 
phate. 

Lamellae Cocainae, Discs of Cocaine, — each disc contains -^ grain of Cocaine Hydro- 
chloride. 

Lamellae Homa tropin ae, Discs of Homatropine, — each disc contains -^ grain of Ho- 
matropine Hydrobromide. 



Vaginal Injections for Leucorrhea. 

Aluminis, 5 j. 

Zinci Sulphatis, 5ss. 

Sodii Boratis, gr. iv. 

M. Sig. — Dissolve in half-a-pint of warm 
water, and use with a vaginal syringe. 

1$. Acidi Tannici, § j. 

Glycerini, §iv. 

M. Sig. — One-half with an equal quantity 
of water to be injected twice daily. 



jach disc contains 



grain of 



Lamellae Physostigminae, Discs of Physostigmine,- 
Physostigmine Sulphate. 

Liniment a, Liniments, — are very thin ointments for external application, 

intended to be applied with friction to the skin. They are solutions of various 

substances in oily liquids or in alcoholic liquids containing fatty oils. Of the 

following 8 official Liniments 2 have as their basis Cotton-seed Oil, 1 Linseed 

Oil, 1 Oil of Turpentine, 2 Alcohol, 1 Alcohol and Water, and 1 a fluidextract 

(Linimentum Belladonnae). 

Linimentum Ammonias. Linimentum Chloroformi. 

Linimentum Belladonnae. Linimentum Saponis. 

Linimentum Calcis. Linimentum Saponis Mollis. 

Linimentum Camphorae. Linimentum Terebinthinae. 

Besides the above, (except Lin. Saponis Mollis), the Br. Phar. contains Lin. Aconiti, Lin. 
Camphorae Ammoniatum, Lin. Crotonis, Lin. Hydrargyri, Lin. Opii, Lin. Potassii Iodidi cum 
Sapone, Lin. Sinapis, and Lin. Terebinthinae Aceticum. 



PHARMACEUTICAL PREPARATIONS, 



535 



Extemporaneous Liniments may correspond to the official ones or they may 
be simple mixtures of fluids without either fat or soap. A prescription for each 
kind is appended. The official Linimentum Saponis (soap liniment) is a good 
basis for extemporaneous preparations of this class. 



Compound Chloroform Liniment. 
"fy Fluidextr. Belladon. Rad., ... § ss. 
Fluidextr. Aconiti, 

Chloroformi, aa 3ij. 

Spiritus Camphorae, 5 j 

Alcoholis Diluti, q.s. ad 5 viij. 

M. Fiat linimentum. 
Sig. — Poison. To be rubbed on the pain- 
ful part. 



Stokes' Liniment. 

1$. Olei Terebinthinae, § iij. 

Acidi Acetici, §ss. 

Olei Limonis, 5 j. 

Vitellum, j. 

Aquae Rosae, §iij. 

M.Fiat linimentum. 
Sig. — Liniment. 



I*. 



Army Medical Wagon Liniment. 
Aquae Ammoniae, 
Ol. Terebinthinae, 
Ol. Olivae, 

aa, partes aequales. 
M. Fiat linimentum. 
Sig. — Liniment. 



Anodyne Liniment. 

1$ Tinct. Aconiti, 5ij- 

Tinct. Opii, 5iv. 

Tinct. Arnicae, § j. 

Chloroformi, 3 ij. 

Linim. Saponis, q.s. ad §iv. 

M. Fiat linimentum. 
Sig. — Poison. Liniment. 

An Embrocation is a similar preparation, but of thinner consistence. The term is almost 
obsolete. 

Liquor es, Solutions, — comprise all aqueous solutions of non-volatile sub- 
stances, except the syrups, infusions and decoctions, which naturally form dis- 
tinctive classes. There are 25 official solutions, 13 of which are simple solutions 
of the medicament, the rest being chemical solutions, in which the dissolved 
substances are altered by chemical action and new ones formed. They are 
named as follows: — 



Liquor Acidi Arsenosi, (1). 

Liquor Ammonii Acetatis, (7). 

Liquor Arseni et Hydrargyri Iodidi, (1). 

Liquor Calcis, (0.14). 

Liquor Cresolis Compositus, (50). 

Liquor Ferri Chloridi, (29). 

Liquor Ferri et Ammonii Acetatis. 

Liquor Ferri Subsulphatis, (67.5). 

Liquor Ferri Tersulphatis, (36). 

Liquor Formaldehydi, (37). 

Liquor Hydrogenii Dioxide, (3). 

Liquor Hypophysis. 

Liquor Iodi Compositus, (5). 



Liquor Magnesii Citratis. 
Liquor Plumbi Subacetatis, (25). 
Liquor Plumbi Subacetatis Dilutus, (1). 
Liquor Potassii Arsenitis, (1). 
Liquor Potassii Citratis, (8). 
Liquor Potassii Hydroxidi, (5). 
Liquor Sodae Chlorinatae, (2.5). 
Liquor Sodii Arsenatis, (1). 
Liquor Sodii Chloridi Physiologicii, (8.5). 
Liquor Sodii Glycerophosphatis, (50). 
Liquor Sodii Hydroxidi, (5). 
Liquor Zinci Chloridi, (50). 



The figures represent the percentage by weight of the ingredient named in the title. 

Lotio, A Lotion or Wash (Unofficial) , — is a solution or mixture of medicinal 
agents, intended for external application; usually consisting of some soluble, 
astringent salt, dissolved in water, with perhaps some glycerin or alcohol. A 
Fomentation (Fotus) is a similar preparation used hot, or flannel may be wrung 
very dry out of boiling water, applied and covered with oiled silk. Spongio- 
piline, a fabric composed of sponge and wool coated with rubber, is an excellent 
vehicle for the application of warmth and moisture. The inner surface is 



53^ PHARMACEUTICAL PREPARATIONS. 

moistened with hot water; and its utility may be increased by sprinkling the 
moistened surface with charcoal or yeast, or by saturating it with any desired 
lotion or liniment. A Collyrium is an eye-wash, and generally contains a solu- 
ble astringent salt dissolved in rose-water or distilled water, in the proportion of 
gr. j-iv to the § . The only official preparation suitable for a lotion is the Liquor 
Plumbi Subacetatis Dilutus (Lead- water) . A well-known anodyne, refrigerant 
and astringent lotion is that represented by the upper two of the following pre- 
scriptions. 



Lead-Water and Laudanum. 

ty. Liq. Plumbi Subacetatis, 3 j. 

Tinct. Opii, 5j. 

Aquae, q.s. ad § viij. 

M. Fiat lotio. Sig. — Lotion. 

(Gross.) 



Collyrium. 

If . Sodii Boratis, gr. x. 

Aquae Camphorae, oij- 

Mucil. Cydonii, 

Aquae Destil, aa 5ss. 

M. Fiat collyrium. Sig. — Eye-water; a 
few drops to be put into the eye three or four 
times daily. 



Lead and Opium Wash. 
1$. Liq. Plumbi Subacetatis, 

Tinct. Opii, aa 5 j. 

Aquae, q.s. ad § viij. 

M. Fiat lotio. Sig. — Lotion. 

(Sturgis.) 



Collyrium of Four Sulphates. 
1$. Zinci Sulpha tis, 
Ferri Sulphatis, 
Cupri Sulphatis, 

Aluminis, aa gr. j. 

Aquae Destillatae, 5 j. 

M. Fiat collyrium. Sig. — For use with 
bush to palpebral conjunctivae, and to be 
washed off with clean water. 



Massae, Masses, — are Pill-masses prepared as described under the subtitle 
Pilulte. The official Masses number 2, viz. — 

Massa Ferri Carbonatis. Massa Hydrargyri. 

Mellita, Honeys, — differ from syrups merely in being prepared with honey 
as a base. The Oxymel and OxymelS cilice of theB. P. are similar preparations, 
containing also Acetic Acid. There are 3 official Honeys, including two forms 
of honey itself, viz. — 

Mel. Mel Depuratum. Mel Rosee. 

Misturse, Mixtures, — in official pharmacy are aqueous preparations of 
insoluble substances held in suspension by a suitable vehicle. In extemporan- 
eous pharmacy the term mixture has a wider signification, as explained below. 
Mixtures are generally prepared extemporaneously upon prescriptions, as few of 
them have the stability necessary to insure their preservation beyond a few 
days. The official mixtures are 2 in number, and are named as follows, — 

Mistura Cretae. Mistura Glycyrrhizae Composita. 

In extemporaneous pharmacy the term Mixture is applied to every fluid 
compound intended for internal use, except a few which bear distinctive titles, 
as Emulsions, Draughts, Enemas, Elixirs and Drinks. The simplest form of 
mixture in this extended sense is that in which two or more liquids are mixed 
together; but a great variety of substances may be prescribed in this form, 
chief among which are most of the soluble salts, light insoluble powders, salts 
which may be diffused by agitation, extracts, gum-resins, and the fixed essential 
oils. They are generally ordered in 2, 3, 4, 6, 8, 10 and 12-ounce vials. 



PHARMACEUTICAL PREPARATIONS. 



537 



Substances suitable to the mixture-form, properly so called, are those which, 
though more or less insoluble in water, will mix therewith by means of agitation, 
trituration, etc. Those most frequently ordered are as follows: — 



Diffused by Agitation: — 

Calcii Phosphas Praecipitatus. 
Cinchona (powdered). 
Ipecacuanha (powdered). 
Magnesia. 
Quininae Sulphas. 
Sulphur Praecipitatum. 

Suspended by Viscid Excipients: — 
Essential Oils. 
Oleum Amygdalae. 
Oleum Morrhuae. 
Oleum Olivae. 
Oleum Ricini. 
Copaiba. 
Ferri Carbonas Saccharatus. 

Best Suspended by the aid of a Fixed Oil or Yolk of Egg: — 

Extr. Cannabis. Oleum Terebinthinae. 

Camphora. Chloroformum. 

Solutions intended for internal administration are classed as Mixtures in 
extemporaneous pharmacy, for the reasons already stated. The following list 
of acids and salts comprises most of the solids which are best adapted for use 
in liquid form, by reason of their solubility in water. 



Miscible only by Trituration: 
Ammoniacum. 
Asafoetida. 
Confectio Rosae. 
Confectio Sennae. 
Extractum Aconiti. 
Extr. Belladonnae Fol. 
Extr. Conii. 
Extr. Hyoscyami. 
Extr. Stramonii. 
Extr. Glycyrrhizae. 
Extr. Krameriae. 
Extr. Taraxaci. 
Guaiacum. 
Scammonium. 
Myrrha. 



Acidum Citricum. 
Acidum Tannicum. 
Acidum Tartaricum. 
Alumen. 

Ammonii Chloridum. 
Antim. et Potass. Tartras. 
Bariii Chloridum. 
Calcii Chloridum. 
Calcii Hypophosphis. 
Ferri Pyrophosphas. 
Ferri Sulphas. 
Ferri et Ammonii Citras. 



Ferri et Potassii Tartras. 
Ferri et Quininae Citras. 
Magnesii Sulphas. 
Mangani Sulphas. 
Potassii Acetas. 
Potassii Bicarbonas. 
Potassii Bromidum. 
Potassii Carbonas. 
Potassii Citras. 
Potassii Chloras. 
Potassii Hypophosphis. 
Potassii Iodidum. 



Potassii Tartras. 
Potassii et Sodii Tartras. 
Morphinae Acetas. 
Morphinae Hydrochloridum. 
Morphinae Sulphas. 
Sodii Bicarbonas. 
Sodii Boras. 
Sodii Carbonas. 
Sodii Chloridum. 
Sodii Hypophosphis. 
Sodii Phosphas. 
Sodii Sulphas. 



A few require the use of viscid substances as vehicles or correctives, 
are as follows: — 



They 



Ammonii Carbonas. 
Plumbi Acetas. 



Potassii Hydroxidum. 
Potassii Cyanidum. 
Hydrargyri Chloridum Corrosivum. 



Certain salts are best ordered by prescribing such agents as when in solution 
together react upon each other and produce the desired salt. Instances of this 
may be found in the pharmacopceial process for most of the official Liquores, 
some salts so produced being the following: — 



Ammonii Acetas. 
Magnesii Citras. 
Potassii Citras. 
Ferri Citras. 



Ferri Acetas. 
Ferri Chloridum. 
Ferri Nitras. 
Hydrargyri Nitras. 



Potassii Arsenis. 
Potassii Hydroxidum. 
Sodii Hydroxidum. 
Zinci Chloridum. 



538 PHARMACEUTICAL PREPARATIONS. 

Certain other substances require the addition of other agents in order to form 
eligible solutions. Such are the following: — 

Quinine Sulphate, — requires acidulated water for its solution, the acid used being 
generally Diluted Sulphuric, or the Aromatic Sulphuric. This method of prescribing the 
salt develops its bitter taste to the utmost, and is often avoided by ordering the drug to be 
suspended in a viscid liquid, such as Pulv. Acaciae in Syrup of Ginger. In such a case an 
officious dispenser anxious to show his smartness by adding some dilute Sulphuric Acid to 
dissolve the Quinine would thereby defeat the object of the prescriber. 

Quinine Sulphate may be prescribed with Aromatic Spirit of Ammonia, Spirit of Nitrous 
Ether, Tinctures or other alcoholic preparations together with Glycerin or Syrup and Water. 
In such cases the salt should be first dissolved in the alcoholic portion of the prescription, 
then the glycerin or syrup and finally the aqueous portions should be added gradually. It 
may also be ordered with Diluted Sulphuric Acid and some vegetable infusion containing 
Tannin, in which case a pecipitate of Quinine Tannate will be produced. This of course 
should not be filtered, but should be dispensed with a "Shake-label." 

For the use of Velatine as a vehicle for the administration of Quinine Salts, see under the 
tide Cinchona, in Part I. 

Chinoidin, Cinchonine Sulphate and Quinidine Sulphate, — also require the addi- 
tion of a dilute mineral acid for their solution in aqueous mixtures. 

Iodine, — requires the addition of Potassium Iodide for its solution in a convenient quan- 
tity of water, as in the case of the official Liquor Iodi Compositus. 

Hydrargyri Iodidum Rubrum, Red Mercuric Iodide, — requires the addition of Potas- 
sium Iodide or Mercuric Chloride for its aqueous solution. 

Potassii Bitartras, Cream of Tartar — requires the addition of Borax or Boric Acid for 
its solution in water. 

Sodium Phosphate, — is theoretically soluble in 6 parts of water, but in practice it is 
soluble with difficulty in aqueous preparations unless Citric Acid be added. 

Benzoic Acid, — requires the addition of Borax to aid its solubility in water, an equal 
part of the latter making it 5 times more soluble than when alone. 

Lime, — is more soluble in sweetened water than in plain water, the sugar aiding its 
solution. 

Excipients are substances which give form and consistence to prescriptions, 
and serve as vehicles for the exhibition of the other ingredients. Some of the 
excipients are Diluents, or agents which effect the dilution or division of the 
active ingredients; while others act in the double capacity of diluents and 
Flavoring agents. The Excipients most generally used in mixtures may be 
tabulated as follows, — 

Diluents. True Excipients. 

Water (Aqua). Acacia (in powder or mucilage). 

Medicated Waters (Aquae). Tragacanth (in powder or mucilage). 

Syrups. Confections. Sugars. 

Mel Rosae. Some Extracts. 

Elixir Aromaticum. Yolk of Egg (Vitellus). 

Flavoring Agents. 

Oleum Amygd. Amarae. Tinct. Cardamomi. Spiritus Anisi. 

Oleum Cari. Tinct. Cardamomi Comp. Spiritus Lavandulae. 

Oleum Caryophylli. Tinct. Cinnamomi. Spiritus Menthae Piperitae. 

Oleum Cinnamomi. Tinct. Gentianae Comp. Spiritus Menthae Viridis. 

Oleum Gaultheriae. Tinct. Tolutana. Syrupus Tolutanus. 

Oleum Sassafras. Tinct. Vanillae. Syrupus Zingiberis. 

Tinct. Aurantii Dulcis. Tinct. Zingiberis. 



PHARMACEUTICAL PREPARATIONS. 539 

Compounding the Mixture is a matter of no slight importance, and one 
which is best learned at the dispensing counter, though a few directions may 
not be out of place. In the case of the simplest form of mixture, where two 
or more fluid preparations are prescribed together, the only operations required 
are the measuring of the several ingredients and pouring them into the vial. 
In doing this the compounder should pursue a regular and definite order of 
procedure. Taking in his left hand a graduate of sufficient capacity to hold 
the whole quantity prescribed, he should walk alongside the shelves, and with 
the right hand pour from the stock-bottles the requisite quantity of each ingre- 
dient in the order in which they are entered on the prescription. A skillful 
druggist will hold the graduate between the thumb and first finger, the pre- 
scription between the second and third fingers, and the stopper of the stock- 
bottle between the little finger and the hand, leaving his right hand free for the 
manipulation of the bottles containing the ingredients. 

When an actively poisonous agent is ordered it should always be the last 
thing put into the mixture. Attention to this rule will prevent the danger of 
the toxic substance being put in twice. 

The order in which the ingredients are put together is not of so much impor- 
tance in compounding a simple mixture as in the case of an emulsion, and the 
order of the prescription can usually be followed, with the exception noted in 
the preceding paragraph. Still, when several alcoholic preparations, syrups 
and waters are ordered together, it is good practice first to mix the alcoholic 
fluids, then to add the syrups and finally the water, so as to avoid the precipita- 
tion of resinous principles which would occur if the alcoholic solutions were 
added to the water. Distilled water should always be used, in order to insure 
uniformity in taste and appearance, and also as a matter of purity and clean- 
liness. All mixtures should be well shaken before being labelled. 

Solids which are comparatively insoluble or slowly soluble require to be 
rubbed up in a mortar with one or more of the fluid ingredients. Glass mortars 
are much employed for this purpose, and many compounders mix all the ingre- 
dients in such a mortar before transferring them to the vial. Vegetable powders, 
(rhubarb, ipecac, etc.), or finely pulverized inorganic substances, are often 
ordered in intimate mixture with water, thickened with mucilage or syrup. In 
such cases the mixture should be made in a porcelain or wedgewood mortar, 
enough mucilage or syrup being added at first to make a thick paste, and after 
this is rubbed smooth the water may be gradually added during the continued 
process of mixing. This process will answer for all inorganic substances in 
powder, except Magnesia, which is best mixed by being thrown on the surface 
of the water; after it has sunk to the bottom as a uniform sediment the other 
ingredients may be added and the whole well shaken. Froth upon the surface 
of the liquid, which often arises after agitation and may prevent the corking 
of the bottle, will quickly subside on the addition of a few drops of alcohol. 



54° PHARMACEUTICAL PREPARATIONS. 

The following are specimens of prescriptions for medicines to be admin- 
istered in mixture form: — 



Bismuth Mixture for Children. 
1$. Bismuthi Subcarbonatis, . . . . 3 ij- 
Syrupi Acaciae, 

Aquae Cinnamomi, aa 5ij. 

Misce. Sig. — A teaspoonful every hour 
in choleraic diarrhea. 



Quinine Mixture for Children. 
1$. Quininae Sulphatis (pulv.),.. 5ss. 

Acaciae (pulv.), 5ss. 

Syrupi Zingiberis, 5 iv. 

Fiat mistura. Sig. — A teaspoonful thrice 
daily. 



Mucilagines, Mucilages, — are thick, viscid liquids prepared by dissolving 
gum in water, or by extracting with water the mucilaginous principles from 
certain plants. They are easily spoiled and should be kept only in small quan- 
tities. The official Mucilages number 2, as follows: — 

Mucilago Acaciae. Mucilago Tragacanthae. 

Oleata, Oleates, — are liquid solutions of metallic salts or alkaloids in Oleic 
Acid, intended for external administration. They are not definite chemical 
compounds, though the term is also employed in trade to designate certain solid 
preparations which are claimed to be chemical compounds of the same acid 
with various bases. [See under Acidum Oleicum, page 73.] There is 1 
official Oleate as follows: — 

Oleatum Hydrargyri (25 per cent.). 

Oleoresinae, Oleoresins, — are concentrated liquid preparations consisting 
principally of natural oils and resins extracted from vegetable substances by- 
percolation with Ether. They differ from fluidextracts in not bearing any 
uniform relation of mils to the gramme of drug, in containing principles which 
though soluble in Ether are not so in alcohol, and in the instance of Cubeb, 
alcohol is used as a menstruum because this solvent will alone extract the 
active principles. They are the most concentrated liquid preparations of 
drugs which can be produced, and are prepared by percolating the powdered 
drug with Ether until exhausted, recovering the greater part of the Ether by 
distillation, and exposing the residue in a capsule to spontaneous evaporation 
until the remaining Ether has evaporated. The official Oleoresins are 6 in 
number, viz. — 

Oleoresina Aspidii. Oleoresina Petroselini. 

Oleoresina Capsici. Oleoresina Piperis. 

Oleoresina Cubebae. Oleoresina Zingiberis. 

Pigmenta, Paints (Unofficial), — are preparations for external use, which 

cannot be classed with the preceding. They are generally prescribed in skin 

diseases, for use over inflamed joints, or for application to the throat with a 

camel's-hair brush. 



]$. Tinct. Iodi, Bj. 

^Etheris, § iij. 

Tinct. Aconiti, 3ss. 

Fluidextr. Belladon. Rad.,.. . 3iv. 

Morphine Sulph, gr. ij. 

Iodi, 3jss. 

Sig. — Paint 4 or 5 coats freely over the in- 
flamed and painful parts. 



3. Alcoholis Saponis Mollis, 

Olei Cadini, aa 5 j. 

Sig. — Paint over the part. 

3 OleiTiglii, 3j. 

Athens, 3ij. 

Tinct. Iodi,. 3 v. 

M. Sig. — Paint on once in 3 days. 



PHARMACEUTICAL PREPARATIONS. 541 

Pilul®, Pills, — are spherical masses composed of medicinal agents and 
intended to be swallowed whole. The mass consists of the active ingredients 
and the excipient, the latter being the substance which gives to the mass its 
adhesive and plastic qualities. In official pharmacy the excipients are specified 
both as to composition and quantity in each case, and those directed to be used 
in the preparation of the 2 official Masses and the 7 official Pills are as follows, — 

2 are made with Soap and Water, — Pil. Aloes, Pil. Asafcetidae. 
1 is made with Water alone, — Pilulae Rhei Compositae. 

1 with Diluted Alcohol, — Pil. Catharticae Comp. 

2 with Glycerin and Water, — Pil. Ferri Carbonatis, Pil. Phosphori. 
1 with Acacia and Water, — Pilulae Ferri Iodidi. 

The pharmacopceial directions for the formation of the pill-mass vary in 
each case, but in general they prescribe that the ingredients shall be mixed 
intimately, then beaten with the excipient to form a mass and divided into a 
certain number of pills. Two of the official pills are directed to be coated 
with an ethereal solution of the balsam of Tolu, — Pilulae Ferri Iodidi and Pilulae 
Phosphori. Full descriptions of the various details of pill-making are given 
below. 

The number of official pills is 7, for the composition of which the student 
is referred to their several titles in the section on Materia Medica. They are 
named as follows, — 

Pilulae Aloes. Pilulae Ferri Iodidi. 

Pilulae Asafoetidae. Pilulae Phosphori. 

Pilulae Catharticae Compositae. Pilulae Rhei Compositae. 
Pilulae Ferri Carbonatis. 

Pills constitute a form of medicine very much used in extemporaneous 
pharmacy, and one with the preparation of which the compounder should be 
perfectly familiar, for it will constitute fully one-third of his work at the dis- 
pensing counter. Pills should not exceed 5 grains in weight, unless the ingre- 
dients are very heavy, as Bismuth, Calomel, and Hydrargyrum cum Creta, of 
which 6, 8, or 10 grains may be made into a pill which may be readily swallowed. 
A Bolus is a similar mass, but larger than a pill, while the names Granule and 
Parvule are given to masses smaller than the average pill. 



The Process of Pill-making. 

The Process of Pill-making is briefly as follows: The ingredients ordered in 
the prescription are separately weighed out in the order of their bulk, commenc- 
ing with that one of which the smallest quantity is to be used. If any require 
pulverization they should be placed first in the mortar and reduced to powder, 
the other dry ingredients added, next the soft extracts and the excipient selected ; 
the whole being worked up into a mass, the pill-mass, by the aid of the mortar 
and pestle. The perfect pill-mass should be uniform throughout, should not 
show any particles of any one ingredient, should have such a consistence that the 



542 PHARMACEUTICAL PREPARATIONS. 

pills made from it will retain their shape, should not be too hard, nor too dry, 
nor should it stick to the fingers. The mortar should be large and shallow, 
of unpolished wedgewood ware ; having a thick, smooth and well-formed bottom 
and a pestle which fits it. The operation of working up the mass is one of 
kneading it between the end of the pestle and the side of the mortar, and if 
proper ingredients and excipient are used and the work is well done, the mass 
will eventually loosen itself from both mortar and pestle. If it does not do so it 
should be removed with a spatula when sufficiently worked, and may be kneaded 
for a few minutes between the fingers. It should then be placed upon the tile 
or slab previously dusted with a little Lycopodium or Starch in fine powder, 
and rolled into a long cylinder by the aid of a broad-bladed spatula, until the 
mass is of a length corresponding to the divisions on the tile-scale which repre- 
sent the number of pills to be made. The mass should then be placed along the 
scale, and a cut made through it with the spatula at each division, the pieces 
being rounded separately into pills by the thumb and two fingers of each hand. 
A pill-machine is often employed, consisting of two metal plates having semi- 
cylindrical grooves on one side, set into wooden boards, the whole forming a con- 
venient apparatus for rolling the mass and then cutting it into the required 
number of pills by one movement. The pills are then left to dry upon the slab 
while the label is being written, after which they are placed in a pill-box, or in 
a wide-mouthed bottlle if they contain volatile ingredients, and surrounded by a 
conspergative powder (lycopodium, powdered chalk, dusted talc), to prevent 
their adhering together or losing their shape. 

Excipients used in pill-making are seldom mentioned in the prescription, 
but are usually left to the choice of the compounder. Some substances need 
no excipient, but may be made at once into pills; such being the softer extracts 
ands ome gum-resins, the former if too hard only needing a little water, and 
the latter a few drops of spirits to soften them to the required degree of plasticity. 
Every druggist has his favorite pill-excipient, many using a paste made of pow- 
dered Tracaganth i, Glycerin 3^ and Water 1 part, while others, use Extract 
of Malt or a mixture of Syrup and powdered Acacia for general use. Powdered 
Tragacanth to give tenacity, Glycerin to keep the mass soft, and Water to 
develop the adhesive qualities of many ingredients, will answer for fully nine- 
tenths of all the cases which occur in practice. These three excipients should 
stand on the dispensing counter ready for use, and all ready-made pastes or 
mixtures should be discarded as being slovenly, dirty and liable to change. 
The excipients described below are those in general use and are arranged in 
the order of their comparative importance. 

Liquid Excipients. 

Glycerin, — is a very valuable excipient, as it continually attracts moisture from the 
atmosphere, and pills made from it do not get hard. It should always be used for Quinine 
pills. Glycerite of Starch or Tragacanth are generally useful excipients. The former is 
official, the latter is made in the proportion of oss to the §. 



PHARMACEUTICAL PREPARATIONS. 543 

Glucose, — is a good excipient, being colorless, adhesive, and not readily volatilized at 
ordinary temperatures. Since its introduction by Mr. Lascheid for this purpose it has steadily 
grown in favor. 

Honey, — may be used for dark-colored substances. It should be evaporated to one- 
half its bulk, and then if mixed with a little Tragacanth it makes an excellent excipient for 
nsoluble powders. 

Extract of Malt, — is a pretty fair excipient, but has the disadvantage of its dark color. 

Syrup, — is a fair excipient for powders, but it should not be used for metallic salts, espe- 
cially Calomel, which it reduces in a short time. Syrup of Acacia is good where there is 
little room left for the excipient, but pills made with it become very hard and insoluble if they 
are kept long. 

Mucilage of Acacia, — is very adhesive, but not a good excipient for the same reason as 
given for the syrup. 

Water, — is only used alone as an excipient when the ingredients possess sufficient ad- 
hesiveness to be developed by the water. Such are the following powders: Aloe, Rhubarb, 
Kino, Tannic Acid, Opium, Squill, Asafcetida, — also Ferric Citrate, Berberine Sulphate, 
and some other salts. 

Alcohol, — is used to soften Camphor, Compound Extract of Colocynth, Guaiac, resinous 
extracts, gums, etc. 

Solid Excipients. 

Tragacanth, — is an excellent excipient, especially for substances which are too soft, 
giving them body and elasticity. 

Acacia, — is added to give more adhesiveness than can be obtained from viscid liquids 
alone. Pills made with it are generally very hard. It is used for Silver Nitrate, which may 
explode if mixed with vegetable extracts or glucose. 

Soap, — is the best for resinous and fatty substances, increasing the solubility of the 
former. It should not be used for substances which are decomposed by an alkali, nor for 
Tartar Emetic. 

Bread-crumb, Mica Panis, — is an excellent excipient for Croton Oil, or other powerful 
liquid substances, as volatile oils. 

Confection of Rose, — is too bulky for general use, but it is a good excipient for very active 
agents like Strychnine, which are used in small quantity. 

Althaea, — is good for absorbing and adhesive purposes, but is too bulky for general use. 

Petrolatum, Cacao Butter, and Rosin Cerate, — are used for oxidizable substances, 
as Potassium Permanganate. 

Kaolin, — is well adapted as an excipient for Silver Nitrate and other substances which 
are easily decomposed. 

Licorice, — is an old excipient, but not much employed now. In powder it may be used 
for oils. 

Conspergatives are absorbent powders which are dusted upon the finished 
pills and put around them in the box or vial in which they are dispensed, to 
keep them from sticking together and losing their shape. Powdered Licorice 
was formerly much used for this purpose, but the best conspergatives are Lyco- 
podium, Talc, Althsea and Rice Flour, the latter especially for white pills. 

Substances suitable for the pilular form of medicine are — ■ 

Those acting in small doses. Heavy, insoluble substances. 

Those intended to act slowly. Fetid substances. 

Those to act on the lower bowel. Vegetable extracts. 

Gum-resins, Balsams, Turpentine. 

When the basis is an unadhesive substance, one of the other ingredients 
should be an extract or a vegetable powder which will form a mass by moisture 



< 



> 



544 PHARMACEUTICAL PREPARATIONS. 

alone. Attention to this rule in prescribing pills will often prevent the increase 
of their size by the use of inert excipients. 

Substances difficult to combine, except by peculiar treatment, are met with 
frequently. The following notes will cover most such cases: — 

Aloe, — is best treated on a heated slab with alcohol in very small quantity. Soap is the 
excipient in the official Pilulae Aloes. 

Butyl Chloral Hydrate, — should be treated with a litde Confection of Rose and thick 
mucilage. 

Calcium Sulphide, — should be well triturated with an equal quantity of Sugar of Milk, 
and then worked up with a little powdered Licorice-root and Mucilage of Tragacanth. 

Camphor, — should be powdered with a little alcohol, and may be worked into a pill- 
mass with Glycerite of Tragacanth after the evaporation of the alcohol. 

Phenol, — requires nearly an equal part of wheaten flour or bread-crumb, with a very 
minute quantity of Glycerite of Tragacanth. Creosote may be made into a mass by the 
addition of Powdered Licorice with a very little bees' wax. If made into a pill with Silver 
Oxide it will explode unless the silver salt be first diluted by trituration with Licorice, Gen- 
tian, or some other inert powder. 

Iron and Quinine Citrate, — is very deliquescent with most excipients. Canada Balsam 
is the best for it. 

Copaiba, — may be made into a pill-mass by the addition of a little Magnesium Car 
Donate or Wax. 

Croton Oil, — is best worked up with bread-crumb, though powdered Licorice and Mu- 
cilage of Acacia may be used. 

Ferrous Iodide, — in pill form requires special manipulation and protection to remain 
unoxidized. The official Pil. Ferri Iodidi is prepared with Iodine and Reduced Iron, has 
Licorice, Sugar, and Acacia as excipients, and is protected by a coating of Balsam of Tolu. 
In other formulae, Acacia, Althaea, Cacao-butter, Elm bark, and Licorice are used as excip- 
ients. 

Ferrous Sulphate, — is used in Blaud's Pill, with Potassium Carbonate, to form by 
mutual decomposition Ferrous Carbonate, which quickly passes into the ferric salt by ex- 
posure. 

Gallic Acid, — makes a good pill with a very small quantity of Glycerin. Tannic Acid 
requires about one-fifth its weight of Glycerin and one-tenth of Mucilage. 

Phosphorus, — presents the problem of combining it in pill without letting it oxidize. 
This is believed to be accomplished by the pharmacopceial directions for the Pil. Phosphori, 
according to which the Phosphorus is dissolved in Chloroform in a test-tube, then quickly 
worked into a mass with Althaea, Acacia, Glycerin and Water, and finally the pills are coated 
by shaking with an Ethereal solution of Balsam of Tolu. Carbon Disulphide is a better 
solvent, but when it is used the pill-mass retains its disgusting odor. 

Potassium Acetate, — requires Canada Balsam to secure its stability in pill form. Po- 
tassium Iodide is best manipulated by rubbing it into a smooth paste with a very little water, 
then adding a small quantity of Licorice powder. Potassium Permanganate should be 
worked up with Kaolin and a very little water. Rosin Cerate, Soft and Hard Paraffin and 
Cacao-butter are also used as excipients. 

Quinine, — requires very clean hands and tools, and a colorless excipient, as Glycerin 
or Glucose, to make a nice-looking pill. If one part of Tartaric Acid is added to four of the 
Quinine salt, the mass will be less likely to crumble and will be of less bulk. Q uinine Sul- 
phate may be made into small and soluble pills by simply triturating it with Aromatic Sulphuric 
Acid TTftiij to each 5 grains of the salt. The moulding into pills should be done at the moment 
when the mass has begun to dry. A drop of syrup or honey, added at this time, will prevent 
the too rapid hardening of the mass. 

** Rhubarb, — in powder makes a good mass with one-fifth of its weight of Glycerin; but 
Water is the excipient ordered for the official Pilulae Rhei Compositae. 

Substances unsuited to the pilular form are — 
Those requiring large doses, and those which are volatile. 



PHARMACEUTICAL PREPARATIONS. 



545 



Emetics, and other agents administered for immediate effect. 
Essential Oils in quantity exceeding half a drop to each pill. 
Oils and other bodies which require much solid matter to make a mass; except 

those prescribed in very small dose, as Croton Oil. 
Deliquescent Salts, unless intended to be used immediately. 
Efflorescent Salts, unless deprived of their water of crystallization. 



Deliquescent Salts. 
Ammonii Iodidum. 
Nitras. 



-Valeras. 



Auri Chloridum. 

Calcii Chloridum. 

Chinoline Salts, except the Tartrate, which 

is stable. 
Lithii Citras. 

B romidum. 

Salicylas. 

Magnesii Citras. 
Potassii Acetas. 

Carbonas. 

Citras. 



Cyanidum. 

Hydroxidum. 

Hypophosphis. 

Sulphis. 

Tartras. 

Sodii Hypophosphis. 

Iodidum. 

Zinci Bromidum. 
■ Chloridum. 



-Iodidum. 



Efflorescent Salts. 
Alumen (slightly). 
Ammonii Carbonas. 

Phosphas. 

Antim. et Potassii Tartras (slightly). 
Cupri Acetas. > 

Sulphas. 

Magnesii Sulphas (slightly). 
Potassii et Sodii Tartras (slightly). 

Ferrocyanidum (slightly). 

Quininae Bisulphas. 

Sulphas (after a time). 

Sodii Acetas. 

Arsenas (slightly). 

Benzoas. 

Boras (slightly). 

Carbonas. 



Hydroxidum . 

Hyposulphis. 

Phosphas. 

-Sulphas. 

Sulphis. 

Strychninae Sulphas. 
Zinci Acetas. 
Sulphas. 



I 



Coated Pills are manufactured upon a large scale by the great drug houses, 
extensive machinery being employed for the purpose. The coating material 
used is either Sugar or Gelatin. The U. S. Pharmacopoeia directs that two of 
the official pills shall be coated by being shaken with a solution of Balsam of 
Tolu in Ether, — Pil. Ferri Iodidi and Pil. Phosphori. In extemporaneous phar- 
macy it is rarely practicable to coat pills with anything except gold or silver 
leaf, and this is sometimes directed by the prescriber, the word " Deaur enter — 
let them be gilded" being used in the subscription. To do this neatly the pills 
should have no trace of powder on them, but should be first coated with a trifle 
of fresh mucilage by rolling between the mucilage-moistened fingers, each pill 
being then dropped directly on to a sheet of gold or silver leaf, until a dozen 
or more are so deposited. The leaf and its pills are then allowed to slide into 
a globular boxwood shaker, or the leaf may be first placed in the shaker and 
the pills dropped on it there. A cautious circular movement being given to 
the shaker the pills are caused to travel around its walls, and when the cover 
is removed they will be found to have each received an even coating of the metal 
used. Gold leaf should always be employed for pills of Blue Mass or Asaf cetida 
as silver is amalgamated with the former and turned black by the latter. 

Pills intended for direct medication of intestines are coated with Salol or 
Keratin thereby preventing digestion in passing through the stomach. 
35 



146 



PHARMACEUTICAL PREPARATIONS. 



Albumin may be used for coating small numbers of pills, which should be of very firm 
consistence before the coating is applied. Each pill is rolled between two fingers with a little 
white of egg, and then revolved in a warm pan. Another method of finishing them is, after 
coating with albumin, to rotate them in a tray with powdered French chalk until their sur- 
faces become smooth and shiny. This process gives a very nice finish. 

The following prescriptions represent the composition of a few unofficial 
pills in general use. A complete pill formulary is easily obtained, being pub- 
lished annually by the principal manufacturers. 



Anaphrodisiac and Sedative. 

]$. Camphorae, gr. xxx. 

Lupulini, gr. xx. 

Fiat massa et div. in pil. xx. 
Sig. — One thrice daily. 



3. 



Hooper's Female Pills. 

Pulv. Aloes Purif., gr. xlviij. 

Ferri Sulph. Exsic, gr. xxiv. 

Extr. Hellebori Nig., 

Pulv. Myrrhae, 

Saponis, aa gr. xij. 

Pulv. Canellae Alb., 

Pulv. Zingiberis, aa gr. vj. 

Aquae vel Syrupi, q.s. 
Fiat massa et div. in pil., quispue pondo gr. 
ijss. 
Sig. — One to three pills at a dose. 



Astringent Pill. 

fy. Plumbi Acetatis, gr. xvj. 

Pulv. Camphorae, gr. xij. 

Pulv. Opii, gr. iij. 

Bismuthi Subcarb., gr- xij. 

Extr. Gentianae, q. s. 
Fiat massa et div. in pil. xij. 
Sig. — One pill thrice daily. 

Tonic Pill for Women. 
1$. Strychnine Sulph., \t 

Arseni Trioxidi, aa gr. j. 

Extr. Belladonnas Fol., gr. v. 

Quininae Sulph., .v' gr. xxxv. 

Massac Ferri Carb., gr. xc. 

Fiat massa et div. in pil. xxxv. 
Sig. — One pill three times daily. 



Emmenagogue Pill {Otto). 

1$. Ferri Sulph. Exsic, gr. xlviij. 

Pulv. Aloes, gr. xij. 

Terebinthinae, gr. xxvij. 

Ol. Terebinth., ttjjx. 

Fiat massa et div. in pil. xxx. 
Sig.-^Two pills three times a day. 



Cholagogue Pills (Squibb). 



3. 



• v gr- vj. 
. . . gr. iij. 



Resinae Podophylli, . . . 

Extr. Belladon. Fol., . 

Pulv. Capsici, 

Pulv. Sacch. Lactis, aa gr. xxiv. 

Pulv. Acaciae, gr. vj. 

Glycerini, Syrupi, aa q. s. 
Fiat massa et div. in pil. xxiv. 
Sig. — One or two pills as required. 



Aperient Pills. 

T$. Pulv. Aloes Purif., gr. xxiv. 

Pulv. Rhei, gr. xlviij. 

Hydrarg. Chlor. Mitis, gr. iv. 

Antim. et Potas. Tart., gr. ij. 

Fiat massa et div. in pil. xxiv. 
Sig. — One or two pills as needed. 
Anti-Bilious Pills. 
1$. Pulv. Scammonii, 
Pulv. Aloes Purif., 
Pulv. Gambogiae, 
Hydrarg. Chlor. Mitis, 

Potassii Bitart., aa gr. xx. 

Extr. Taraxaci, q. s. 
Fiat massa et div. in pil. xx. 



Potus, A Drink (Unofficial), — is a solution or a mixture intended to be used 
ad libitum, and generally consists of a potassium or sodium salt, or a mineral 
acid, in dilute solution, sweetened and flavored. 

The Imperial Drink. 1$. Potassii Bitartratis, 5ij; Olei Limonis, ngv; Aquae Bul- 
lientis, q. s. ad §xx. M. Fiat potus. Sig. — Use as a drink. 

Pulveres, Powders, — are usually prepared extemporaneously, but a few 
compound ones have been made official, the ingredients being directed to be 
rubbed together until reduced to a fine powder and thoroughly mixed. Special 
directions are given for the preparation of two, the Compound Effervescing 
Powder and the Compound Powder of Morphine. There are 7 official powders 
named as follows, — 



PHARMACEUTICAL PREPARATIONS. 547 

Pulvis Aromaticus. Pulvis Glycyrrhizae Compositus. 

Pulvis Cretae Compositus. Pulvis Ipecacuanhas et Opii. 

Pulvis Effervescens Compositus. Pulvis Jalapse Compositus. 

Pulvis Rhei Compositus. 

The composition of each of these preparations will be found in the section on Materia 
Medica under the title from which its name is derived, except that of the Compound Effer- 
vescing Powder, which is placed under the title Potassium. Pulvis Ipecacuanhae et Opii is 
really a trituration, its ingredients being rubbed together with sugar of milk into a very fine 
powder. 

As prepared extemporaneously Powders are generally compound and may 
be mixed on a slab with a spatula, but a better method of mixing them is by 
trituration in a mortar. The latter should always be employed except in the 
case of substances which may explode if so treated, as Potassium Chlorate with 
oxidizable substances. (See page 510.) The diluent best employed in powders 
is Sugar of Milk, on account of its hardness, density and comparative insolubil- 
ity. A coloring agent, as Carmine in minute quantity, is a useful ingredient, 
enabling the eye to judge of the degree of mixing and subdivision obtained. 
Powders containing soluble salts, extracts, volatile oils, camphor, or any other 
hygroscopic or volatile substances, should be dispensed in waxed paper. For 
ordinary powders the plain white paper of the drug-stores will answer, but a 
better paper for small powders is a very thin one having a high surface finish, as 
the white glazed French demy. Powders are often ordered in Wafers (Cachets), 
to be swallowed without unfolding. The division of powders into the number 
of Papers (Chartulce) ordered and folding them neatly, require a considerable 
amount of practice. A small machine is used, over which the ends of the papers 
are bent, in order to have them of the proper size for the box in which they 
are dispensed. If they are to be put into an envelope, less exactness of folding 
is required, and the mechanical contrivance may be dispensed with. 

Substances suitable to administration in the form of powders are those which 

are insoluble, those which would be chemically incompatible in fluid form, and 

certain pulverizable extracts. Those which are unsuited to this form are such 

as have a nauseous taste or odor, substances of which the dose is large, those 

which are deliquescent, efflorescent or very volatile, and those which liquefy on 

mixing. A list of deliquescent and efflorescent salts is found on page 545, while 

the following-named, though dry alone, become moist when triturated together, 

viz — . 

Sodium Sulphate and Potassium Carbonate. 
Zinc Sulphate and Lead Acetate. 
Camphor and Hydrated Chloral. 

Many substances cannot be powdered without the intervention of another 
body: thus Opium requires a hard substance like sugar of milk or potassium 
sulphate, Camphor requires a minute quantity of alcohol, Myrrh needs sugar 
or gum. Substances, as the alkaloids and their salts, which are very active and 
are used in very small doses, require some inert substance to give them bulk 
enough for division and handling. Sugar of Milk is the best agent for this 



548 



PHARMACEUTICAL PREPARATIONS. 



purpose. Prescriptions may order the ingredients for a single powder, with 
directions to dispense a certain number of the same composition; or they may 
give the quantities for the whole number of powders ordered, with instructions 
to divide into a certain number. The dispenser should carefully scan the pre- 
scription in order to avoid the multiplication of quantities where division is 
intended. The official powders are named on page 561, and the following 
formulas will serve to illustrate those generally prescribed: — 



Astringent Powder for Infants. 

1$. Plumbi Acetatis, gr. ij. 

Pulveris Opii, gr. ss. 

Camphorae, gr. j. 

Sacchari Lactis, gr. iij. 

Trit. et div. in chartulas xij. 
Sig. — One powder every 2 or 3 hours in 
diarrhea of infants. For an adult the above 
represents one dose. 



9. 



► 



Gastric Sedative. 

Bismuthi Subnitratis, 5 j. 

Pulveris Rhei, 

Pulveris Aromat., aa 3ss. 

M. et div. in chartulas vj. 

Sig. — One powder before each meal. 



Laxative Powder. 

1$. Hydrarg. Chlor. Mitis., gr. x. 

Sacchari Lactis, gr. xx. 

M. et fiant pulv. x. 

Sig. — One powder twice daily. 



Bismuth and Soda. 
t. Bismuthi Subnitratis, 

Sodii Bicarb., aa 3ij. 

Pulv. Zingiberis, gr. xl. 

M. et div. in chartulas xij. 
Sig. — One after each meal. 
Correctfve in dyspepsia, acne and eczema. 



Antipruritic Powder. 

R/,. Pulveris Camphorae, 5 j. 

Zinci Oxidi, 5iv. 

Pulv. Amyli, 5 j. 

M. et fiat pulvis. 

Sig. — Use locally as a dusting powder to 
relieve itching. 



Catarrh Powder. 
),. Bismuthi Subnitratis, 5 iij. 

Pulv. Acaciae, 3 j. 

Pulv. Talci, 3ij. 

Morphinae Hydrochlor., . .gr. j. 
M. Sig. — Use by insufflation. 



Compressed Tablets are really powders which have been compressed into 
tablet shape by machinery. A little pressure from the blade of a spatula will 
restore them to the powder form. 

Resinae, Resins. — Pharmaceutical resins are solid preparations obtained 
by precipitating the resinous principles of plants from their alcoholic solution 
by the agency of water. They differ from alcoholic extracts in containing only 
those principles which are soluble in alcohol and insoluble in water, while the 
extracts contain all principles which are soluble in alcohol. Including Resina 
itself, which is the residue left after distilling off the volatile oil from Turpentine, 
there are 4 official Resins, three of which correspond to the above description. 
They are named: — 



Resina. 

Resina Jalapae. 
True Resins are defined on page 9. 



Resina Podophylli. 
Resina Scammonii. 



Spiritus, Spirits, — are alcoholic solutions of volatile substances, which may 
be solids or liquids. They are officially prepared either by simple solution, 
by solution with maceration, or by chemical reaction. The menstruum is 
Alcohol in nearly all instances, 4 having Water in addition. The official 
spirits are 15 in number, as follows, — 



PHARMACEUTICAL PREPARATIONS. 549 

Spiritus ^Etheris (32^). Spiritus Cinnamomi (10). 

Spiritus iEtheris Nitrosi (3.5 to 4.5). Spiritus Glycerylis Nitratis (1 to 1.1). 

Spiritus Ammoniae Aromaticus (9). Spiritus Juniperi (5). 

Spiritus Amygdalae Amarae (1). Spiritus Juniperi Compositus (0.4). 

Spiritus Anisi (10). Spiritus Lavandulae (5). 

Spiritus Aurantii Compositus (20). Spiritus Menthae Piperitae (10). 

Spiritus Camphorae (10). Spiritus Menthae Viridis (10). 

Spiritus Chloroformi (6). 

The figures placed after the above preparations indicate the quantity of the principal 
ingredient in grammes to each 100 cubic centimeters of the preparation. 

Succi, Juices, — are expressed from fresh, medicinal plants, and preserved 
by the addition of alcohol i part to 3 of the juice. Limonis Succus (lemon - 
juice) is official in the U. S. Pharmacopoeia, and contains no alcohol; the fol- 
lowing-named are official in the British Pharmacopoeia: — 

Succus Limonis. Succus Scoparii. Succus Taraxaci. 

Suppositoria, Suppositories, — are solid bodies containing medicinal sub- 
stances, and intended for introduction into the vagina, rectum or urethra. The 
Pharmacopoeia prescribes a general formula for their preparation, according to 
which the medicinal portion may be incorporated with Oil of Theobroma, 
Glycerinated Gelatin, or Sodium Stearate. 

In the U. S. Pharmacopoeia the only official suppositories are those of Glyc- 
erin, in which Stearic Acid is used to give the requisite consistence. In the 
British Pharmacopoeia the following 7 suppositories are official: — 

Suppositoria Acidi Carbolici, Phenol Suppositories, — Phenol, 12 grains; White Bees- 
wax, 24 grains; Oil of Theobroma, q. s. for 12 suppositories, each containing 1 grain of Phenol. 

Suppositoria Acidi Tannici, Tannic Acid Suppositories, — Tannic Acid, 36 grains; Oil 
of Theobroma, q. s., for 12 suppositories each containing 3 grains of Tannic Acid. 

Suppositoria Belladonnae, Belladonna Suppositories, — Alcoholic Extract of Belladonna, 
18 grains; Oil of Theobroma, q. s. for 12 suppositories, each containing i£ grains of the extract 
or approximately -^ grain of the alkaloids of belladonna root. 

Suppositoria Glycerini, Glycerin Suppositories, — Gelatin, cut small, $; Glycerin, by 
weight, 2\', Distilled Water, a sufficiency to make as many suppositories as desired, according 
to size, each containing 70 per cent, by weight of Glycerin. 

Suppositoria Iodoformi, Iodoform Suppositories, — Iodoform, 36 grains; Oil of Theo- 
broma, q. s. for 12 suppositories, each containing 3 grains of Iodoform. 

Suppositoria Morphinae, Morphine Suppositories, — Morphine Hydrochloride, 3 grains; 
Oil of Theobroma, q. s. for 1 2 suppositories, each containing \ grain of the Morphine salt. 

Suppositoria Plumbi Composita, Compound Lead Suppositories, — Acetate of Lead, 
36 grains; Opium, in powder, 12 grains; Oil of Theobroma, q. s. for 12 suppositories, each 
containing 3 grains of Lead Acetate and 1 grain of Opium. 

In extemporaneous pharmacy Suppositories are usually prepared with Oil 
of Theobroma (Cacao-butter) as a vehicle, but for those intended for the uterus 
or urethra a mixture of Gelatin and Glycerin is considered the best vehicle, 
being firmer and more plastic than cacao-butter, and more easily handled. 
Hollow cones of cacao-butter, or some composition resembling it, are kept in the 
shops, and will be used by the average druggist in filling prescriptions for rectal 
suppositories unless prohibited, as they save him considerable labor; the active 
drug being simply placed in the centre of the cone, which is then sealed by a 
plug fitting into its base. These contrivances are not so efficient as the regular 



550 PHARMACEUTICAL PREPARATIONS. 

suppository, in which the medicinal agent is thoroughly incorporated with the ex- 
cipient, for the former smear the rectum with a quantity of melted grease before 
the active ingredient is permitted to come into contact with its walls. The agents 
used in suppositories are chiefly extracts and alkaloids, some few powders and a 
few metallic salts are occasionally employed. Those for the adult rectum should 
contain about 15 grains of the excipient, for the vagina a drachm of cacao-butter 
is the average quantity. Those for the uterus and urethra are made of cylin- 
drical instead of conical form, and about the diameter of a No. 9 catheter. 

The methods of compounding suppositories are two — that by the use of 
moulds (the official method), and that by hand, which is as follows: The medica- 
ment is mixed with finely shaved Cacao-butter by the aid of a spatula, on a 
board or tile lightly dusted with lycopodium or starch. After a smooth and 
uniform mixture is thus obtained, the mass may be rolled into cylindrical form, 
cut into the required sizes and with the spatula given the required shape. When 
dispensed, they should be placed in a powder-box between layers of cotton. 

Bougies or Pencils, as urethral and uterine suppositories are often termed, 
may be prepared by melting together White Gelatin 3, Glycerin 1, and Distilled 
Water 1 part by weight, then adding the medicament and drawing the mass 
into a glass tube previously oiled inside. When cold the bougie may be pushed 
out and cut into suitable lengths. 

Suppositories and Bougies may be prescribed in the manner illustrated by 
the following formulae: — 

Anodyne Suppository. Wade's Bougies. 

]$. Extr. Opii, gr. vj. | ]$. Iodoformi, 

Extr. Belladonnse Fol., gr. ss. 

r Extr. Hyoscyami, gr. ij. 

Olei Theobromse, q. s. 
M. Fiant suppositoria vj. 
Sig. — One into the rectum morning and 
night. 



Anthelmintic. 

1$. Santonini, gr. xij. 

Olei Theobromae, 5 j. 

M. Fiant suppositoria vj. 

Sig. — One into the rectum as directed. 

Quinine Suppository. 

1$. Quininae Sulpha tis, gr. v. 

Olei Theobromae, gr. x. 

Fiat suppositorium unum, mitte tales sex. 



Bismuthi Subnitrat aa 3j. 

Chlorali Hydra ti, gr. viij. 

Morphinae Sulphat., gr. iij. 

Ol. Rosas, ttjjx. 

Gelatini et Glycerini, q. s. 
M. Fiant bougia xij. 
Sig. — One into urethra thrice daily. 



Bougie for Gleet. 

]$. Zinci Sulphatis, gr. vj. 

Phenolis, irjuij. 

Pulv. Hydrastis, gr. xij. 

Extr. Belladonna? Fol., gr. xij. 

Gelatini et Glycerini, q. s. 
M. Fiant bougia xij. 
Sig. — One into the urethra night and 
morning. 

Syrupi, Syrups, — are concentrated solutions of Sugar in water or in aqueous 
liquids. They sometimes contain acetic acid, and occasionally alcohol; and 
are termed simple, medicated or flavored, according as they are simple solutions 
of sugar in water alone, or contain soluble medicinal substances or flavoring 
ingredients. The sugar used should be very dry, and its official description 
corresponds with the granulated sugar of commerce. The permanence of these 
preparations depends chiefly on their possessing the proper relative proportions 



PHARMACEUTICAL PREPARATIONS. 



551 



of sugar and water. They are prepared either by solution with heat, by agita- 
tion without heat, by adding a medicated liquid to simple syrup, by digestion or 
maceration, or by cold percolation. They are best preserved by being poured 
while hot into pint bottles, which should be corked securely while full, and the 
tops dipped into melted sealing-wax. Fermented syrups are useless for dispens- 
ing purposes. The number of official syrups is 22, as follows, — 



Syrupus. 

Syrupus Acaciae, (10). 
Syrupus Acidi Citrici, (1). 
Syrupus Acidi Hydriodici, (0.13 to o 
Syrupus Aurantii, (5 of tinct.). 
Syrupus Aurantii Florum. 
Syrupus Calcii Lactophosphatis. 
Syrupus Ferri Iodidi, (6.75). 
Syrupus Hypophosphitum. 
Syrupus Ipecacuanhae, (7). 
Syrupus Lactucarii, (10 of tinct.). 
The figures represent the percentage of 



Syrupus Picis Liquidae, (5:1000). 

Syrupus Pruni Virginianae, (15). 

Syrupus Rhei, (10). 
.145). Syrupus Rhei Aromaticus, (15 of tinct.). 

Syrupus Sarsaparillae Compositus, (20). 

Syrupus Scillae, (45 of vinegar). 

Syrupus Scillae Compositus, (8). 

Syrupus Senegae, (20). 

Syrupus Sennae, (25). 

Syrupus Tolutanus, (5 of tinct.). 
9 Syrupus Zingiber is, (3). 
the drug or preparation named. 



Tabellae, Tablets (Unofficial), — are largely manufactured by several reliable 
firms, and consist of various medicinal powders pressed into tablet shape by 
machinery. They are convenient preparations for the physician's use; quite a 
variety can be carried in a pocket-case, and as slight pressure is sufficient to 
reduce them to powder they can be dispensed with facility and accuracy of 
dosage. The terms Tabloid and Soloid are proprietary designations of com- 
pressed tablets manufactured in England. The following list includes the most 
important of these preparations, the figures representing the number of grains 
in a tablet in each case: — 



Acid, Arsenous, ■£$, iV> 

Benzoic, 5. 

Gallic, 5. 

Salicylic, 2$, 5. 



5- 



Tannic, 2, 

Aconitina, J^. 

Aloes, 2. Aloes et Ferri (U. S. P.). 

Aloes, 2, et Myrrh, 1. 

Aloes, §, et Rhei, i£, et Gentian, f . 

Aloin, i, J, £. 

Ammonium Bromide, 5, 10. 

Ammonium Chloride, 3, 5, 10. 

Antiseptic, Hydr. Chlor. Corros., 7*. 

Atropine, ^ 

Bismuth Subcarb., 5. 

Subnitrate, 5, 10. 

Borax, 5. 

Caffeine Citrate, 1. 

Calcium Sulphide, ^, £, $, 1. 

Calomel, £, £, 1, 2, 3, 5. 

Calomel, 2, Opium, 1. 

Camphor Monobromated, 2, 3, 5. 

Carbo Animalis, 10. 

Cathartic, Compound (U. S. P.). 

Vegetable (U. S. P.). 

Cerium Oxalate, 2. 
Chloramine Pastilles (Spencer). 



Cinchona Alkaloids (mixed). 

Cinchonine Sulphate, 2, 3, 4, 5. 

Cinchonidine Sulphate, 2, 3, 4, 5. 

Cocaine Hydrochloride, £. 

Codeine, \. 

Digitalin, ^. 

Extract of Cannabis, J. 

Extract of Ignatia Amara, J, $. 

Extract of Nux Vomica, J, §. 

Fehling's Test for grape-sugar in urine. 

Ferrum (Quevenne's), 1, 2. 

Arsenate, |, £. 

Proto-carbonate, 3, 5. 

Lactate, 1. 

Ferrum Pyrophosphate, 2. 

and Quinine Citrate, 2, 3, 5. 

Hydrargyrum, 1, 3, 5. 

Chloridum Corros., -io, ^, ^, T V 

Iodidum Rub., 3V, tV 

Iodidum Flavum, T V, £, £, J. 

Oxidum Flavum, j^o' 

Ipecac, et Opii, 2, 3, 5. 
Morphine Sulphate, T \, $, £, £, J. 
Opium, Deodorized, 1. 
Opium, £, and Lead Acetate, i£. 
Pepsin, Saccharated, 2, 5. 
Podophyllin, T V, |, i, J, 1, 2. 
Potassium Bromide, 5, 10. 



552 



PHARMACEUTICAL PREPARATIONS. 



Potassium Chlorate, 5. 

and Borax, aa 2 J. 

Iodide, 5. 

Nitrate, 5. 

Permanganate, £, 1, 2. 

Quinine Bisulphate, £, 1,2, 3, 4, 5. 

Salicylate, 2. 

Quinine Sulphate, £, 1, 2, 3, 4, 5. 

Quinquinine, 2, 3. 

Rhubarb, 3. 

Rhubarb, 2, and Magnesia, 2. 

Salicin, z\, 5. 

Santonin, 1. 

Santonin, 1, and Calomel, 1. 



Sodium Bicarbonate, 5. 

Salicylate, 3, 5. 

Strychnine, yfo, -fay up to ^. 
Zinc Phosphide, T V up to $. 

Hypodermic Tablets. 

Morphine Sulphate, T ^ to §. 
Morph. Sulph. and Atropine Sulph. 
Atropine Sulphate, 2F0-7V 
Strychnine Sulphate, y^. 
Apomorphine Hydrochloride, ^V 
Pilocarpine Hydrochloride, ^-|. 
(And several others.) 



) 



Tincturae, Tinctures, — are alcoholic solutions of medicinal substances, and 
with one official exception, Tincture of Iodine, are made from non-volatile 
bodies. They are prepared by percolation,* maceration,! solution or dilution; 
the menstrua employed being chiefly Alcohol, Diluted Alcohol, and Alcohol 
and Water in various proportions. Two ammoniated tinctures are made with 
Aromatic Spirit of Ammonia, in one Acetic Acid is an ingredient of the men- 
struum, and several have Glycerin. The official tinctures are now practically 
in two classes as to strength, 10 per cent, for the more powerful ones, and 20 
per cent, for the others, with a few exceptions. They number 54, and are named 
in the following list, the figures placed after each giving the number of grammes 
of the drug in each 100 cubic centimeters of the tincture: — 



Tinctura Aconiti (10). Tinctura 

Tinctura Aloes (10). Tinctura 

Tinctura Arnicae (20). Tinctura 

Tinctura Asafcetidae (20). Tinctura 

Tinctura Aurantii Amari (20). Tinctura 

Tinctura Aurantii Dulcis (50). Tinctura 

Tinctura Belladonnas Foliorum (10). Tinctura 

Tinctura Benzoini (20). Tinctura 

Tinctura Benzoini Composita (10). Tinctura 

Tinctura Calumbae (20). Tinctura 

Tinctura Cannabis (10). Tinctura 

Tinctura Cantharidis (10). Tinctura 

Tinctura Capsici (10). Tinctura 

Tinctura Cardamomi (10). Tinctura 

Tinctura Cardamomi Composita (2 J). Tinctura 

Tinctura Cinchonas (20). Tinctura 

Tinctura Cinchonas Composita (10). Tinctura 

Tinctura Cinnamomi (20). Tinctura 

Tinctura Colchici Seminis (10). Tinctura 

Tinctura Digitalis (10). Tinctura 

Tinctura Ferri Chloridi (13). Tinctura 

Tinctura Gambir Composita (5). Tinctura 

Tinctura Gelsemii (10). Tinctura 

Tinctura Gentianas Composita (10). Tinctura 

Tinctura Guaiaci (20). Tinctura 

Tinctura Guaiaci Ammoniata (20). Tinctura 

Tinctura Hydrastis (20). Tinctura 



Hyoscyami (10). 

Iodi (7). 

Kino (10). 

Lactucarii (50). 

Lavandulae Composita (0.8). 

Limonis Corticis (50). 

Lobelias (10). 

Moschi (5). 

Myrrhas (20). 

Nucis Vomicae (10). 

Opii (10). 

Opii Camphorata (0.4). 

Opii Deodorati (10). 

Physostigmatis (10). 

Pyrethri (20). 

Quassias (20). 

Rhei (20). 

Rhei Aromatica (20). 

Sanguinariae (10). 

Scillas (10). 

Stramonii (10). 

Strophanthi (10). 

Tolutana (20). 

Valerianae (20). 

Valerianae Ammoniata (20). 

Veratri Viridis (10). 

Zingiberis (20). 



For Tinctures of Fresh Herbs {Tinctura Medicameniorum Recentium), the National 

Formulary prescribes a general formula, according to which, when not otherwise directed, 

* Type Process P. 

f Type Process M. 



described in U. S. P. IX, under Tinctures. 



PHARMACEUTICAL PREPARATIONS. 553 

they are to be prepared by macerating 50 grammes of the fresh herb, bruised or crushed, in 
100 cubic centimeters of alcohol, for 14 days, then expressing the liquid and filtering. 

Triturationes, Triturations, — form a class of powders having for their 
diluent Sugar of Milk, and possessing a definite relation between the active 
ingredient and the diluent. The Pharmacopoeia prescribes a general formula 
for these preparations, according to which 10 grammes of the substance and 
90 of Sugar of Milk are to be well mixed by a spatula, the latter being added 
in successive quantities, and both triturated in a mortar until the substance is 
intimately mixed with the diluent and finely comminuted. There is but one 
official trituration (Trituratio Elaterini) , though the Pulvis Ipecacuanhae et Opii 
practically belongs to this class. Sugar of Milk is employed as the diluent 
because of its hardness and its comparative insolubility. The first of these 
qualities secures the fine comminution of the active ingredient, whereby the 
action of the medicine is increased and better distributed. Its insolubility 
makes it the best diluent for powders or triturations administered from a spoon 
or glass with fluid, as is so often done, for unlike cane sugar it is not readily dis- 
solved and does not leave the active substance behind on the surface of the uten- 
sil. Triturations are excellent forms for the adminstration of powerful alkaloids, 
which may thus be divided with great accuracy into the minute quantities re- 
quired. Mercury and its salts are especially adapted to this method of prepara- 
tion, being more uniformly divided and hence more active than when adminis- 
tered in any other form. Triturations of mercury with sugar were commonly used 
in England a hundred years ago, and triturations of many substances were 
employed by the Arabian physicians of the 13th century; but the subsequent 
adoption of these preparations by the homeopathists produced such a prejudice 
against them in the ranks of the regular profession, that until recently any one using 
them stood in danger of being stigmatized as a homeopath. Their recog- 
nition by the U. S. Phamacopceia under their proper title does away with any 
such implication. The preparations of Pepsin daily prescribed by physicians 
all over the country are really sugar-of-milk triturations of that ferment, and 
not pure pepsin as many suppose. Professor H. G. PifTard, in his treatise 
on the Materia Medica and Therapeutics of the Skin, after detailing the re- 
sults of several microscopical examinations of pills and triturations, uses the 
following language:' — 

"It is to be expected, therefore, that the protoiodide trituration will prove, ceteris paribus, 
more active than the pill, and such we have found it. . . . Since we have used the tritu- 
rations, however, in preference to the ordinary pills, patients more rarely complain of dis- 
agreeable sensations. We have been enabled to materially reduce the size of the dose in order 
to obtain the desired effect. In other words, a larger proportion of the drug is utilized for 
specific purposes, while but a small amount remains to give rise to local irritation. . . . 
I have nothing to add to this, except that I continue to use triturations of Mercury and other 
substances with increasing satisfaction. Beside those mentioned I employ Calomel, Cyanide 
of Mercury, Black Oxide of Mercury and Corrosive Sublimate in this form." 

The following examples will illustrate the mode in which Triturations may 
be prescribed: — 



554 



PHARMACEUTICAL PREPARATIONS. 



P^. Hydrarg. Oxidi Flavi, gr. ss. 

Sacchari Lactis, gr. 1. 

Trit. et div. in chartulas xxiv. 
Sig. — One powder twice daily. 



. Hydrarg. Chlor. Mitis, . . 

Sacchari Lactis, q. s. 
Trit. et div. in chartulas x. 
Sig. — One powder daily. 



gr. 



1$. Morphinae Sulph., gr. j. 

Sacchari Lactis, gr. xvj. 

Trit. et div. in chartulas viij. 

Sig. — One powder every six hours. 

1$. Arseni Trioxidi, gr. ss. 

Sacch. Lactis, gr. xl. 

Trit. et div. in chartulas xx. 
Sig. — One powder thrice daily. 



Trochisci, Troches, also called Pastilles and Lozenges, — are small flat- 
tened cakes of medicinal substances, prepared from a mass made with a basis 
of Sugar, some having Mucilage of Tragacanth, others Orange-flower Water, 
Syrup of Tolu. etc., as excipients. They are especially useful when the active 
ingredients are intended to come into contact with the mucous surface of the 
throat. There are 5 official Troches, named as follows: — 



Trochisci Acidi Tannici. 
Trochisci Ammonii Chloridi. 
Trochisci Cubebae. 



Trochisci Potassii Chloratis. 
Trochisci Sodii Bicarbonatis. 



Troches are not readily compounded at the dispensing counter, but may 
be obtained in all first-class shops, being prepared in great variety by the manu- 
facturers. Besides the official Troches, those named in the following list are 
generally for sale: — 

Alum, gr. ij. Ginger and Sodium Bicarbonate. 

Alum, gr. i£, Catechu, gr. ij. Guaiac, gr. ij. 

Ammonium Chloride, gr. ij, and Cubeb, gr. j. Kino, gr. ij. 

Ammon. Chlor., gr. ij, Licorice, gr. viij. Lettuce, gr. j. 

Benzoic Acid, gr. \. Logwood, gr. ij. 

Borax, gr. iij. Magnesia, gr. iij. 

Bismuth, gr. ij, and Charcoal, gr. v. Pellitory. gr. j. 

Bronchial, — Oleores. Cubebae, gr. \, Tolu, gr. Pepsin, gr. iij, Charcoal, gr. iij, Magnesia, 

\, Ol. Sassafras, gr. T V, and Extr. of Lico- _ gr. ij, and Ginger, gr. j. 

rice, gr. vij. 
Brown Mixture. 



Potassium Bitartrate, gr. iij. 
Potassium Citrate, gr. iij. 
Santonin, gr. 4-, and Calomel, gr. \. 



Unguent a, Ointments, — are soft, fatty mixtures of medicinal agents with 
a basis of lard, petrolatum, or fixed oils with a solid fat such as wax or sperma- 
ceti. They are intended for application to the skin by inunction, and have a 
melting point which is below the ordinary temperature of the human body. 
Of the 20 official Ointments 1 is prepared by chemical reaction (Unguentum 
Hydrargyri Nitratis), 7 by fusion and 12 by incorporation of the ingredients 
with each other, they being mixed together by trituration or through the agency 
of a spatula and a porcelain slab. Unguentum itself is prepared by fusing to- 
gether 80 of Benzoinated Lard and 20 of White Wax, and is the basis of 3 other 
ointments; while 8 have Benzoinated Lard, and 2 have Lard as their basis. 
The official Ointments are — 



Unguentum. 

Unguentum Acidi Borici (10). 



Unguentum Acidi Tannici (20). 
Unguentum Aquas Rosae. 



PHARMACEUTICAL PREPARATIONS. 555 

Unguentum Belladonna? (10). Ung. Hydrargyri Oxidi Flavi (10). 

Unguentum Chrysarobini (6). Unguentum Iodi (4). 

Unguentum Diachylon. Unguentum Iodoformi (10). 

Unguentum Gallae (20). Unguentum Phenolis (3). 

Unguentum Hydrargyri (50). Unguentum Picis Liquidae (50). 

Ung. Hydrargyri Ammoniati (10). Unguentum Stramonii (10). 
Unguentum Hydrargyri Dilutum (30). Unguentum Sulphuris (15;. 

Ung. Hydrargyri Nitratis (7). Unguentum Zinci Oxidi (20). 

The figures in parentheses show the percentage of the extract or other active ingredient 
in the ointment. The composition of each may be found in the section on Materia Medica 
under the title from which the preparation is named, except Unguentum, which will be found 
under the title Adeps, and Unguentum Diachylon under Plumbum. 

Ointments and Cerates are frequently ordered on extemporaneous formulae, 
though the numerous official preparations of these classes would seem to give 
the physician a sufficiently wide field for selection. The basis is usually either 
the official Ceratum, Unguentum or Wool Fat, but Petrolatum, Lard, and 
Lead Plaster with a fixed oil, may be employed. Lard and Wool Fat are 
probably the best bases for ointment intended to be absorbed to a greater 
or lesser extent by skin. It is to be remembered that the disadvantage of 
lard is that it will become rancid if kept for any great length of time. Cerates 
only differ from ointments in their firmer consistence, melting at tempera- 
tures above 104 F., while the latter melt below the ordinary temperature of 
the body. 

The process of compounding an ointment or a cerate is sufficiently simple, 
being generally a mere matter of triturating the ingredients together in a mortar, 
or their incorporation on a slab by means of a spatula. Rarely will melting 
be required in the compounding of extemporaneous ointments. When extracts, 
powders or gritty substances are ordered, the ingredients should be first pul- 
verized into a fine powder, then triturated with a small quantity of the basis 
into a smooth, impalpable paste, the remainder of the basis being added gradu- 
ally, until the whole is thoroughly incorporated. A warm mortar may be re- 
quired for hard extracts. Soluble salts should be triturated with a little water 
before adding the excipient. Camphor needs a little alcohol to enable it to be 
pulverized. Iodine should be rubbed to a fine powder, then a little alcohol 
added and finally the excipient by degrees. Sulphur Iodide requires persevering 
work with a small portion of olive oil. Borax should be triturated with glycerin 
and Red Mercuric Oxide with distilled water. A bone or horn spatula should 
be used for all ointments, as steel or iron blades will injure many substances, 
particularly alkaloids, free acids, tannin, iodine and several of the mercurial 
salts. Volatile substances are added last and quickly worked in, so that their 
evaporation may be as slight as possible. 

Ointments are dispensed usually in amber-colored glass pots with wooden 
or metallic covers, or in porcelain jars called Gallipots. In hospital and dis- 
pensary practice the common chip pill-box is used, but soon becomes dirty and 
disagreeable to handle. 



I 



55^ ELECTROTHERAPEUTICS. 

Unguentum Iodoformi Composition. Unguentum Anti-pruriticum. 



. Iodoformi 5 j. 

Ol. Anisi, ttjjxx. 

Ol. Rosae, 

Ol. Ylang-ylang, aa ttjjv. 

Ung. Aquae Rosae, § j. 

M. Fiat unguentum. 
Sig. — Ointment. 



]$. Camphorae, 

Chlorali Hydrati, aa 5 j. 

Tere una ad liquorem, dein 
adde cum tritu — 

Unguenti Aquae Rosae, 5 j. 

M. Fiat unguentum. 
Sig. — Ointment for itching. 



Vina, Wines (Unofficial), — when medicated are practically the same as 
tinctures. 

ELECTROTHERAPEUTICS* 



Electricity as a therapeutic agent is employed more frequently now than 
ever before. The evolution from empiricism to accurate knowledge of some 
of the physiological effects of electricity has been gradual but sure, until at 
the present time it may be said that there is a sound scientific basis for the 
employment of electrotherapeutic measures. 

In addition to its known value electricity has great future possibilities, 
and perhaps may solve some of the elusive and difficult physical problems 
that have hitherto resisted scientific endeavor. It is true that many condi- 
tions can be treated with greater benefit by drug or other measures than by 
electricity, but experience also teaches that in many pathological conditions, 
the benefits to be derived from the application of electricity are greater than 
those obtained by any other means. 

Physiological Action and Therapeutics. 

Electricity, though always the same force, is manifested in many ways and 

when modified and applied with knowledge, intelligence and skill, may be 

made to produce different physiological effects. It is upon this variability 

that the whole superstructure of electrotherapeutics rests. The known effects 

produced by electricity may be classified as follows: (1) Mechanical, (2) 

electrolytic or chemical, (3) counter-irritant, (4) thermic, (5) actinic, (6) 

psychic. These effects may be postulated, and it requires but simple logical 

deduction to reveal their application to rational therapeutics. 

Mechanical contractions of nerves, muscles, ligaments and viscera may 

be produced by the interrupted galvanic, the plain or interrupted faradic, 

the sinusoidal, the static wave, static sparks, static induced current and the 

. high frequency resonator discharge. These contractions may be general or 

local, slow or rapid, superficial or deep; irregular, or so rhythmical that they 

may be made exactly to synchronize with the heart beat. The employment 

of electrical contractions alternating with relaxations, accomplishes exercise 

without fatigue, with the incidental stimulating, developmental, eliminative 

*By Dr. William L. Clark, Lecturer on Electrotherapeutics, Jefferson Med. Coll., 
Philadelphia. For an adequate presentation of the principles of electricity, the types of 
apparatus and methods of technic employed, which is not possible in this book, the reader 
is referred to special monographs. 



ELECTROTHERAPEUTICS. 557 

and metabolic effects. All these currents have some particular indications, 
although there are conditions in which they may be used interchangeably 
or in combination. 

The Electrolytic or Chemical action of the galvanic current is utilized to 
advantage in medicine, and offers a fruitful field for future research work. 
The destruction of small growths and treatment of hypertrichosis by electro- 
lysis is well known. By a method known as ionic medication, various drugs 
may be introduced into the tissues. Copper, zinc, silver, mercury, magne- 
sium and other metals may be separated from their salts and driven into the 
tissues from the anode, as may cocaine, morphine or aconite. Iodine, the 
salicylates and other useful drugs are driven in from the kathode. The 
advantage of ionic medication over introduction of the drug through the 
alimentary tract is that the direct application of drugs insures a maximum 
effect, while when introduced by the stomach, chemical changes and dis- 
tribution of action may materially lessen the local potency of the remedial 
agent. The opposite poles have opposite chemical reactions, the positive 
being acid in reaction, while the negative is alkaline; the positive contracts; 
the negative dilates; the positive is sedative; the negative is stimulating. 
Heating of tissue is produced by the various forms of high frequency 
currents and from carbon, tungsten and nitrogen therapeutic lamps. The 
effect produced by a high frequency current may range from a slight irrita- 
tion of the skin and the production of a simple hyperemia, to actual coagula- 
tion, desiccation or incineration. The action may be localized in one area 
or generalized over the surface of the whole body. The current may pene- 
trate the body at given points; a joint may be heated, as may the liver, lung, 
kidney, or indeed any organ. This heat may also be distributed equally 
through every portion of the organism with a consequent elevation of the 
body temperature. The heat from electric therapeutic lamps, as far as is 
known, is comparatively superficial, although the lamps furnish a convenient 
method of applying surface heat, and are of undoubted value. 

All degrees of counterirritation may be produced by the application to 
the skin of the galvanic and high frequency currents, the static brush dis- 
charge, heat from electric therapeutic lamps, and the ultraviolet rays. The 
counterirritation from the ultraviolet rays is more lasting in effect than that 
obtained by the other methods. 

Actinic effects are produced by some of the spectral and extra spectral 
rays generated by electrical currents. Blue rays are known to be sedative 
and red rays stimulating. The action of the other spectral rays are not so 
well determined. Very little is known of the action of infra-red except that 
of heat. The ultraviolet rays are strongly actinic and are bactericidal in 
action to a marked degree, very stimulating and irritating, even to the point 
of producing the destruction of superficial tissue. Under modifications of 
application, consisting of filtration of irritating wave lengths by interposing 
blue ultraviolet glass, and compression of tissue for the purpose of producing 



558 ELECTROTHERAPEUTICS. 

ischemia by quartz lenses while the rays are passing through, these rays 
may be made less irritating. The rays cannot penetrate any substance 
colored red, hence the necessity of producing a temporary ischemia to insure 
penetration by the rays. Under ischemia, the penetration is from one to 
four millimeters. The ultraviolet rays may be used with success in some 
skin lesions and in such systemic conditions as are benefited by sunlight. 
The :v-ray properly comes under electrotherapeutics, but because of the 
extent of the subject and the numerous excellent text-books dealing with it 
in a special way, it will not be discussed here. 

The beneficial psychic influence of electricity upon some impressionable 
patients is undoubted, and is welcomed in the treatment of such conditions 
as hysteria and hypochondriasis, but this is the least of the beneficial effects 
of electricity, and not the greatest, as some have taught. There is an in- 
fluence aside from the psychic one. It may be safely asserted that the 
individual who comes in unexpected contact with a live wire does not die 
from the psychic effect; conversely the therapeutic application of a selected 
current benefits the recipient. 

Let us now consider some of the fallacious teaching. 

i. The word modality seems to have been recently coined and is used 
frequently in literature dealing with electrotherapeutics to express the par- 
ticular method employed in a given case. There is no necessity for coining 
this word, as the terms current, methed or mode amply express the intended 
meaning. 

2. The belief that the galvanic current on account of its low voltage 
follows the surface of the body and does not penetrate into the deep tissue, 
is an erroneous one. The dry skin is a poor conductor, but when it is mois- 
tened electricity passes through it with ease. The deeper tissues are largely 
of saline fluid composition, therefore, they are a good conducting medium, 
and the galvanic current passes through them freely. Living bone, with its 
constant moisture, is a much better conductor than the skin. The brain is 
acted upon perhaps more freely than any other tissue, because of the large 
percentage of fluid of which it is composed, and the current easily reaches 
the brain because it is a better conductor than either the scalp tissue or the 
cranium. The action of the galvanic current upon the brain is shown by the 
dizziness or even syncope which results when the current is passed trans- 
versely and not longitudinally; this also results from a sudden break in the 
current or when the circuit is opened and closed too suddenly. When the 
galvanic or any other current is applied in a bath and the body is submerged 
during the passage, the action is largely upon the skin surface, because it 
requires less electro-motive force for the current to pass through the water 
than through the skin to the deeper tissues. 

3. It has been asserted that high frequency currents produce their effects 
by various mystical influences, among which has been mentioned "fine 



ELECTROTHERAPEUTICS. 559 

cellular massage." There is no evidence to show that there is any action 
other than that of heat, but it may be truthfully said that for the superficial 
or deep application of heat, with its known benefits, high frequency currents . 
hold first place. 

4. The application of high frequency glass vacuum tubes is often errone- 
ously called ultraviolet ray treatment. Ultraviolet rays will not penetrate 
ordinary glass. If the tube is held a short distance from the body allowing 
the sparks to pass through an air space, a very small amount of ultraviolet 
rays that may reach the skin is generated, but not a quantity sufficient to 
produce any therapeutic effect. Practical ultraviolet rays can be produced 
only by iron carbon or quartz mercury-vapor lamps, and projected through 
clear water, air or rock crystal. The quartz mercury-vapor lamps are much 
more powerful than the iron carbon lamps and have largely superseded them. 

5. Physical contractions by the static wave current and static sparks have 
been recommended for acute neuritis for the purpose of aborting or shorten- 
ing the attack, by hastening the absorption of exudates, promoting tissue 
drainage, relieving pressure, reducing muscle spasm and alleviating pain. 
This is a plausible theory, but does not work out in practice in the case of 
acute neuritis. Because of its high voltage and relatively low amperage, 
the static wave current is less irritating than the interrupted galvanic and 
faradic currents, and may do less harm, but even so, why treat an acutely 
inflamed nerve by any manipulation, no matter how slight, that produces 
trauma? 

Absolute rest and immobility are the first indications. In addition, heat 
from electrical sources, such as high frequency currents and therapeutic 
lamps, or mild positive galvanism to lessen. nerve irritability, may be used 
to advantage. Mechanical or electrical contractions should never be induced 
during the acute stage of a true neuritis, whatever the anatomic location. 
During the sub-acute and chronic stages, the static wave current and static 
sparks, together with diathermy may be used, and will not only give relief, 
but also materially hasten the cure. Reported cases of acute neuritis aborted 
or cured by the static wave current and static sparks probably were not 
cases of true neuritis at all, but neuralgias or myalgias. For the relief of 
muscle spasm these currents are exceedingly valuable. In cases of inflam- 
mation due to infection, or in cases where pus is present, electrical contractions 
are always contraindicated and may produce harmful results. High fre- 
quency currents, ultraviolet rays and radiant light and heat may be used to 
advantage to promote phagocytosis before and after incision and drainage. 

6. Another error is the claim of the reduction to normal size of large 
fibrous prostates. Honest but mistaken physicians have reported that these 
results have been obtained and have indeed gone so far as to assert that 
operative surgery can be dispensed with in these conditions. What really 
has been accomplished is the relief of the superimposed infiltration and chronic 



560 ELECTROTHERAPEUTICS. 

inflammation, the abatement of which ameliorated or obviated the symptoms. 
The static wave current is extremely valuable for this purpose, and may 
obviate the need for surgical interference in cases that would otherwise 
require prostatectomy. In cases of hypertrophied fibrous prostates, in 
which the tissue drainage affected by the static wave current does not relieve 
the coincident congestion sufficiently to abate the symptoms, and in which 
there is an accompanying cystitis, bladder atony and dilatation, the Roentgen 
ray may affect the fibrous tissue as it does the tissue of uterine fibroids. If 
the application of the ray produces no improvement, prostatectomy is the 
only means of relief, unless it be permanent catheter life. An acutely in- 
flamed prostate should not be treated by the static wave current for the same 
reason that an acute neuritis should not be so treated. 

7. There is a widespread belief that the static positive and negative poles 
may be used interchangeably. This is an error inasmuch as sedative or 
irritating effects are dependent upon the polarity. 

8. It is claimed that ozone generated by the high frequency current and 
passed through aromatic oils (for the purpose of absorbing the irritating 
nitrous acid, which is generated with the ozone) is beneficial in diseases of 
the respiratory tract, such as catarrh, bronchitis and tuberculosis. Pure 
ozone alone is irritating to mucous membranes, and much more so when mixed 
with nitrous acid, which is seldom if ever entirely absorbed by the oils. 
Ozone is very unstable, and even though it did possess virtue it could not 
reach the throat or lungs in a pure state, because of the chemical combinations 
it would form, especially with nitrogen, before reaching its destination. 
Its use should be condemned because it produces an irritating effect and 
aggravates the conditions rather than relieves them. There may be some 
beneficial effect from nebulized oils alone, but not from ozone passed through 
them. This so-called ozone therapy has been a fruitful field for charlatans 
and many have been its victims. 

9. In the case of pathologically incurable diseases, such as locomotor 
ataxia, paralysis agitans, chronic Bright's disease, diabetes, etc., extravagant 
claims too ridiculous for refutation have been made for electricity. The em- 
ployment of electricity is amply justified in these cases, for the improvement 
of metabolism, the promotion of comfort and the prolongation of life, but 
no cure can be expected. 

10. The question of the value of high frequency currents for the reduction 
of blood pressure is of interest to the profession, and there is much difference 
of opinion regarding it. Indeed, some eminent therapeutists have declared 
them to be of no value whatever. Auto condensation, if administered prop- 
erly, is a very valuable adjunct to dietetic, pharmacal, hydrotherapeutic 
and hygienic measures, in cases where the reduction is indicated, especially 
when autointoxication is the causative factor. In chronic nephritis, the rise 
in blood pressure may be a compensatory condition, and it may not be pru- 



ELECTROTHERAPEUTICS. 561 

dent to lower it beyond a certain point. Autocondensation acts by the 
dilatation of the peripheral vessels, thus producing an equalization of the 
circulation and probably increased oxidation and elimination. Increased 
specific gravity of the urine is noted after autocondensation treatment; to 
some extent this may be due to greater concentration after an increase of 
perspiration. It is often possible to reduce the pressure from ten to twenty 
points, or even more, by one treatment. With continued treatment, there 
is more or less permanency in the reduction, although this doubtless is par- 
tially due to other measures coincidentally employed. Were it necessary to 
choose between ordinary rational measures and autocondensation, the former 
would be chosen as first in value, but when both are used together, there is 
no doubt that better results are accomplished than when either is used alone. 
This conclusion has been reached after years of careful observation. It 
may be added that static wave currents elevate the blood pressure in the 
case of hypotension, while high frequency currents lower it when hyper- 
tension exists. The following are a few conditions in addition to those al- 
ready mentioned that may be successfully treated by electricity, together 
with the types of current employed: 

Intestinal impactions and obstructions are favorably influenced by 
the dilating and softening action of negative galvanism, the bowel having 
first been distended by normal saline solution, which acts as the conductor 
of the current. In some cases of intestinal stasis and chronic constipation 
the patients recover under treatment by the interrupted galvanic and faradic 
sinusoidal, static induced and static wave currents. 

Ziegler, of Philadelphia, has reported good results from negative galvan- 
ism in glaucoma and in some cases of optic atrophy; and from positive 
galvanism in plastic iritis, spongy iritis, iridocyclitis, choroiditis and intra- 
ocular hemorrhage. These results have been verified by other eminent 
ophthalmologists. Bell's palsy usually responds to treatment by negative 
galvanism. 

Some cases of lumbago and sciatica are quickly relieved by the static 
wave current, static sparks and diathermy. Regeneration after anterior 
poliomyelitis, simple or multiple neuritis, hemiplegia or muscular atrophy 
from any cause is hastened by the use of interrupted galvanism, faradism, 
sinusoidal current and diathermy. 

There is evidence that patients placed in an electromagnetic field may be 
relieved of conditions of nervous instability, Successful treatment of chorea 
has been reported. Conditions of nerve exhaustion or neurasthenia are bene- 
fited by the static breeze and static bath. Tic douloureux is frequently con- 
trolled by diathermy, salicylic ionization and radiant light and heat. 

Obesity is benefited by the Bergonie method of general faradization. 

Simple goitre improves under iodine ionization. 

Anal and other fistulas often heal following copper or zinc ionization. 
36 



( 



562 ELECTROTHERAPEUTICS. 

Chronic cystitis often may be satisfactorily treated by copper or zinc 
ionization, the bladder being distended with a weak aqueous solution of cop- 
per sulphate or zinc chloride, the water acting as a conductor of the current 
and the drug being dissociated in the bladder wall. 

The electric incandescent lamp cabinet bath is valuable to dilate the 
peripheral vessels and to produce diaphoresis in conditions where increased 
elimination is indicated. The bath has an advantage over the Turkish baths 
in that the patient is not subjected to the deleterious influences of vitiated air. 

Chronic articular rheumatism and rheumatoid arthritis improve under 
the application of diathermy, the static wave current, static sparks and 
salicylic ionization. 

Effusions after sprains or other trauma are often rapidly absorbed by the 
use of the static wave current and static brush discharge. 

Chronic leg ulcers are favorably influenced after treatment by zinc ioni- 
zation and ultraviolet rays. 

The sterilization of wounds or prevention of surgical infections is fre- 
quently accomplished by the ultraviolet rays, and by ionization. These 
methods are being used extensively and with success in the present European 
war. 

Infantile uteri, whether congenital or due to superinvolution, often de- 
velop under negative galvanism, and the relief from sterility from this 
cause frequently follows. There is no other method so effective as this 
one. Remarkable results have been reported by Dr. Barton Cooke Hirst 
of Philadelphia. 

Physiologic involution of a subinvoluted uterus usually follows treatment 
with positive galvanism. 

Some cases of endometritis respond to copper and zinc ionization. 

Hyperchlorhydria and atony of the stomach improve under negative 
galvanism applied by means of intragastric electrodes, water in the stomach 
acting as a conductor. These electrodes are first swallowed and then with- 
drawn after the treatment. 

As an adjunct to other measures, the treatment of surgical and pulmonary 
tuberculosis by diathermy, which consists of heating joints, lungs, etc., to a 
temperature sufficient to produce hyperemia, is highly beneficial. In the 
case of lung cavities, care must be taken in regulating the thermic intensity 
to avoid the danger of pulmonary hemorrhage. 

Resuscitation by means of strong rhythmical faradic shocks over the dia- 
phragm, precordia and the phrenic nerve, may be possible after ordinarily 
lethal accidents due to chloroform, opium, electrocution, drowning or gas 
asphyxia. 

Some urethral, esophageal and rectal strictures, also uterine stenosis, 
yield to treatment by negative galvanism. Careful technic must be prac- 
ticed to insure success. 



ELECTROTHERAPEUTICS. 563 

A notable achievement is the destruction of papillomas and some other 
bladder growths by means of the high frequency current applied through a 
cystoscope. This method of destruction is also applicable to growths of the 
larynx, esophagus, rectum, urethra, vagina and uterine cervix, when suitable 
endoscopes are used to expose the growths. 

Hypertrophic infected tonsils may be reduced by the desiccation method. 

Some malignant growths in accessible regions, even where bone is in- 
volved, may be treated with success by the high frequency desiccation, sur- 
gical diathermy, de Keating Hart's method of fulguration (which is used in 
combination with operative surgery), and zinc- mercury ionization. Care 
should be taken with these methods, except de Keating Hart's fulguration, 
when working near large blood-vessels, as secondary hemorrhage may result 
on separation of the slough. 

Electrolysis is the only reliable method for the treatment of hyper- 
trichosis. 

Tattoo marks may be removed by the desiccation method. Nevus 
flammeus, lupus, acne, eczema, psoriasis and some types of alopecia often 
may be treated with success by the ultraviolet rays ; 

The electrocautery is well known and is used extensively throughout 
the medical world for sterilizing wounds and for general surgical purposes. 

These few illustrations give some idea of the almost limitless field of use- 
fulness open to electricity. 

The following are some of the future possibilities in electrotherapeutics: 
The abstraction of metallic poisons from the body, such as mercury, arsenic, 
lead, etc., by ionization. This is theoretically feasible, in fact, good results 
have been reported. Safe local and general anesthesia with loss of conscious- 
ness and perfect relaxation seems possible through the application to certain 
brain and nerve centres of a rapidly interrupted galvanic current, known as 
the Leduc current. This has been demonstrated by animal experimentation 
and Leduc himself submitted to the experiment and pronounced it success- 
ful. There has been some controversy over the practicability of this method, 
however, and for this reason it may be said that it is yet in the experimental 
stage. It seems possible that analgesia from pain due to any cause and 
the rapid induction of natural sleep may sometime be accomplished by 
sedative action on the nerve centres or by peripheral nerve blocking, thus 
lessening the necessity for the use of opiates. It is not beyond the bounds 
of possibility that a method may be established whereby electrical means 
may be used to promote the formation of antibodies against some forms of 
infectious diseases. There is at least theoretical basis for the hope that 
future research may bring about a realization of all these desirable results, 
visionary though they now may seem. 

The present attainments and future possibilities of electrotherapeutics 
are surely sufficient to make a serious study of the subject worth while. 



( 



564 electrotherapeutics. 

Resume. 

Success in electrotherapeutics depends on an adequate knowledge of phys- 
iology and pathology as related to the human body; on a mastery of the laws 
that govern electricity; on the possession of efficient apparatus, the achieve- 
ment of good technic by practice and the good judgment to apply all these 
acquirements to the best advantage. Given two men with the same appa- 
ratus, one may get excellent results and the other poor results, for the same 
reason that in the hands of one, calomel may be a potent remedy, while in 
the hands of another it would fail. 

Electrotherapeutics is not a system to be used to the exclusion of other 
therapeutic measures, but is a worthy additional unit to any physician's 
armamentarium. Competence in this, as well as in other methods of phys- 
ical therapy, will do much to discourage irregular practitioners who are 
thriving on charlatanism. 






PART III. 

SPECIAL THERAPEUTICS 



Authorities. The principal authorities to whom references are made, 
with their initials, are included in the following list. When a statement is not 
followed by any reference by name or initial, it is to be understood as coming 
from the writer of this book. 

References and Bibliography. 

(A) Aitken. — The Science and Practice of Medicine, by Wm. Aitken. 

(Ag) Agnew. — The Principles and Practice of Surgery, by D. Hayes Agnew. 

(B) Bartkolow. — Materia Medica and Therapeutics; also On the Antagonism 

between Medicines and between Remedies and Diseases, by Roberts Bar- 

tholow. 
(Br) Brunton. — Pharmacology, Therapeutics and Materia Medica, by T. Lauder 

Brunton. 

(CI) Clarke. — A Manual of the Practice of Surgery, by W. Fairlie Clarke. 

(D) Druitt. — A Manual of Modern Surgery, by Robert Druitt. 

(DaC) Da Costa. — Notes of Clinical Lectures, delivered by Professor J. M. Da Costa 

at the Pennsylvania and Jefferson Hospitals. 
(Da Costa) . Da Costa. — Modern Surgery, by J. Chalmers Da Costa. 

(E) Emmet. — Principles and Practice of Gynecology, by Thos. Addis Emmet. 

(El) Ellis. — A Practical Manual of Diseases of Children, by Edward Ellis. 

(F) Fothergill.— The Practitioner's Handbook of Treatment, by J. M. Fothergill. 

(G) Goodell. — Lessons in Gynecology, by William Goodell. 

(H) Hamilton. — Nervous Diseases, etc., by Allan McLane Hamilton. 

(Hare) Hare. — Practice of Medicine, by H. A. Hare. 

(Id) Idem. — The same author mentioned last. 

(K) Kolmer. — Infection, Immunity and Specific Therapy, by J. A. Kolmer. 

(L) Leishman. — A System of Midwifery, by William Leishman. 

(M) Murrell. — A Manual of Pharmacology and Therapeutics, by Wm. Murrell. 

(Mil) Manson. — Tropical Diseases, by Patrick Manson. 

(M & P)... .Meigs and Pepper. — Diseases of Children, by J. F. Meigs and Wm. Pepper. 

(N) Niemeyer. — A Text-book of Practical Medicine, by Felix von Niemeyer. 

(O) , Osier. — The Principles and Practice of Medicine, by Wm. Osier. 

(O & M). . .Osier and McCrae. — Modern Medicine. A System of Medicine, Vols. I-V. 

Edited by Wm. Osier and Thomas McCrae. 

(?) Phillips. — Materia Medica and Therapeutics, by Chas. D. F. Phillips. 

(R) Ringer. — A Handbook of Therapeutics, by Sidney Ringer. 

(Ros) Rosenthal. — Diseases of the Nervous System, by M. Rosenthal. 

(S) Stilli. — Therapeutics and Materia Medica, by Alfred Stille. 

(St) Sturgis. — The Student's Manual of Venereal Diseases, by F. R. Sturgis. 

(Stitt) Stitt.— Diagnostics and Treatment of Tropical Diseases, by E. R. Stitt. 

(Stw) Stelwagon. — Treatise on Diseases of the Skin, by Henry W. Stelwagon. 

(T) Tanner. — An Index of Diseases and their Treatment, by Thos. H. Tanner. 

(Tr) Trousseau and Pidoux. — On Therapeutics, by Trousseau, Pidoux and Paul. 

(Tt) Tait. — Diseases of Women, by Lawson Tait. 

(Ty) Tyson. — The Practice of Medicine, by James Tyson. 

(W) Wood. — Therapeutics, its' Principles and Practice, by H. C. Wood. 

565 



( 



566 ABORTION. 

(Wa) Waring. — Practical Therapeutics, edited by Buxton. 

(Y) Yeo. — A Manual of Medical Treatment, by I. Burney Yeo. 

Besides the above-named, occasional references are made to other works by the same 
authors. References will also be found, with names in full, to Anstie, Brown-Sequard, 
Clymer, Cohen, Flint, Fordyce-Barker, Gross, Hammond, Hilton, Lister, Loomis, Mitchell, 
Nelaton, Noyes, Nussbaum, Ricord, Roosa, Simpson, A. A. Smith, Thomas, several authors 
in AUbutfs System of Medicine, and many writers in current medical literature. 

Applied Therapeutics may be studied either with the various therapeutic 
agents as the objects of chief consideration, as in the first part of this work; 
or with the different diseases and morbid conditions forming the objects of study 
in respect to their modification and treatment by medicines. In the following 
pages the latter method is followed, the therapeutics of each affection being 
exhibited in the form of an Analytical Index to the recognized authorities quoted. 
Every indication for the use of a drug, or statement regarding its value, is 
followed by the name or initial (in parenthesis) of its author: these references 
enabling the book to be used as an Index to the Authorities, for more strict differ- 
entiation between indicated remedies, — while the brief analyses given include 
sufficient material to make each section a synopsis of the therapeutics of the 
disease or symptom named in its title. 

Abortion. 

Opium, cautiously in threatened abortion, is often very valuable (Wa) ; the 
tincture, ttlxx-xxx by rectum (Parvin); Opium to check uterine action and 
Ergot to restrain hemorrhage (B). Ergot, small tonic doses give excellent 
results in threatened abortion (P). Tannin, combined with Opium and 
Ipecac (W). Cimicifuga, to prevent miscarriage when uterus is irritable 
and prolapsed (R). Savin, the dried powder of the leaves, gr. xv-xx, thrice 
daily, one of the most powerful remedies against the hemorrhage indicative 
of approaching abortion (Wa) ; the tincture in doses of 5 to 10 drops, every 
i to 3 hours, useful against the hemorrhage (P). Viburnum Prunifolium, 
in threatened and habitual abortion, has a very high reputation. Potas- 
sium Chlorate, gr. x thrice daily, begun in the 3rd week and continued until 
term, as a prophylactic against habitual miscarriage (Jardine) ; gr. iij daily 
the best prophylactic in cases of non-syphilitic origin (Remy). Iron, with 
Potassium Chlorate, throughout the pregnancy, when fatty degeneration is 
the cause of habitual abortion (McLane). Asafcetida, is highly efficient in 
habitual abortion; given in pills of gr. jss each, 2 daily, gradually increased 
to 10 daily, as soon as a new pregnancy occurs, and continued until the 
labor is over (Turazzo). Cotarnine Hydrochloride, is a powerful uterine 
hemostatic, and is not ecbolic, so it can be safely used for the hemorrhage in 
threatened abortion, in dose of gr. jss-iij hypodermically (Bosse). Tam- 
ponade, of the cervix uteri, with cotton or sponge, dipped in vinegar or 
glycerin, when abortion is inevitable and it is desirable to hasten it and re- 
strain hemorrhage. Empty the uterus thoroughly with the finger, placenta- 
forceps liable to do harm (Barker). Abortif acients ; Quinine and Ergotin, 
of each gr. ij in pill every 3 hours, the routine abortifacient of many irregular 
practitioners. Only by the production of such violent irritation of the 



ABSCESS ACNE. 567 

abdominal and pelvic organs as generally endangers life, can the pregnant 
uterus be stimulated to expel its contents (P). The abortifacient effect 
of Savin and other drugs cannot be obtained unless by the administration of 
a quantity sufficient to endanger life (B). 



1$. Fluidextr. Ergotae, 5v. 

Tinct. Opii Deodorat., 5iij- 

Syrupi Limonis, 5 j. 

M. Sig. — A teaspoonful thrice daily. 



]$. Acidi Tannici, gr. xy. 

Pulv. Ipecacuanhae, gr. xij. 

Extracti Opii, gr. iij. 

Ft. pil. xij. Sig. — One every six hours. 



Abscess (See also Furunculosis). 

Belladonna, as plaster to subdue (B); painted around areola (Wa); 
internally often successful in aborting abscesses (R). Calcium Sulphide, 
half-grain doses frequently repeated, to abort abscess or to hasten forma- 
tion of pus (B); gr. -fa every hour or two, gives striking results in healing 
large abscesses (R). Calcium Phosphate, in large abscesses (R). Mercury 
and Morphine, the Oleate locally, diminishes induration due to old abscesses 
and prevents the formation of new ones (R). Phenol, a weak solution used 
as injection after evacuation, also as a dressing (Lister). Ichthyol, as oint- 
ment after lancing, applied until healing is complete; brings about union 
(Unna). Silver Nitrate, a strong solution in Nitrous Ether if applied early 
to adjacent surface will check inflammation (B). Blisters or Iodine, as 
counterirritants around or adjacent to seat of disease (R). Potassium 
Permanganate, 5j to the pint of water, to correct fetor (B). Iodine, the 
tincture injected after opening large abscesses (R); especially in scrofulous 
abscess (Wa). Salicylic or Boracic Acid, as dressings (B). Cod-liver 
Oil, improves and lessens discharge from scrofulous abscesses (Wa). Poul- 
tices, to check, or to promote maturation; may be smeared with extract of 
Belladonna or Opium (R). Opening is necessary in all deep abscesses, or 
when on face, near anus, mammary, or if danger of its opening into an 
internal cavity. Open with grooved director and forceps; never open a 
deep abscess with a plunge (Hilton). Drainage-tube may be required, also 
irrigation of the cavity and pressure (Agnew). Weaning of child necessary 
in chronic mammary abscess (Gross). Psoas abscess may result from strain 
or laceration of muscle, as by heavy lifting, effort to recover balance when 
skating, etc., as well as from spinal disease; the symptoms are often obscure, 
simulating those of chronic malaria. Early opening by lumbar incision neces- 
sary; then tonics, good food, and daily irrigation of the cavity with an antiseptic 
solution. [Compare Suppuration, Carbuncle.] 

1$. Quininae Sulph., 5j- 

Ferri Pyrophosphatis, 5 j- 

Strychninse Sulph., gr. j. 

Ac. Phosphor. DiL, 3ij- 

Syrupi Zingiberis, §ij. 

Aquae, q. s. ad § iv. 

M. Fiat mistura. Sig. — A teaspoonful thrice daily. 

Acne. 

Acne cannot be treated by external applications alone, as there is usually 
some underlying constitutional factor which has been responsible, at least in 
part, for the eruption. In many cases, there is a marked constipation which 
requires very careful attention. Diet should be rigid in the elimination of 



568 



ACNE. 



all rich and fried foods, pastry, candy, ice cream, alcoholic or spirituous 
liquors. It is especially important that nothing be eaten between meals. 
Many cases of acne in women are referable to some pelvic disturbance and 
a thorough examination may reveal some unsuspected factor. The Exter- 
nal Treatment consists in steaming the face from ten to fifteen min- 
utes every day; removing the blackheads with a comedo extractor or the 
rounded end of a wire hairpin; rubbing the face with alcohol and applying one 
or more of the following remedies, the best of which is Lotio Alba. It is 
of advantage to produce a certain amount of exfoliation. If, however, the 
action of these drugs produces an uncomfortable amount of dryness of the 
skin, Unguentum Aquae Rosae should be rubbed in in the morning. Punc- 
turing the papules with the skin stretched and scraping with a blunt edged 
curet is recommended (G. H. Fox). While this produces temporary dis- 
figurement and irritation, it is claimed that there is no more permanent 
atrophy than in other methods. Arsenic is only of service as a tonic, having 
little or no direct influence on the eruption. Boric Acid in combination with 
other remedies is of slight value. Bromides for nervous patients may be re- 
sorted to. Calx Sulphurata, once used so commonly, may produce in certain 
cases a beneficial influence. High Frequency Current may be at times of con- 
siderable value in obstinate cases (Stelwagon) . Ichthyol in a weak solution 
or in petrolatum may be used, but it is difficult to remove from the pores. 
Iron may be prescribed if there is an associated anemia and if this drug does 
not produce constipation. Laxative Mineral Water may be resorted to in 
case of mild constipation though in many cases of habitual constipation, 
strong purgatives must be used. Mercury in solution of i to iooo may be 
applied with advantage to the face. Resorcin, gr. xx to xxx, should be in- 
corporated in Lotio Alba in sluggish cases with marked induration. Roent- 
gen Rays in many cases give brilliant results, particularly where there is 
induration. Salicylic Acid, gr. xx to an ounce, is indicated in the indurated 
type where stimulation is required. Green Soap or Castile Soap is usually 
better than highly medicated or perfumed soaps. Steaming the face with 
hot water twenty minutes each day is of considerable value, particularly 
when followed by a thorough rubbing with Alcohol. Sulphur in various 
forms is used extensively both as a dusting powder and in petrolatum but 
much better results are obtained by using it in a lotion as in the following 
prescriptions. Vaccines of mixed staphylococci are often of decided value 
when the lesions are pustular but should be combined with the acne bacillus. 
The Ultra Violet and Violet Rays have been employed with success. 



Lotio Alba. 

fy Zinci Sulphat., 

Potassii Sulphuret, aa 5j~5iij- 

Aquae Rosas, q. s. giij. 

M. Sig. — Apply after steaming face. 

1$. For Inflammatory Type. 

Pulvis Calaminae, 

Zinci Oxidi, aa 3ij- 

Phenolis, njjxx. 

Liq. Calcis, § j. 

Aquae, q. s. 5 iv. 

M. Sig. — Apply every 4 hours. 



Kummerf eld's Lotion. 

]$. Sulphuris ppt., 5iv. 

Pulv. Camphorae, gr. x. 

Pulv. Tragacanthi, gr. xx. 

Aquae Calcis, oij- 

Aquae, q. s. §iv. 

M. Sig. — Apply after steaming face. 

]$ Ext. Nucis Vomic, gr. iv. 

Pepsin, 

Salol, aa 5ij 

M. Pone Cap. No. xxiv. Sig. — One 
after meals. 



ACNE ROSACEA — ADDISON S DISEASE. 

Acne Rosacea. 



569 



See Acne for internal and dietary treatment, as the same factors are often 
present in both diseases. In the early stages, mild applications, such as the 
Calamine Lotion, page 568, or Calamine Liniment, page 656, with the correction 
of the diet will often effect a cure which, however, can only be maintained by 
strict hygiene and dietary regime. Alcohol in any form is contraindicated as is 
the use of tea, coffee and highly seasoned foods. The Electric Needle when 
applied directly to the dilated capillary vessels will obliterate them, the 
needle being attached to the positive pole and the negative held in the hand 
or on the neck. Electricity in the form of the High Frequency or Galvanic 
Current is very frequently of great value, especially in the late second stage 
where there is considerable fibrous enlargement. Ichthyol has more effect 
in this disease than in acne and in the form of the Varnish as given below 
is of considerable value. Lotio Alba and Kummerfeld's Lotion (prescrip- 
tions given in the treatment for acne), are of considerable value, especially 
when resorcin gr. v to xx to the ounce is added. Purgatives are of even 
more value than in acne and every effort must be made to keep the bowels 
acting freely. Sulphur is well regarded in the treatment of this disease, 10 
to 30 grains to the ounce of petrolatum, and of the greatest value in the follow- 
ing prescription when used in the second stage of the disease. 



1$. Sulphur. Praecip., 

Saponis Viridis, aa 3iv. 

Betanaphtholis, 5ij- 

Petrolati, q. s. §iv. 

M. Sig. — Apply locally daily; allow to 

remain 20 minutes. (Gaskill.) 



1$. Ichthyolis, f 3j. 

Pulv. Camphor., gr. x. 

Pulv. Tragacanth, gr. xx. 

Aquae Calcis, f 3ij- 

Aquae, q. s. fgiv. 

M. Sig. — Apply daily to face. (C. 
Davis.) 



N. 



Actinomycosis. 

Potassium Iodide is no doubt the best drug for this disease, usually the 
dose being started with 10 grains t. i. d., and increasing daily until full physio- 
logical action is obtained, though massive doses may be given at the start and 
be well borne. This drug internally with Sodium Iodide in one per cent, solu- 
tion injected locally has produced good results (Rydygier) . Copper Sulphate, 
\ to 1 grain t. i. d. and applied locally in a 1 per cent, solution has been 
advocated by Bevan. Lugol's Solution is at times of value. X-Ray is fre- 
quently of value alone, but is much more efficacious when used with one of 
the iodides internally. 



Addison's Disease. 

Arsenic, with cod-liver oil, gives the best results (Da C). Iron and other 
tonics are useful, especially a combination of the chloride, glycerin and chlo- 
roform (Greenhow). Phosphorus, has seemed to exert a beneficial influence 
(Wilks). Adrenal Extract, cured 6 cases and improved 22, out of 48 cases 
treated (Kinnicut). Iron, is especially indicated when anemia is a promi- 
nent symptom (Tirard). Treatment must be symptomatic and is of little 
use, the disease being usually fatal (H). 



57° ADYNAMIA — AFTER-PAINS. 



]$. Tinct. Ferri Chloridi, 

Spt. Chloroformi, aa. 5 j. 

Glycerini, § vj. 

M, Sig. — A dessertspoonful in water 
thrice daily. (Greenhow.) 



1$. Quininae Sulphatis, gr. xij. 

Ac. Sulphurici Dil., njjxij. 

Ferri Sulphatis, 5ij- 

Aquae, q. s. ad § vj. 

M. Sig. — A tablespoonful or two thrice 

daily. (Tirard.) 



Adynamia. 

Cinchona, or Quinine, with Arsenic, for pale, badly-fed town-dwellers 
(R) ; as a general tonic when flesh flabby, skin perspiring (P) . Arsenic, for 
swelled feet of old or weakly persons, and breathlessness from weak heart 
(R); as a tonic in continued doses of gr. ^ to T V (Wa). Nux Vomica, in 
adynamia of drunkards; Tinct. Capsici 5vj; Tinct. Nucis Vom. 5ij; gtt. xx 
in water every 4 hours (B) . Calcium Phosphate, when from prolonged town- 
life or overwork; gr. j with grain j each of Iron Phosphate and Calcium Car- 
bonate as a dose (R). Iron, promotes appetite and digestion; gr. j-iij of the 
Sulphate, or the U. S. P. VIII Iron and Aloes pill, or with Manganese (B); 
anemic subjects (R). Hydrastine, as substitute for Quinine, to promote 
appetite and digestion and improve assimilation (B). Digitalis, in debility 
with weak heart action (B). Bitters, especially Calumba and Gentian, are 
useful for a short time (B). Sanguinaria, when stomach needs stimulation 
(P). Sarsaparilla, in broken-down, syphilitic constitutions (P). Alcohol is 
of great value, but has been abused; hurtful when it increases temperature 
and pulse, dryness of tongue, etc. (B); a wine with much ether in debility of 
old age, especially where sleeplessness, indigestion and stomach cramps (R). 
Aliment, sugar and saccharine fruits, vegetables, oil, milk, cod-liver oil, wine 
of good body and strength (B); Porter or Rum-and-milk for town-living 
women (R) . Sea-bathing is useful in chronic illness, with much debility (R) . 
Turkish Baths, when debility is caused by the tropics, but caution necessary; 
when town-dwellers become stout and flabby, are easily tired, suffer from a 
lack of energy and from mental depression, a course of baths is beneficial (R). 
[Compare Anemia, Convalescence Neurasthenia.] 

Tonic Prescriptions. 



1$. Arseni Troxidi, gr. j- 

Quinine Sulphat., 5 j« 

Ferri et Potass. Tart., 3ij- 

M. Ft. pil. no. xxx. Sig. — One pill 

after each meal. 



]$. Liq. Potas. Arsenitis, tt#x. 

Fluidextr. Nucis Vom., .... tt^xx. 
Tinct. Gentianae Compos., 
Tinct. Cinchonae, 
Tinct. Calumbae, 

Vini Kolae aa giv. 

M. Sig. — A wineglassf ul after each meal . 

1$. Quininae Sulph., 5j- 

Strychninae Sulph., gr. j. 

Tr. Ferri Chloridi, 5 v. 

Ac. Phosph. Dil., §ij. 

1$ . Tinct. Nucis Vom., 5 ij- Syr. Limonis, ad 5 vj. 

Tinct. Cinchonae, ad giv. M. Sig. — A teaspoonful in water thrice 

M. Sig. — A teaspoonful after each meal.| daily, in nervous debility. 

After-pains. 

Opium, more certain in action than any other remedy (Wa). Morphine 
and Atropine together hypodermically (B). Cotarnine Hydrochloride, as 



AGALACTIA — ALCOHOLISM. 



571 



hemostatic and anodyne, for after-pains due to blood-clots (Freund) ; in dose 
of gr. j with Ergotin gr. v, every 2 hours. Belladonna, as ointment, much 
used in France (L). Camphor, gr. x with gr. % of Morphine, an effective 
remedy (B) ; Chloral, will stop the pains, but large doses, gr. xx-xl, are neces- 
sary (R). Chloroform, the Linimentum Chloroformi § j, withLinim. Saponis 
applied on flannel to the abdomen (Barker). Quinine, gr. v-x night and 
morning, with the above chloroform limiment locally, in neuralgic after- 
pains which do not yield to opiates, the uterus being tender on pressure 
(Barker). Gelsemium, suspends them, large doses, Tfl,xx, necessary (B). 
Cimicifuga, relieves the pains, and allays general nervous excitement (P). 
Ergot, is better than Cimicifuga (R). Poultices, warm, over the hypogas- 
trium, with soothing injections into the vagina (L). 

Agalactia. 

Gossypium, an emulsion of the seeds has repute in India as a galactago- 
gue; a wineglassful of the decoction every 20 to 30 minutes (P). Pilocarpus, 
remarkably increases the secretions (B); Pilocarpine is a galactagogue, and 
probably the only example of this class we possess, it distinctly increasing the 
secretion of milk in nursing women (M) . Tea, a good black tea is thought 
to promote the milk supply. [Compare Lactation.] 



Albuminuria. 

Aconite, in incipient albuminuria with high body-temperature (R). 
Turpentine, gtt. ss-j, every 2 to 4 hours, or one to two drop doses night and 
morning, of great value in chronic albuminuria without other marked symp- 
toms of B right's disease (P). Gallic Acid, the most efficient agent in the 
acute form to restrain loss of albumin (P). [See Aitken's formula below.] 
Cannabis is indicated when bloody urine (R). Cantharis, Tfl.j of the 
tincture every 3 hours, after the subsidence of acute symptoms, especially 
when bloody urine (R) . Alkalies, the citrates and acetates as diuretics (R) ; 
the Buffalo Lithia Water of Virginia is highly recommended. Strontium 
Lactate, has been used with benefit, but should not be given when scanty 
urine or symptoms of uremia are present. Nitroglycerin, Tflj of a 1 per 
cent, solution to dilate the peripheral vessels, relieving the heart and lessen- 
ing the renal congestion (B) . Turkish Baths, benefit by relieving the kidneys 
of work (R). Milk-cure, with buttermilk, has proved very efficient in many 
cases (B). Chalybeate Waters, especially those having purgative qualities, 
are beneficial (B). [Compare Bright's Disease.] 



1$. Acidi Gallici, 5 j-ij. 

Ac. Sulphurici Dil., 5ss. 

Tinct. Lupuli, 5 j. 

Infusi Lupuli, q. s. ad § vj. 

Sig. — Tablesp. thrice daily. — (Aitken.) 



1$. Liq. Ferri et Ammonii 

Acetatis (U. S. P.), gvj. 

Sig. — Teasp. to a tablesp. according to age, 
well diluted, thrice daily. 

(Basham.) 



Alcoholism. 

Ammonia, a full dose of the Spirit, 5 ss-j, will often sober a drunkard 
speedily (R) ; a few drops of Aqua Ammonise, diluted have prompt action (S) ; 



572 ALCOHOLISM. 

oj of the aromatic spirit with Caspicum (see formula below). Ammonium 
Chloride, is remarkably efficient in straightening up a subject of acute alcohol- 
ism; 5ss in J pint of water, swallowed at one draught, by a patient on the 
verge of delirium tremens, is said to quickly restore the faculties. Ammon- 
ium Acetate, the solution, in full doses, is one of the most efficient agents for 
quickly straightening up a drunkard. Arsenic, a drop of Fowler's solution 
before breakfast for the morning vomiting of drunkards (R). Capsicum 
for the dyspepsia of chronic alcoholism and to induce sleep, also as a substitute 
for alcohol by removing the distress at pit of the stomach; the tincture in 10- 
minim doses should be taken shortly before meals, or whenever there is a 
depression or craving for alcohol; it obviates the morning vomiting, and pro- 
motes appetite and digestion (R). Cinchona, especially Cinchonia Rubra, for 
gastric catarrh of drunkards (B) ; Quinine, gr. ij-vj daily to raise the nervous 
tone (P). Nux Vomica, for stomachal disorders (B) ; in the tremor of chronic 
alcoholism is of much value (P); the tincture in 5-minim doses with 15 of 
Tinct. Capsici,in water every 4 hours, is exceedingly effective in diminishing 
the craving for spirits and sustaining the nervous system. Strychnine, gr. 
3V-1V hypodermically thrice daily for ten days, is an absolute cure for 
dipsomania (Luton); a very valuable remedy for chronic alcoholism and 
dipsomania, not merely curing the attacks, but abolishing the desire for 
drink, the patients abstaining from spirits of their own accord (Pombrak); 
the Keeley injection contained Strychnine or Brucine, with Atropine or 
Hyoscine, and an occasional "cross-shot" of Apomorphine. Caffeine in 
doses of gr. j-ij every 2 or 3 hours, will in 48 hours effectually quench the 
craving for alcohol, to which it is physiologically antagonistic (Hall) . Kola 
is a good tonic for cases of chronic type. Chloral is very useful as a 
hypnotic and calmative, must be cautiously employed in old worn-out 
drunkards with weak hearts (B) ; in solution with Potassium Bromide is 
much used as a sedative to the nervous system. Hydrastine, the sulphate 
in doses of gr. -fa increased to gr. 2V, hypodermically four times a day, 
is one of the "cures," and has been used for this purpose in Canada for 
many years. Potassium Bromide with Chloral (see above) ; 3 j every 4 to 
6 hours in the "horrors" (B). Cimicifuga, is said to be useful in the treat- 
ment of the drunkard's stomach (R). Hyoscine is efficient against the 
tremor of chronic alcoholism. Picrotoxin, small doses for the tremor, gr. 
? V repeated (B). Zinc Oxide, is very useful an chronic alcoholism, to 
diminish the craving, to relieve the gastric catarrh and lessen the tremor 
(B). Phosphorus is a useful remedy in chronic alcoholism (Anstie). Opium 
should be used cautiously if at all (B); Apomorphine in dose of gr. ■$■ 
as a sedative in the stage of excitement (Polk); gr. -fa hypodermically is 
efficient for the insomnia of acute alcoholism (Shannon). Acute Alcoholic 
Poisoning requires an emetic or the stomach-pump, cold douche to the head 
and breast, warmth to the feet and limbs. Artificial respiration may be re- 
quired. Milk, mucilaginous drinks, and black coffee, are the principal 
remedies. A milk diet often creates a disgust for alcohol. Kumyss is a 
valuable nutrient. Chronic Alcoholism is not a disease, as sentimentalists 
would have us believe, but is simply a vicious drug-habit, and may be over- 
come, like any other drug-habit, by the exercise of the subject's will-power 
alone in abstaining therefrom. The effort to gradually reduce the amount 
consumed simply prolongs the agony and is much less efficient than the total 
and immediate withdrawal thereof entirely. This should be carried out in an 



ALOPECIA AND ALOPECIA AREATA. 



573 



inebriate asylum in most cases. [Compare Delirium Tremens, Neuritis, 
Poisoning by Alcohol, Vomiting.] 



fy Chlorali Hydrati, 

Potassii Bromidi, aa 5 ij. 

Tinct. Capsici, 5j- 

Aqua Cinnamoini, . .q. s. ad oviij. 
M. Sig. — A tablespoonful or two every 

two hours in water, for acute alcoholism. 

The dose may be doubled at bed-time. 



]$. Zinci Oxidi, 5 j- 

Piperini, gr. xx. 

M. Fiant pil. no. xx. Sig. — One pill 
thrice daily. 



1$. Tinct, Capsici, §ss. 

Potass. Bromidi, 5 ss. 

Vel Liq. Potass. Arsenit.,. . njjl. 

Vel Tinct. Nucis Vom.,. . . 3ij- 

Spt. Ammoniae Aromat.,.. §iij. 

Syr. Tolutani, q.s §vj. 

M. Fiat mistura. Sig. — A dessert- 
spoonful in water four or five times daily. 

fy Tinct. Gentianae Co., gij. 

Tinct. Calumbae Co., S ij. 

Tinct. Nucis Vom., tt^Ixxx. 

M. Sig. — A dessertsp. before each meal, 
for rum-stomachs. (Loomis.) 



Alopecia and Alopecia Areata. 

General consideration of the patient's health and especially the nervous 
system must be given. Tonics such as Iron, Arsenic, Quinine, Strychnine, 
are at times indicated. For other patients, sedatives such as the bromides 
are of value. Rest and exercise must be prescribed and systematic bathing. 

The various lotions should be applied with a medicine dropper or pledget 
of cotton and rubbed in very thoroughly. Applications should be made 
daily. Betanapthol, gr. xx to xl, has some advantages. Cantharides, the 
tincture, one part to eight of Castor Oil well rubbed into the roots of hair 
night and morning (Wa.) This drug is also of advantage in combination with 
other drugs. [See prescription below.] Capsicum in the form of the tincture 
is a very valuable drug in the treatment of this disease: io to 30 minims to the 
ounce in combination with other stimulating remedies. Carbolic Acid full 
strength applied directly to small areas and neutralized with alcohol in from 
40 to 60 seconds will produce considerable hyperemia and may act as a 
stimulant to the new hairs. Castor Oil alone or in combination with alcohol 
and stimulating drugs is sometimes of advantage, especially when there is 
marked dryness of the hair and seborrhcea of the scalp. Coal Tar Products 
might be of considerable use if it were not for their disagreeable odor but the 
one derived from the mineral tar, Liquor Carbonis Detergens, 1 to 4 drachms 
to ounce of water or water and alcohol, is very stimulating and the odor is not 
so objectionable. Corrosive Sublimate, 1 to 1000, is often of advantage, 
especially when the treatment is alternated with one of the following pre- 
scriptions. The High Frequency Current is used with considerable success 
in many of these cases if started sufficiently early. Intensive Light Lamps 
have been a great assistance in many cases. Pilocarpine, while producing 
sweating if taken internally, has little effect in that direction when applied 
externally, though well recommended. Resorcin is of the greatest value in 
the treatment of this condition, either combined with a petrolatum base or in 
aqueous solution in the dose of 20 to 60 grains to the ounce. Care, however, 
should be taken that this drug is not prescribed for a person with light hair 
because it will turn it dark nor for a person with gray hair, as it may turn it 
yellow. Salicylic Acid, 5 to 10 grains to the ounce, is one of the most valuable 
drugs we have in the treatment of this disease. Shampooing should not be 



574 



AMBLYOPIA — AMENORRHEA. 



done oftener than at intervals of two or three weeks unless there is an ac- 
cumulation of grease, in which case it can be done more frequently, combin- 
ing ammonia water, 2 drachms to the pint. Thyroid Extract has done good 
service in alopecia totalis. Various authorities have claimed good results with 
the other glandular extracts. 



I*. Ol.Ricini, 3ss. 

Phenolis, 3 j- 

Tinct. Cantharid., §ss. 

01. Rosmarin., gtt. xv. 

Alcoholis, ad 3iv. 

M. Sig. — For external use over the 
scalp with friction. (Ormsby.) 

]$. Acidi Salicylici, gr. xxx. 

Aquas Ammonias, 3iv. 

Phenolis, ttjxx. 

Alcoholis, 5 iss. 

Aquae, q. s. § iv. 

M. Sig. — Apply to scalp if oily. 



Ff. 01. Terebinth., 

Ol.Ricini, aa §ss. 

Tinct. Origani, 3 j- 

01. Camphorat., 5 j. 

Liniment. Ammoniae,.. . .ad §iij. 
M. Sig. — For external use with a brush 
until the scalp is irritated. (Sabouraud.) 

]$. Tinct. Capsici, 3ij- 

Tinct. Cantharid., 3ij- 

Acidi Salicylici, gr. xxx. 

Resorcini, 3ij- 

Glycerini, 3ij to iv. 

Alcoholis, 3 iss. 

Aquae, q. s. §iv. 

M. Sig. — Apply to scalp. 



Amblyopia. 

When due to alcohol and tobacco, absolute abstinence from these sub- 
stances is imperative. Strychnine gr. -gV thrice daily, increasing the dose 
up to the limit of tolerance, is of service. Potassium Iodide, gr. x to xx 
thrice daily, is also useful and may be used in alternating periods with the 
strychnine. In quinine amblyopia, treatment consists of discontinuing the 
drug; the use of Nitroglycerin, Strychnine, Digitalis and the Bromides. In- 
halations of amyl nitrite may also be of service (May). In the uremic form, 
treatment is that of uremia. Hysterical amblyopia requires no particular 
treatment. Electricity and massage may be of service in restoring the vision, 
acting probably through psychic influences. 



Amenorrhea. 

Aconite, in sudden suppression from cold or wet feet (R, P). Iron, 
when from anemia, the most frequent cause; small doses preferred. Solu- 
tion of Acetate, or Ferriet Ammonii Citras gr. ij, or Ferri et Strychninae Citras 
gr. j, also chalybeate waters; make a careful diagnosis before giving iron (B). 
Hemogallol, did good service in cases which could not tolerate inorganic 
forms of iron (Porter). Aloes, when dependent on anemia (B); at the 
periods, with hot pediluvia, friction, etc. (R, P). Potassium Permanganate, 
gr. j thrice daily increased to gr. ij, is the best of all remedies for bringing 
back the menses, having specific action on the uterine tissue (R); excellent 
in amenorrhea from cold feet, and is by far the best emmenagogue; in pill 
it may explode, best in capsule with powdered elm or licorice (Parvin). 
Manganese Dioxide, in pill, gr. ij thrice daily, is a very efficient emmena- 
gogue. Mercury, the Biniodide, is a certain and safe emmenagogue, gr. £ 
in pill, four times daily. Oxalic Acid, is highly praised, gr. ^— f in mixture, 
every hour (Poulet). Apiol, when from functional inactivity; first give Iron 
for the blood; next aloetic purgatives, then apiol, gr. xv, just preceding the 



ANEMIA. 



575 



period; or a daily dose for a week or several days before (B) ; the best emmena- 
gogue next to Potass. Permang. (Parvin). Cimicifuga, has been recom- 
mended (R) ; is of very great value (P) ; when there is a dragging and feeling 
of weight and fulness in the lower abdomen just before the time when the 
monthly discharge should appear (Douner). Arsenic, combined with Iron, 
when from functional inactivity of ovaries (B). Cinnamon, causes a flow 
of blood to the womb (Goodell). Nux Vomica, small doses of the extract, 
of benefit in some obstinate cases (Wa). Silver Nitrate, in substance, ap- 
plied lightly to the os uteri, at time of the expected discharge (Wa). Colo- 
cynth, in chlorotic amenorrhea (P). Ergot, has cured when due to plethora 
(B); when anemia after use of iron (R); in chlorotic (P); njjj every \ hour for 
5 or 6 hours the day before and that of the expected flow, is very efficient 
when the cessation is not due to anemia (A. A. Smith). Rue, in functional 
form, HI j-v of the oil (B , P) . Sanguinaria, is indicated for functional amenor- 
rhea in the absence of plethora (B, P). Savine, general atony; ttrv-x of the 
fluid extract (B, R, P). Serpentaria, when anemia or chlorosis (B). Am- 
monium Chloride, for headache (R). Sitz-baths, hot, for six days before 
period; mustard may be added at period; often effectual in sudden suppres- 
sion (B). Spinal Ice-bag, to lower dorsal and lumbar vertebrae, or cold 
sponging; useful (R). Electricity, in atony of uterus and ovaries (B). 
[Compare Anemia, Chlorosis.] 



1$. Tinct. Ferri Chloridi, 5iij- 

Tinct. Cantharidis, 5 j- 

Tinct. Guaiaci Ammon., .. . §iss. 

Tinct. Aloes, 5ss. 

Syrupi, q. s. ad § vj. 

Fiat mistura. Sig. — A tablespoonful 
thrice daily, in simple atonic amenorrhea. 
(#. C. Wood. Dewees.) 



1$. Quininae Sulphat., 5iss. 

Extr. Nucis Vom., gr. xij. 

Olei Sabinae, 3ss. 

Aloes Socotrinae, gr. viij. 

Cantharidis, gr. xxiv. 

Fiant pilulae xlviij. Sig. — One pill thrice 
daily. 



1$. Ext. Aloes, 3j. 

Ferri Sulph. Exsic, 5ij- 

Asafcetidae, 5iv. 

Fiant pilulae ioo. Sig. — One pill after 
each meal, gradually increased to three. 

(Goodell.) 



Anemia. 

Nux Vomica, stimulates the blood-making organs, and is used as an ad- 
junct to restorative remedies (B). Iron, preparations are very valuable 
and should be given after meals; chalybeate waters are also useful (B). 
Some persons require bland preparations, especially when the gastric mucous 
membrane is irritable; a pale and flabby tongue indicates large doses of the 
chloride or sulphate (R). The Organic Iron Preparations are said to be 
more easily assimilated than the inorganic iron salts but this has not been 
unquestionably accepted. (See article on Iron — page 267.) Arsenic, as an 
adjunct to Iron, and when iron cannot be borne or fails (B). Consult Article 
on Arsenic and its preparations, page 152. Cod-liver oil, is often of great 
service, especially in children (W). Thymol, in tropical anemia due to 
ankylostomiasis (see Worms). Calcium Phosphate, in anemia of growing 
persons, and of women weakened by rapid child-bearing or excessive mens- 
truation (R). Calcium Lac to-phosphate, for nursing mothers, or in waste 



576 ANESTHESIA, GENERAL. 

from suppuration (B). Acids, added to purgative salts as tonics to the 
mucous membrane (R). Manganese, alone not of much use; is best com- 
bined with Iron (B) ; is not, like iron, found in the feces, nor does it cause 
constipation (Wa). Galvanization, as an aid to remedies (B). Cold 
Sponging, needs great caution, as it may lower the tone by minute de- 
grees (R). Diet and Hygiene, of prime importance. Nourishing, diges- 
tible food, in as large quantities as can be assimilated — milk, eggs, animal 
broths; afterward fish, poultry, game, mutton. Moderate daily out-of- 
door exercise, in pure air, is indispensable. Bathing, especially sea-bathing, 
aids restoration. It is to be remembered that most cases of anemia are 
secondary or symptomatic of some underlying factor such as bleeding piles, 
tuberculosis, lead poisoning, syphilis, chronic malaria hookworm infection, 
etc., etc., the treatment of which will correct the anemia. [Compare Ady- 
namia, Chlorosis, Convalescence, Leucocythemia, Lymphadenoma, 
Malaria, Worms.] 

Tonic Prescriptions. 

fy Ferri Sulph. Exsiccat., 



1^. Tinct. Ferri Chloridi, 5iv. 

Ac. Phosphorici DiL, 5vj. 

Spt. Limonis, 5 ij- 

Syrupi, q. s. ad § vj. 

Misce. Sig. — A dessertspoonful in water 
after meals. To the above may be added 
5ij of the Liquor Strychninae Hydrochloratis 
of the B. P. (Goodell.) 

fy. Hydrarg. Chlor. Corr., gr. j-ij. 

Liq. Acidi Arsenosi, 5j- 

Tinct. Ferri Chlor., 

Ac. Hydrochlor. DiL,. . . .aa 5iv. . 

Syrupi, §iij. 

Aquae, q. s, ad §vj. 

Misce. Sig. — A dessertspoonful in a wine- 
glassful of water after each meal, as an 
alterative tonic. (A. H. Smith.) 



Potass. Carbonatis, aa 5ij- 

Syrupi, q. s. 

Fiant pilulae no. xlviij. Sig. — One pill 
after each meal, gradually increased to three. 

(Blaud.) 



1$. Quininae Sulphatis, gr. xx. 

Ferri Sulph. Exsic, gr. xl. 

Strychninae Sulph., gr. ss. 

Fiant pilulae xx. Sig. — One pill thrice 
daily. (Bartholow.) 

1$. Massae Ferri Carbonat., 5j- 

Arseni Trioxidi, gr. j. 

Quininae Sulphatis, gr. xl. 

Fiat massa et div. in pilulas no. xl. Sig. 
— One or two pills thrice daily. 



Anesthesia, General. 

Morphine, subcutaneously before the inhalation, diminishes danger, and 
lessens the after-pain if operation is performed (Nussbaum); a preliminary 
injection of Morphine lessens the stage of rigidity and spasm, enables a 
smaller quantity of the anesthetic to be used with full effect, prolongs the 
stage of insensibility, prevents shock, and antagonizes the cardiac and 
respiratory depression (B). Atropine, is decidedly the best antagonist to 
the respiratory paralysis of Ether, and should be given hypodermically 
as soon as alarming symptoms manifest themselves (Amidon) ; the writer of 
this book has saved at least four subjects of chloroform narcosis by the 
hypodermic use of Atropine after both heart and respiration had apparently 
failed. Strychnine, gr. -^ hypodermically, repeated if necessary, the most 
valuable remedy in chloroform poisoning (Vance). Ammonia, the spirit, 
tijjxx-xxx hypodermically, of great benefit in some cases, but uncertain in 
action (Id). Digitalis, of undoubted value to raise the blood pressure and 
strengthen the heart (Id). Its action is too slow for use in emergency and 
hence has fallen into disuse (Ed.). Adrenalin Chloride, the i to iooo solu- 
tion hypodermically, or by intravenous injection when the emergency is 
great, for cardiac and respiratory failure in general anesthesia (Martin). 



ANESTHESIA, LOCAL. 577 

Amyl Nitrite, is of no value, lowers blood pressure, depresses the heart and 
respiration (Vance). Chloretone, prevents the post-operative nausea and 
vomiting (Hirchman); gr. v for 2 doses with a 15-minute interval, just before 
beginning the administration of the anesthetic, and gr. v as soon as con- 
sciousness returns, prevents the vomiting (Bowles). Hyoscine, gr. -fa 
hypodermically half an hour before ether inhalation, decreases mucus and 
checks vomiting (Robertson). Alcohol, 3j~ij of whiskey or brandy before 
inhalation to sustain the heart and prolong narcosis (B) ; a bad stimulant as 
it intensifies the action of chloroform, and lessens the fatal dose (Dubois). 
Oxygen, is the antagonist to chloroform (Sayre). Artificial Respiration 
and rhythmical tongue traction should always be employed in syncope from 
chloroform (Boureau); should be done so that compression is made on the 
chest (Vance). Compression of the Heart by squeezing it through the 
diaphragm, successful in one case of laparotomy under ether (Lane); used 
in 12 cases, without final success (Boureau). Precordial Compression by 
the ball of the thumb midway between the apex beat and the sternum, with 
a quick, strong movement 30 or more times per minute, the Konig-Mass 
method, has been successful in many cases after other methods had failed 
(King). Constriction of the neck, for J hour to 1 hour after ether anesthe- 
sia to produce cerebral hyperemia, used by me in over 60 cases, not one of 
which vomited after the operation ( Ritter) . Testing the ocular reflex by 
touching the conjunctiva should never be done, as it is unnecessary and 
liable to cause conjunctivitis (Wieder). [For the subject of General Anes- 
thesia see the articles in Part I on Chloroform, Ether, Coca, Scopolamine- 
Morphine, and Stovaine.] 

Anesthesia, Local. 

Ether, as spray, projected upon the skin in a continuous stream, produces 
cold and local anesthesia by its rapid evaporation, and may be used for any 
minor operation. Ethyl Chloride freezes the part when sprayed thereon 
and produces local anesthesia. Guaiacol in sterilized olive oil, 1 part in 10 
or 20, hypodermically, is a powerful local anesthetic [see Guaiacol]. Cocaine, 
in 1 to 4 per cent, aqueous solutions injected hypodermically or applied to 
mucous membranes, produces profound local anesthesia; in weak solution by 
infiltration on the theory that fluid infiltration of the tissues is the cause of the 
anesthesia produced by local injection of anesthetic solutions; distilled water 
being too painful, weak anodyne solutions are used for injection. (For 
Schleich's Solutions see under Coca.) Quinine is as good for local anesthe- 
sia as cocaine, and any operation ordinarily done under the latter can be 
done under quinine urea hydrochloride. Adrenalin with Cocaine, increases 
the anesthetic effect of the latter and prevents its toxic action. Eucaine 
is equally effective as Cocaine and much less dangerous. Tropacocaine is less 
toxic than Cocaine and equally effective. Holococaine is too toxic for hypo- 
dermic use, but in 1 per cent, solution instilled on the eye it produces com- 
plete, rapid and painless anesthesia. Orthoform is too insoluble for hypo- 
dermic use, but is efficiently anesthetic when employed as a dusting powder 
or ointment for painful surfaces when it comes into contact with exposed 
nerve endings. Dionin in 4 to 7 per cent, solutions, is a good anesthetic 
for the eye. Phenol, in weak or moderately strong solutions, as a local 
anesthetic for the skin. [Compare the List of Local Anesthetics and 
Anodynes.] 
37 



57^ ANEURISM — ANGINA PECTORIS. 

Aneurism. 

Potassium Iodide, in large doses (gr. xv-3ss), 3 or 4 times a day, gives 
relief (B) ; combined with recumbent position and restricted diet (R). Vera- 
trum Viride aids surgical expedients; also in large internal aneurisms, with 
absolute recumbence and a little Opium to relieve pain, vomiting to be 
avoided (B). Chloroform inhalation for great dyspnea (R). Gelatin, by 
hypodermic injection to increase the coagulability of the blood; used success- 
fully in 9 cases (O). Electrolysis, galvano-puncture in deep aneurisms; not 
very successful (B). The object sought is the coagulation of blood within 
the aneurismal sac; cures have not been attained by this treatment, but in 
many it has produced great amelioration of the most distressing symptoms 
(Petit). Aliment, milk regimen, for denutrition (B); a low diet, with abso- 
lute rest, and Potassium Iodide for deep aneurisms beyond reach of surgical 
treatment (B). Rest, in recumbent posture, and light, unstimulating diet, 
are primary and essential elements in the treatment of aneurisms. Surgical 
Treatment includes ligation of the vessels, also pressure by a tourniquet or 
bags of shot, the operator's ringers, etc., applied to the main artery above the 
tumor and the introduction of fine wire into the sac to favor coagulation 
(see text-books on surgery) . 

Angina Pectoris. 

Amyl Nitrite, as inhalation, affords signal relief (R) ; unsafe in advanced 
degeneration of cerebral vessels and fatty degeneration of heart (B); gives 
great relief during paroxysms (Br). Sodium Nitrite, is less rapid in action 
than Amyl Nitrite, but is more efficient in preventing return of symptoms (Br) . 
Nitroglycerin lU T ^-o nas Deen used with success (Pf, R). Chamomile, in 
pseudo-spasms of hysterical persons (P.) Ether, aborts a mild attack (B); 
Sulphuric Ether in the nervous form, a spoonful immediately on commence- 
ment of attack will greatly mitigate it (Anstie). Phosphorus, often service- 
able (R). Morphine, hypodermicalry, especially when cardiac dyspnea; 
strengthens the heart (R); with Nitroglycerin hypodermicalry to produce 
nervous sedation, of great value in this and other conditions characterized 
by vascular spasm (Mills). Lobelia, a single large dose relieves angina 
pectoris and similar diseases of the chest (Burnett). Potassium Iodide in 
doses of gr. x, withTflj-ij of the 1 per cent. sol. of Nitroglycerin, andttliij of 
Fowler's solution t. i. d. after meals, to keep the arterial tension low (Ran- 
kin). Strychnine, in the milder forms of angina, very small doses (P). 
Turpentine applications, hot over chest, to mitigate severity of the parox- 
ysms, especially in the aged (Wa). Quinine, when intermittent (Wa); or 
when any malarial taint present (Br.) Brandy, in frequent small doses, 
with hot bran poultice over heart and warmth to extremities. Cocaine, in 
doses of gr. % to \ thrice daily for two days, proved curative in four very 
severe cases (Laskevitch). Chloral, may be well prescribed in pseudo-angina 
pectoris (De Holstein). Aconite, believed by Gubler to be appropriate, and 
by Fleming to have been curative in many severe cases resisting other reme- 
dies (P); in cardiac disease its action is uncertain (Br). Diet should be 
saltless for 5 days after an attack, followed by two days of milk diet, before 
returning to the usual plan of mixed meals (Muklen). Arsenic, lessens or 
prevents paroxysms, if used in the intervals (Anstie). 



ANTHRAX — ANUS, FISSURED. 579 

Anthrax. 

In Massachusetts recently (191 6) an outbreak of anthrax among tannery 
workers was reported by Brown and Simpson. Among the 25 cases so studied 
it was found that every one of the persons infected had been handling dried 
" China" hides. In this country the great majority of cases of anthrax in- 
fection are due to imported hides and as a result of contact in the early stages 
of the tanning process. Therefore, this infection can be controlled first, by the 
exclusion of infected material from this country; secondly, by the. disinfection 
of the material after it arrives in this country, and, thirdly, by the safeguard- 
ing of the workers who handle the material (Id). In the group of cases 
studied in the Massachusetts outbreak a wide diversity of treatment was 
practised, excision seemed to be less satisfactory than the expectant treat- 
ment, together with forced feeding in an attempt to overcome the infection 
by fortifying the resistance of the patient. Although the number of cases 
in which serum treatment was applied was too limited to draw conclusions, 
its use is advocated as perhaps the most promising line of treatment. 

Nitric Acid strong, applied steadily, after thorough cleansing and drying, 
to destroy the diseased mass (D). Bromine, to saturate the surface (D). 
Nitric Acid fuming, is the preferable caustic (Greenfield). Sodium Sulphite, 
in doses of gr. x, has been recommended. Morphine for the diarrhea and 
insomnia. Senega and other expectorants when the lungs are affected. Exci- 
sion and Cauterization demanded, when from direct inoculation; the two most 
successful measures (Greenfield). Phenol, a 2 or 3 per cent, solution may be 
injected subcutaneously around the pustule thrice daily, and applied on 
compresses soaked in the solution (Jarnvosky); of 24 cases so treated 17 
recovered (Matveieff). Eschar should be promptly destroyed, to prevent 
contagion. Diet, a plentiful supply of nutritious food, such as milk and eggs, 
etc. Sclavo's Serum was used in several cases with good results (Royer). 

Antrum Disease. 

Cocaine, in 1 per cent, solution as nasal spray, to secure contraction of the 
swollen mucosa (Hickey). Adrenalin Chloride, in solution of 1 to 4000, as 
nasal spray every 2 hours, to reduce the swollen mucosa about the hiatus 
semilunaris, and free the maxillary outlet of the antrum for drainage (Id). 
Cocaine and Adrenalin may be applied locally to shrink mucosa about the 
opening. Argyrol, a 2 per cent, solution caused marked improvement in a 
long-standing case of empyema of the antrum (Fletcher). Operative Mea- 
sures, that in most favor is to enter the antrum through the alveolus of the 
second molar tooth (Garretson) ; to give free drainage and enable medication 
of the diseased mucous membrane it is best to enter the antrum in its most 
dependent portion, through the upper part of the alveolus or immediately 
above it, between the roots of the 2d bicuspid and 1st molar; a gold tube then 
fitted to the opening, so as to project beyond the mucous membrane, will 
give free drainage, without sacrificing a sound or even diseased tooth (Brown). 
Boric Acid, in saturated solution, as wash to cavity twice a day, the after- 
treatment; occasionally injecting Iodine, Zinc Sulphate or Bismuth Sub- 
nitrate (Id). 

Anus, Fissured. 

Hydrastis, locally, promotes healing (B). Iodoform, improves and re- 
lieves pain (B). Iodo-tannin, well applied, effective (B). Belladonna, 



5 8o 



APHONIA — APHTHA . 



locally of great service for painful spasms of sphincter (P). Opium, with 
gall-ointment for fissures of anus; mild purgatives should be simultaneously 
employed (R). Sulphur, as a mild purgative, to cause soft motions (R). 
Ichthyol, pure, applied daily after local anesthesia by cocaine, is very efficient, 
giving complete relief in a week or two (Conitzer) ; 10 to 20 applications cured 
severel cases (Cheron). Tannin, 5j in Glycerin gij, introduced on a tent, 
night and morning, with great advantage (Wa). Collodion, as protective 
covering (P). Potassium Bromide, with 5 parts of glycerin, as local appli- 
cation (R). Silver Nitrate, in solution, to the ulcer after careful cleansing 
and applying a 4 per cent, solution of Cocaine, which prevents the pain due 
to the silver solution; followed by Iodoform oint. gr. xxx to the § ; this is 
most efficient (Adler) . Castor Oil, as a mild pugative (R) ; to keep motions 
soft (Br). Surgical Means, the most efficient; forcible dilatation of sphinc- 
ter or partial division in severe cases, through the mucous membrane and 
a few fibres of sphincter. Anal fissure, when uncomplicated with some 
other rectal affection, is curable in many cases by non-operative methods of 
treatment (Adler) . Mercury, an ointment of the Oxide, 30 grains to the § , 
has cured many cases (Id). 



]$. Hydrarg. Chlor. Mitis, gr. iv. 

Ext. Belladonna, 

Pulv. Opii,. . .^ aa. gr. ij. 

Ung. Sambuci, 3j- 

M. Sig. — To be applied frequently in 
anal fissure. (Allingham.) 



1$. Plumbi Acetatis, 

Zinci Oxidi, aa gr. x. 

Pulv. Calaminae, gr. xx. 

Adipis Benzoinat, 3iv. 

M. Sig. — Ointment for use in anal 
fissure. (Allingham.) 



Aphonia. 

Atropine, in hysterical aphonia and for fatigue of vocal cords, gr. y^ 
to g 1 ^, morning and evening (B). Nitric Acid, Tfl.v-x of the dilute acid, for 
hoarseness of singers, in fatigue of vocal cords (B). Benzoin, the tincture 
by inhalation in laryngeal catarrh (Br). Oil of Rue, as inhalation in chronic 
catarrh (Br). Alum, gr. x-gj aquae, as spray, in chronic coughs and hoarse- 
ness (R). Borax, a piece the size of a pea allowed to dissolve in the mouth 
(R). Glycerite of Tannin, locally in chronic inflammation of the throat 
(R). Sulphurous Acid, by inhalation, spray, or fumigation, in clergyman's 
aphonia (R). Ammonium Chloride, as vapor inhaled, of great value in 
catarrhal aphonia (Wa). Turkish Bath, at commencement of a feverish cold 
(R) ; in acute laryngeal catarrh (Br) . Galvanism, localized, the best treatment 
for hysterical aphonia. 



1$. Acidi Nitrici Dil, oij- 

Tinct. Calumbae, § j. 

Aquae, ad §iv. 

M. Sig. — A dessertsp. in a winegl. of 

water thrice daily. 



1$. Tr. Benzoin Comp., 

Tr. Opii Camphorata. . .aa 5j. 
M. Sig. — A teaspoonful in a pint of hot 
water for each inhalation. 



Aphthae. 

Potassium Chlorate, the best remedy; a solution of gr. x to the § as wash, 
alone or with borax (Br); and gr. x to xx by the stomach (B). Borax, with 
honey, or as glycerite of borax; frequently used (R); crystals allowed to dis- 
solve in the mouth (W). Sulphurous Acid, as solution, strong or diluted, 



APOPLEXY — APPENDICITIS . 



581 



locally (R), diluted as spray (B). Mineral Acids, formerly much used (B). 
Mercury, Hydr. cum Creta in small doses to remove the indigestion on which 
aphthae often depend (B); Borax being used locally when aphthae exist in the 
mouth (Wa). Copper Sulphate, a weak solution painted over mucous mem- 
brane (R). Potassium Iodide, gr. j-v in gj aquae, locally (B). Salicylic 
Acid, one part dissolved in alcohol to 250 of water (R). Bismuth, freely to the 
parts (B); as a local application (Br). Glycerin, will sometimes cure (R). 
Rhubarb, the compound powder to remove indigestion (Br) ; is highly useful 
in small doses (Wa). Limewater, as a mouth- wash, is much used. [Com- 
pare Sprue.] 



]$. Acidi Sulphurosi, 5ij- 

Aquae, q. s. ad gij. 

M. Sig. — Mouth-wash, or may be used 
as a spray. 



1$. Pulv. Rhei Co., 3ij. 

Sacch. Lactis, q. s. 

Triturat. et div. in pulv. xij. Sig. — One 
powder thrice daily. 



Apoplexy. 

Aconite, when full, strong pulse, hot, dry skin, plethoric cases, is the best 
remedy (P) ; to lower blood-pressure and prevent further hemorrhage, where 
the pulse is strong and arterial tension high (Br). Elaterium, as a purgative, 
a large dose (gr. ij) in suppository with soap; or as an injection into the large 
bowel (P). Croton Oil, as purgative, a drop may be put on the back of the 
tongue (Br); TKlf or J each hour (R). Colocynth, as a derivative purgative 
(Br) . ; appears to act well (P) . Cold Water, often harmful, though frequently 
used; is injurious when face pale, surface cool, circulation depressed (B). 
Electricity, very mild galvanic currents to promote absorption; caution neces- 
sary, especially if much headache and vertigo (B). Diet and Hygiene, of 
great importance in patients subject to apoplexy; avoid stimulating food and 
drink, especially beer, over-eating, excitement, haste, exposure to hot sun, 
heated rooms, etc. At no subsequent period should a full animal diet or the 
use of undiluted wines be indulged in (A). Diagnosis. It should be care- 
fully differentiated from alcoholism, with which it is often confounded. 
[Compare Cerebral Congestion.] 



]$. Tinct. Aconiti, ttjjx. 

Aquae Cinnamomi, q. s. ad. . §ij. 
M. Sig. — A teasp. every I hour for 
hours, then every half-hour. 



fy Ext. Colocynthidis Co., gr. xx. 

Olei Tiglii, Tigij. 

Fiat massa et div. in pil. iv. Sig. — One 
pill as required, until free purgation. 



Appendicitis. 

Opium or Morphine, in small doses to relieve pain, but not to narcosis 
(Tirard), not in sufficient quantity to mask the symptoms, and is best 
avoided unless imperative by reason of pain and collapse (Bruce) . Purgation 
by Calomel and salts, during the active stage should be avoided; it disturbs 
the viscera and is liable to set up general peritonitis (Tirard); in my expe- 
rience no acute case has terminated fatally in which neither food nor cathar- 
tics were given by the mouth from the beginning of the attack (Ochsner). 
Cocaine or Chloretone, for the nausea when excessive (Mitchell). Heat by 
fomentations to relieve pain (Tirard). Ice-bag, applied over the appendix, 
the most efficient measure to relieve pain and control inflammation, and has 
cured many cases. It should not be used until the diagnosis has been made 



582 APPETITE — ARTHRITIS DEFORMANS. 

as it masks the pain like morphine, and for this purpose it is inferior to mor- 
phine; it should not be used instead of operation except where the operation 
is refused by the patient. Many a patient has lost his life because of the 
dangerous delay before operation in the hope that the ice-bag would cure. 
Enemata, of soap and water in large quantity, after 72 hours (Bruce); should 
be used at the commencement to unload the colon (Tirard). Rest in bed is 
essential and should be absolute, the patient not rising to the sitting posture 
for any purpose (Id). Diet, none by the mouth for at least four days after 
pain has ceased, not even water, in order to prevent peristalsis, which in- 
creases the area of infection (Ochsner) ; rectal instillation of normal saline solu- 
tion should be used, and the stomach cleansed by lavage if vomiting occurs. 
Operation. Appendicitis is a surgical disease and in every case the physician 
should consult with the surgeon to consider the advisability of operation 
(see text-books on surgery). 

Appetite. 

Bitters, to stimulate the appetite (R). Gentian is perhaps the best of the 
simple bitters and is most efficacious when given a few minutes before meals. 
Calamus chewed, is a good appetizer. Condurango is efficient for the ano- 
rexia of adults, but disappointing in children (Steiner) . Food should be savory 
and well cooked. Habits require examining into, when lost appetite com- 
plained of. [Compare Dyspepsia.] 

]$. Gentianae, Quassiae, Cinnamomi, aa 3ij- 

Sig. — Put into a pint of boiling water, and when cold strain; take a wineglass thrice 
daily as an appetizer. 

Arterio-sclerosis. 

Potassium Iodide lowers the blood-pressure and prevents the extension 
of the disease (Brooks). Nitrites, especially Nitroglycerin, are very largely 
used in cases of high arterial pressure without much arterial fibrosis. Phos- 
phorus, in minute doses, with cod-liver oil (B). Arsenic, often of great value 
in atheroma, especially where imperfect action of kidneys (Br); indicated 
when there are puffy eyes, drowsiness, intellectual torpor (B). Ammonium 
Bromide, to lessen hypertension due to nervous excitement. Cod-liver Oil, 
with Phosphates, or Calcium Lactophosphate, in combination (B). Thiosin- 
amin, the Ethyl-iodide has proved useful in arterio-sclerosis. [Compare 
Aneurism.] 

Arthritis Deformans. 

Focal Infection, the eradication of the local focus of infection is of prime 
importance. This requires an examination of the mouth, throat, nose and 
accessory sinuses, prostate and deep urethra, etc., local treatment, medical 
or operative, or both, may be required. The most important advance which 
has been made in recent years in the therapeutics of chronic arthritis is the 
recognition of the role of focal infections. Arsenic for the pain, anemia, 
rapid pulse, and mal-nutrition (Kolipinski); when referable to nervous affec- 
tions (B) ; in large doses continued is sometimes of great benefit, but its action 
is capricious (R) ; is beneficial in small doses (Da C). Sodium Arsenite gr. f 
and Sodium Chloride gr. jss in 5j of boiled water, hypodermically in the 
gluteal region every third day for a year in severe forms of the disease (Koli- 



ASCITES. 583 

pinski). Antipyrine gr. v for the pain in acute attacks, is often effective 
(McCrae). Iodides, often signally benefit, especially when due to syphilitic, 
mercurial, or mineral poisoning (B); large doses of Potassium Iodide some- 
times required (R); combined with Guaiac, or Corrosive Sublimate, often 
curative in cases resisting these remedies given separately (Wa) ; Potassium 
Iodide should always be fairly tried (Da C). Ferrum Iodide holds the chief 
place in the treatment (Perry); gr. ij-iij with Strychnine Sulphate gr. ^V~~to 
thrice daily before meals (Skinner). Guaiacol Carbonate is the drug which 
has produced most benefit, given in full doses for 6 months (Symes) ; this and 
Potassium Iodide are the most valuable drugs (Luff). Formic Acid, gtt. v. 
of a 2 per cent, solution, preceded by gtt. viij of a 1 per cent, solution of co- 
caine, hypodermically into the most painful locations, proves remarkably 
efficient (Couch). Remedies for articular rheumatism and gout are injur- 
ious in this disease; Salicylates are worthless in all cases (Cornwall). Thy- 
roid Extract gr. v. thrice daily has given extraordinary results in several 
advanced cases (Wilson). Ichthyol locally with friction, is of great benefit 
(Kolbl). Cod -liver Oil locally and internally, is of much value (R). Elec- 
tricity by alternating currents from the induction coil, is a valuable treatment 
(Jones). Exercise, though painful is beneficial, rest in bed aggravates the 
disease; self- massage of the joints (McCrae). Massage is of great value in 
any form (Perry); may be used to ameliorate the condition in chronic and 
incurable cases (Da C). Passive Congestion by Bier's method, from 6 to 
22 hours, has given remarkable results in relieving the pain (Symes). Dry 
Heat by hot-air baking at 350 F. for 20 to 30 minutes only, longer exposure in 
many cases injurious (McCrae). Diet should be full, with meat, the patient 
should take as much nourishment as possible (Id) ; desserts, fruit, and alcohol 
injurious. Baths, Turkish or sulphur; the cold douche, slightly warmed in 
winter, used for one or two minutes, then rub dry (R). Counter-irritation 
by the actual cautery or flying blisters to the affected joints, passive move- 
ments thereof, baths, also Potassium Iodide internally in doses of 10 to 30 
grains in the 24 hours (Letulie) ; cupping or blistering the spine in the vicinity 
of the cervical or lumbar enlargements (Mitchell); if continuous and pro- 
longed has given good results (Latham), and has proved successful (Cham- 
pion). Vaccines, the injection of autogenous streptococcic vaccines with 
attention to the local focus of infection, has been followed by amelioration, 
and by disappearance of the arthritic symptoms in more cases than can be 
ascribed to coincidence (Goadby). 

Ascites. 

Digitalis, when ascites is part of a general dropsy due to cardiac or renal 
diseases; is of the greatest service, except where aortic regurgitation and 
cardiac hypertrophy (P) ; a fresh infusion the best preparation (R) ; its action 
increased by combination with Squill and Mercury (Br.) [See formula 
below.] Jalap, the most generally approved hydragogue purgative is com- 
pound power of Jalap with Podophyllum (B); with Potassium Bitartrate, 
combined in form of electuary, may be persevered with daily though apt in 
some cases to cause gastric derangement (Saundby). Elaterium, as hydra- 
gogue cathartic, gr. J, with a grain of Ext. Hyoscyami, and a drop of some 
aromatic oil, is the most efficient of its class in ascites but its action is very 
exhausting (W); cautiously in debilitated subjects, and is contraindicated 



584 ASPHYXIA AND APNEA. 

where gastrointestinal irritation or inflammation present (B). Arsenic, 
when ascites is due to feeble heart, and in that of old age (B) ; did excellent 
service after tapping in a woman aged 82, from whom the writer removed 6 J 
gallons of ascitic fluid at one tapping, when almost moribund, with the result 
that she lived ten years longer (Potter). Theobromine Sodio Salicylate 
is often of benefit, especially in cases of cardiac and renal origin. [See under 
Dropsy.] Diuretics, are of little use when the accumulation is excessive, the 
venous pressure seems to be too great for them to act (Saundby). Milk-diet 
is an ancient remedy for ascites, and often successful, causing profuse alvine 
and urinary discharges (B); is sometimes very serviceable when the renal 
action is inadequate (Br). Surgical, paracentesis abdominis should be done 
in all cases where excessive effusion; laparotomy in cases of tuberculous peri- 
tonitis with effusion, which has been treated successfully thereby. Com- 
pare Dropsy.] 

1$. Potassii Bitart., qss. B). Potassii Bitart., qss. 

Mellis, 5j- Jalaps (pulv.) 3jss. 

Sig. — A teasp. every 2 hours until bowels Mellis, § j. 

are freely moved. Sig. — A teasp. every 2 hours until bowels 

are freely moved. 

B;. Hydrarg. Chlor. Mitis. 
Digitalis, (pulv.), 

Scillse (pulv.) aa gr. vj. 

Fiat, massa et div. in pil. vj. 
Sig. — One pill thrice daily, in ascites from 
hepatic changes. 

Asphyxia and Apnea. 

Of the New -Born. — Clean the mucus out of nostrils and throat; shaking 
the baby several times while suspended in a horizontal position the physician's 
right hand grasping both feet about the ankles and the left hand supporting 
the shoulders. Several jarring motions usually suffice to dislodge the tra- 
cheal mucus and allow breathing to take place. If the child fails to breathe 
after the throat has been cleared of mucus then resort to (1) slapping the back 
or chest with the end of towel wet with cold water, or (2) immerse alternately 
in warm and cold water or (3) flex the head and legs upon the trunk, folding 
and unfolding slowly and regularly as in other methods of artificial restora- 
tion of respiration. Marshall Hall's method, — by placing child on abdomen, 
then bringing into lateral posture, repeating slowly and deliberately. 

From Foreign Bodies in Air Passages. — If the foreign bodies are round and 
smooth, invert the patient head downwards and strike upon the back. The 
bristle-probang is a good instrument for the removal of fish bones, coins, etc. r 
from the gullet; or a pair of curved forceps will often render good service. 
The writer removed a gold plate with three teeth attached, from the esopha- 
gus of an insane woman, by passing down a curved piece of stout wire, hav- 
ing the end bent upon itself to form a hook. After the hook was passed to 
one side of and below the obstruction, the wire was half rotated, so as to 
engage the plate, which came up on the second trial of the improvised instru- 
ment. Tracheotomy or Larnygotomy may be necessary in an emergency. 
The Bronchoscope is becoming more widely used and Dr. Jackson of Phila- 
delphia has met with wonderful success in removing foreign bodies by this- 
method. 



ASPHYXIA AND APNEA. 585 

From Drowning. — Remove the person from the water as rapidly and 
gently as possible, turn the face downward for a moment and depress the 
tongue, in order that water, mucus, etc., may be removed from immediately 
over the entrance of the windpipe. Give the patient plenty of fresh air, 
fully exposing neck and chest to the breeze, unless that be inclement. Turn 
gently on the face, one forearm being under the forehead, and raise the body 
up that the water may have free discharge from the mouth. Place the pa- 
tient upon the side and apply stimulants (Ammonia, etc.) near to the nos- 
trils; or the cold douche to the face and chest in order to excite respiration. 

The above measures being ineffectual, convey the body to the nearest 
convenient spot, strip it carefully and dry it, and place it on a warm bed, with 
head and shoulders slightly raised, and at once employ one of the following 
methods : — 

Silvester's Method. — Pull the tongue forward, to prevent obstruction to 
entrance of air into windpipe; produce expansion of the chest by drawing the 
arms from the sides of the body and upward until they almost meet over the 
head. Then bring the arms down to the sides again, causing the elbows 
almost to meet over the pit of the stomach, thus producing contraction of the 
chest. This imitation of the act of respiration should be continued at the 
rate of fifteen or sixteen times a minute, as in health. 

Marshall Hall's Method. — The person should be placed flat on the face, 
gentle intermittent pressure being made with the hands on the back, the body 
turned on the side, or a little beyond, then on the face, and the same pressure, 
etc., continued as at first. The whole body must be worked simultaneously. 
The same number and frequency of these artificial processes of respiration 
should be employed as in the other method. 

The Michigan Method. — Lay the body face down, the head upon the 
arm, and stand astride it; grasp it then about the shoulders and armpits, 
and raise the chest as high as you can without lifting the head quite off the 
arm, and hold it about three seconds, then replace the body upon the ground, 
and press the lower limbs downward and upward, with slowly-increasing 
force, for ten seconds; then suddenly let go, to perform the lifting process 
again. 

Whichever process be employed, the effort to restore the temperature of 
the body must be maintained, the body being well rubbed in an upward direc- 
tion with the hands, with warm flannels; bottles of hot water, hot bricks, etc., 
being applied to the stomach, the axillae, and the soles of the feet, stimulants 
and beef tea being judiciously administered when restoration is about taking 
place. The attempts at resuscitation must be persevered in for several 
hours, if necessary. In artificial inflation, always press the larynx and tra- 
chea against the vertebral column, so as to close the esophagus and thus 
prevent the air entering the stomach. Laryngotomy or Tracheotomy, with 
or without catheterization, or forced insufflations of air or oxygen, have 
proved successful, as also has electro-puncture (Garratt). i 

After Long Submersion is Recovery Possible? — According to Harley, 
dogs kept under the water ij minutes always died, if water had entered the 
lungs. If it had not, the trachea being plugged, they survived a submersion 
of 4 minutes. When persons rise after sinking they usually get some air, 
and less speedily come into a state from which recovery is impossible. The 
greatest period between the last inspiration and the stoppage of the heart is 



586 ASTHENOPIA — ASTHMA. 

4 minutes. Some think that no recovery has been made after complete cessa- 
tion of the heart's action. We infer that after complete submersion for 5 
minutes recovery is improbable, unless the person had been previously choked 
or in a fainting state, so that no water entered the lungs. But in Anderson's 
case, the patient had been under water at least 15 minutes, and in Garratt's 
the time was variously estimated at from 15 to 60 minutes. 

When is a Case Hopeless? — If the eyes are open, the pupils dilated, the 
conjunctiva insensible, the countenance placid, the skin cold, frothy mucus 
round the nostrils and mouth, no attempt at respiration, and the heart's 
action is inaudible when the ear is applied to the chest, the case is hopeless 
(Harley). 

Signs of Death. — The following have been suggested as methods of decid- 
ing whether death has occurred: Tie a string firmly about the finger; if the 
end of the finger becomes swollen and red, life is not extinct. Insert a bright 
steel needle into the flesh; if it tarnishes by oxidation in the course of half an 
hour, life may be considered not extinct. Inject a few drops of Liquor 
Ammoniae under the skin; during life a deep red or purple spot is found. 
Moisten the eye with Atropine; during life the pupil will dilate. Look at a 
bright light or at the sun, through the fingers held closely side by side; during 
life the color is pink; after death a dead white. After death a dark spot is 
said to form gradually on the outer side of the white of the eye, from drying 
of the sclerotic, so that the dark choroid shows through. Putrefaction is an 
absolute sign of death; better delay for it than run any risk of burying alive. 

Asthenopia. 

The Proper Glasses. — Careful examination of the refraction of the eye 
under a reliable cycloplegic is the first indication. Cycloplegia should be 
insisted upon in all persons up to 50 years of age, except in those in whom 
there is increased intraocular tension, cupping of the optic disc or other con- 
traindications. The muscle balance should receive attention and any 
anomaly corrected. Atropine (1 per cent.) instilled in the eye once or twice 
daily is of service in spasm of the accommodation. Rest of the Eyes, attention 
to the general health and the institution of hygienic measures are aids in the 
treatment of asthenopia of nervous origin. 

Asthma. 

Potassium Iodide, when from acute bronchial catarrh, gr. xv-xx each 2, 3, 
or 4 hours (R) ; the best medicament to suppress the asthmatic attack, in 
bronchial asthma, is Potassium Iodide and Chloral (Lazarus) ; is the specific 
in*asthma, if any drug can be so called; should be given with Lactucarium 
(See). Belladonna, relieves paroxysm when expectoration abundant, skin 
cool and moist (B) ; internally in large doses, also in cigarettes (Br) . Atropine, 
is more efficient, gr. -g 1 ^ hypodermically at bedtime to abort morning paroxysm 
(B); large doses required but very satisfactory (R); very much valued by 
Salter and See (P). Duboisine, may be used instead of Atropine. Stramo- 
nium, twenty grains of the dried leaves or ten of the powdered root may be 
smoked; Datura is sometimes better; Stramonium preparations are often of 
bad quality (R). Scopolamine, the Hydrobromate, gr. 2^, with Morphine 



ASTHMA. 587 

Sulphate gr. J—J and Strychnine Sulphate gr. 6 V~¥o j tne best combination for 
the paroxysm (S. Solis-Cohen). Morphine hypodermically quickly aborts 
the paroxysm (B) ; in some cases will induce a paroxysm (R). Apomorphine, 
gr. T V hypodermically has proved effective; or gr. ^ in camphor-water every 
3 or 4 hours, with or without Morphine or Ipecac. Heroin, gr. T \ hypoder- 
mically, a prompt and efficient respiratory antispasmodic (May) ; a valuable 
remedy with Potassium Iodide (Hyams). Epinephrine in 1 to 1000 solution, 
by spray into the fauces with full inspiration, is very effective in the par- 
oxysm (Savage); Suprarenal extract is useful in bronchial asthma (Solis- 
Cohen); TTlv-xx of a 1 to 1000 solution of Epinephrin given hypoder- 
mically will often relieve an asthmatic attack with miraculous promptness. 
Nux Vomica, in nervous subjects (B); often of great benefit in spasmodic 
asthma (*P) ; the tincture in drop doses every five minutes has rendered extra- 
ordinary results in both cardiac and bronchial asthma, and in asthma of 
peripheral reflex origin, as from phimosis (Macfarlan). Antipyrine, is suc- 
cessfully employed in bronchial asthma. Aconite, in spasmodic (P) ; often 
averts the attack, if given at commencement; useful also in the asthma follow- 
ing coryza and sneezing in children (R) . Ipecacuanha, the wine as spray to 
the fauces, sometimes useful in severe bronchial asthma, but not of much 
service in genuine asthma (R) ; nauseant and emetic doses in the spasmodic 
form (B). Lobelia, gtt. x of the tincture every J hour during paroxysm; 
Tflx ter die, with additional doses at night, in bronchitic asthma when worse 
at night; cautiously if heart disease(R); often gives permanent relief (B); no 
remedy of more value in spasmodic form, also in asthmatic bronchitis of the 
child with increased secretion (Burnett). Veratrum Viride, there is no 
remedy which gives results as quickly, asTfl,x of Norwood's tinct. (Landis). 
Aspirin gr. xv repeated after 2 hours, gave almost immediate relief in severe 
cases of bronchial asthma (Gresic). Pilocarpine Hydrochloride, gr. £ in 
water, at bedtime, promptly and effectively relieves, in cases of bronchitic 
asthma with hypertrophic rhinitis; in some of nine years' standing it appar- 
ently gave permanent relief (Wyss). Grindelia, gives relief in spasmodic 
form (B) ; 3 grains of extract thrice-daily, to prevent attacks, or ITLxx-xxx 
of fluidextract every half-hour or hourly from the onset of paroxysm (R). 
Arsenic, as cigarettes, as well as by internal administration (B); Tflj 
of Fowlers solution ter die, in attacks from bronchitis, local irritation, 
etc., allied to hay fever (R). Ethyl Iodide, very valuable in spasmodic form, 
and lessens liability to subsequent attacks; Tfl,v-xx thrice daily by inhalation 
(B). Cocaine, hypodermically, is used with the best results, even where 
other remedies failed to relieve (Mosler); the leaves of the coca-plant make 
the best cigarrettes for asthma (Nachtigal) . Chloroform, inhaled from warm 
water; anesthetics relieve, but increasing doses required, leading to habit (R). 
Amyl Nitrite, inhaled, quickly checks spasmodic asthma (R). Tetranitrin 
gr. ss, to reduce the high arterial tension (Huchard). Chloral, is highly 
efficient in spasmodic asthma; may arrest a paroxysm (R). Paraldehyde, 
Tfl.xlv-3 j, used in 30 cases of asthma with rapid and complete relief in most 
and lessening of distress in the others (Hearder). Mustard, as a counter- 
irritant over the vagus, from beneath the right ear to the right sterno-clav- 
icular articulation (Waugh). 

Euphorbia Pilulifera, 5ss-j of the fluidextract thrice daily, used with 
excellent results in asthma and asthmatic bronchitis (Dujardin-Beaumetz). 
Eucalyptus, smoked with Stramonium, Belladonna Tobacco (B). Potas- 



5SS ATROPHY OF SKIN. 

shun Nitrate, the inhalation of fumes of burnt nitre paper will sometimes 
avert a paroxysm; different methods of preparation useful for different cases 
i^R\ Chamomile Oil, has been found very serviceable (P). Antimony, in 
an affection of children like asthma, dissolve a grain of Tartar Emetic in half 
a pint of water, and give a teaspoonful of this every \ hour for the first hour, 
then hourly; if vomiting induced, lessen the dose (R). Coffee, a small cup of 
very strong* coffee often useful in a paroxysm (R); asthmatics should not use 
it as a beverage (P). Tobacco, smoking, sometimes relieves (R). Pyridine, 
the fumes are highly efficient (See). Colchicum, in gouty subjects (R). 
Galvanism, of pneumogastric often relieves, + pole beneath mastoid process, 
— pole to epigastrium; Faradism of no use (B). Diphtheria Antitoxin is 
dangerous in all patients subject to asthmatic attacks. (See article on Diph- 
theria Antitoxin, page 431). Prophylaxis, avoidance of exciting causes, 
especially indigestible food, wet, damp, and sudden changes of temperature. 
Attention to the stomach will do most for many asthmatic patients. An 
important point is to take the heaviest meal early in the day, and very little 
solid food after 2 p. m. Shower-bath and out-of-door, exercise, not however 
to a fatiguing extent (R) . In special cases of reflex origin from exposed nerve- 
filaments, operative treatment of the nose and naso-pharynx, is required 
(Lazarus). [Compare Dyspnea.] 



Arsenical Cigarettes. 

3$. Sodii Arsenatis, 5ss-j. 

Aquae Destillatae, § j. 

Moisten unsized white paper, and roll into 
cigarettes, each containing gr. \ to gr. j. of 
the salt. Two or three |of these to be in- 
haled daily. (Bartholow.) 



B;. Ammonii Bromidi, gr. clx. 

Ammonii Chloridi, gr. xc. 

Tinct. Lobeliae, 3iij- 

Spt. Athens Comp., o j- 

Syrupi Acaciae, q. s.ad §iv. 

M. Sig. — A dessertspoonful in water, every 
hour or two, for the paroxysm. 

(Pepper.) 

B>. Belladonnae Fol., 3j- 

B;. Ext. Stramonii, gr. ij. Stramonii Fol., 

Potassii Iodidi, . 3jss. Hyoscyami, aa 3ss. 

Ammonii Carbonatis, 3j. Extracti Opii, gr. iij. 

Tinct. Lobeliae, 3jss. Aquas Laurocerasi, q. s. 

Aquae Chloroformi, . .q. s. ad gviij. Dissolve the opium in the water, and 

Ft. mistura. Sig.— A tablespoonful every I moisten the leaves therewith. When dry, 

4 to 6 hours. I r °U mto twelve cigarettes. Smoke two to 

I four daily. (Trousseau.) 



Atrophy of Skin. 

In well advanced cases, very little can be done, a recognition however of 
the causative factor is of the utmost importance, if such can be found. Mild 
or beginning cases may very frequently be benefited by the use of the follow- 
ing remedies. Baths, either Turkish or Russian, are of some little value 
in early cases. Constitutional remedies, such as Arsenic in ascending 
doses with Quinine and Iron are frequently indicated in these conditions. 
Protection of the parts from injury is advisable as friction or blows aggravate 
the disease. 

In early stages of atrophy of the skin, ointments containing Boric Acid 
and a small quantity of Oxide of Zinc should be thoroughly rubbed into the 
skin. Electricity is sometimes of value in this disease, the Galvanic Current 
being applied directly to the parts. Olive Oil might also be tried, rubbing it 
into the skin night and morning. Sulphur, 2 to 3 grains, three times daily, 



BALANITIS — BERIBERI. 589 

in some instances, seems to have an alterative effect (Stel wagon). For 
atrophy of the nails, paint them every day with 5 to 10 per cent, solution of 
Resorcin or Salicylic Acid. 

Balanitis. 

Mercury, Hydrarg. Chlor. Corp. gr. j to § jss Aquae Calcis, as lotion, if not 
much inflammation (Br). Oil, on linen, to inflamed part beneath foreskin, 
which must be again drawn forward; strict cleanliness. Astringent Lotions, 
of Alum or Zinc Sulphate, with warm water injections (Br). Lime-water, 
the best lotion if much inflammation (D). Tannin, in alcohol, equal parts, 
as dressing after washing with a weak solution of common salt. Dusting 
Powders, stearate of zinc, boric acid, bismuth subnitrate or borated talc in 
later stages after cleaning with salt or boric solution. [Compare Phimosis, 
Gonorrhea.] 

Bed-sores. 

Alcohol, Brandy, or Eau-de-Cologne, to harden skin of parts exposed to 
pressure (R); as wash to parts threatened (B). Glycerin, or glycerin cream, 
rubbed over the parts exposed to pressure, after washing morning and even- 
ing, is one of the best preventives (R). Alum, §ss, whites of four eggs, 
Tinct. Camphorae 5ij> an excellent application (B). Thymol Iodide dusted 
over the part, an excellent application. Zinc Stearate with Tannic Acid, is 
very efficient. Silver Nitrate, a solution (gr. xx ad 5 j) to be painted on the 
threatened but unbroken skin, as soon as it becomes red, will prevent sores; 
if Nitrous Ether solution be used, gr. v to the § is enough (R). Iodoform, 
dusted over sores (R). Linen, air-dried better than that which is ironed or 
mangled, by reason of its greater softness. Remove Pressure over threatened 
area by encouraging patient to change position, or by using an air cushion 
ring or " birds' nest" of absorbent cotton. 

Beriberi. 

Prophylaxis. — " It must be remembered that not only is rice, from which 
the neuritis preventing vitamine has been removed by excessive milling, 
productive of beriberi but that the same applies to other cereals which have 
been similarly deprived of their vitamines. The same result may be ob- 
tained by the employment of excessive sterilization for canning. Fresh meat 
is as valuable as fresh vegetables in prophylaxis, but if either kind of food 
be subjected to excessive heat, as in the case with tinned meats, etc., they not 
only do not prevent beriberi but in a negative way are beriberi producing" 
(Stitt). 

Digitalis or Strophanthus, small doses seem to do good in the cardiac cases 
(Mn). Nitroglycerin, full doses, TTliij-v of the 1 per cent, solution every J 
to \ hour, when signs of acute cardiac distress appear (Simon). Amyl 
Nitrite, by inhalation in sudden cardiac attacks, pending the action of nitro- 
glycerin (Mn). Bleeding from the arm or external jugular, 8 or 10 ounces, if 
signs of cardiac distress or failure persist and increase, in spite of the above- 
mentioned drugs (Id). Magnesium or Sodium Sulphate, in small and re- 
peated doses from the outset, to counteract constipation and drain the tissues 
of fluid (Mn). Strychnine, Arsenic and Silver Nitrate, as tonics for the nerv- 
ous and muscular complications. Medication should be purely sympto- 



;qo 



BILIOUSNESS — BLADDER, IRRITABLE. 



matic, no drug known has any specific influence on the disease (Mn); the 
symptoms are treated as in other forms of neuritis (Ty). Faradization 
and Massage, are of great service for the muscular atrophy and cutaneous 
anesthesia; but should not be employed until the muscular hyperesthesia 
has subsided (Mn). Diet, should be nutritious but not bulky, animal food 
in reasonable amount, milk, eggs, wheaten flour, oatmeal, beans, are all indi- 
cated. Rest in bed for the worst cases, especially those showing cardiac 
complications; the milder cases should be up and out in the open air. 

Biliousness. 

Podophyllum acts as a cathartic (B); corrects deficient secretion of bile, 
especially in children and infants; gr. ¥ * ¥ to T V, every six hours, to correct 
white or clayey stools; also in general hepatic derangement (P). Aconite, in 
occasional doses, improves the effect of Podophyllum (R). Mercurial 
Cathartics, act only as purgatives; Calomel, gr. j-x, or Pil.Hydrarg. gr. v-x; 
Mercury as purgative restricted to cases where there is excess or deficiency of 
bile (B); frequent small doses of gray powder for deficiency (R); Calomel, 
gr. iij, followed by 5ij e ach of Rochelle and Epsom Salts, when the tongue is 
heavily coated and furred (Gross). Mercury, Yellow Oxide, in doses of gr. 
-^-q to 3*o, in trituration with sugar of milk, exceedingly efficient in many dis- 
ordered conditions of the alimentary canal and its appendages (Schaffer). 
Hydrastis, gtt. v-vx of fluidextract daily before meals, for biliousness with 
chronic gastric catarrh and dyspepsia (B). Mineral Acids, before meals, 
Hydrochloric Acid after meals, in atonic dyspepsia (B). Ammonium Iodide, 
gr. 5 — iij in water each 2, 3 or 4 hours, for catarrh of duodenum and biliary 
ducts (B). Ammonium Chloride, is much employed in Germany for hepatic 
derangements, and with success. Euonymus, is considered a' very efficient 
remedy by many practitioners in cases of hepatic dyspepsia, or "bilious 
attacks," so called. Aloes, in biliousness with constipation. Calumba, is of 
benefit in many forms (P). Alkalies, and their laxative salts, in the bilious 
state, with uric acid diathesis (B). Milk-cure, in obstinate cases; buttermilk 
or skimmed milk often agrees best (B). [Compare Dyspepsia, Hepatic 
Congestion, Duodenal Catarrh.] 



1$. Fluidextr. Stillingise, 5 v. 

Tinct. Aloes, 3ij. 

Tinct. Nucis Vom., 3 J- 

M. Sig. — Twenty drops in water thrice 
daily. (B.) 



1$. Ext. Euonymi, qss. 

Ext. Hyoscyami, gr. xv. 

Ext. Gentianae, gr. vj. 

Fiat massa et div. in pil. xij. Sig. — One 
pill every other day. 



1$. Hydrarg. Oxidi Flavi, gr. j. 

Sacch. Lactis, q. s. 

Triturat et div. in chart, xlviij. 

Sig. — One powder dry on the tongue 
twice daily. 



ty. Massae Hydrargyri, 

Ext. Colocynthidis Co.,. .aa gr. iij. 

M. et div. in pil. ij. 

Sig. — Take at once, and follow it in a few 
hours with a saline cathartic. 



Bladder, Irritable. 

Belladonna, in nocturnal incontinence, due to relaxation of sphincter, or 
irritable mucous membrane (B); gtt. v-xx of tincture every 3 or 4 hours give 
gradual but sure relief (P). Cantharis, in women, without acute inflamma- 
tion (B); incontinence on coughing (R). Benozic Acid, when from enlarged 



BLADDER, PARALYSIS OF — BLEPHARITIS. 59 1 

prostate, removes fetor of urine; also renders phosphatic or alkaline urine 
acid (P). Ammonium Benzoate, may be used instead of Benzoic Acid (Br). 
Gelsemium, the best remedy for irritable bladder of women of hysterical 
type, with constant desire to urinate (B). Cubeb, is often successful in women, 
but Cantharis generally better (B); is of especial value when vesical catarrh 
present (P). Cannabis, in spasm of the bladder and in irritable conditions 
of that organ, is generally useful. Eucalyptol, is often very efficient, but 
frequently fails, Tfl,ij on sugar two or three times a day. Antipyrine, 20 grains 
in solution, by rectal or vesical injection, powerfully lessens irritability of the 
bladder (Chastelet). [Compare Cystitis, Dysuria, Enuresis, Lithiasis, 
Calculi, Urinary Disorders.] 

1$. Tinct. Gelsemii, 5ss. 

Sodii Bromidi, 5iij- 

Fluidextr. Tritici, §iss. 

M. Sig. — A teaspoonful in water 
every four hours, for irritable bladder. 

Bladder, Paralysis of. 

Cannabis, in retention from spinal disease (R). Ergot, in paralytic 
dysuria, especially when sensation of bladder being only partially emptied 
(P), when incontinence from paralytic sphincter, and in paralysis from over- 
distention (Wa). Arnica, has proved curative (P). Strychnine, gr. ^ to 
^o> is useful (B). Cantharis, often given with excellent effect, when bladder 
atonic (Wa). Galvanism, may greatly benefit (B); electro-magnetic current 
from the bladder to the spine, of great use ( Wa) . 

Blastomycosis. 

Complete Excision in many cases produces the best results, though other 
methods should be tried first if cosmetic effects are to be considered for the 
scar caused by excision is often worse than that produced by the absorption 
or destruction of the focus through the action of drugs. Copper Sul- 
phate, } to 1 grain t. i. d., and applied locally in a 1 per cent, solution 
has been advocated by Bevan. Internally, Potassium Iodide and the 
other iodides have been used, though the action is usually very slow and 
must be kept up over a period of several months. Radium has been used in 
the treatment of this disease and in many cases with apparently perfect re- 
sults. Strychnine, Iron and Quinine are given for their systemic effects. 
A Vaccine made from autogenous filtrate has been used in a few cases with 
apparently good results. X-ray treatment when given alone or following 
surgical means has been reported as having been successfully used. 

Blepharitis. 

Hygienic Measures constitute the first indication, in order to remove the 
cause, if possible. Cleanliness, change of faulty habits and Correction of 
Errors of Refraction are great aids to local treatment. Mercury, the yellow 
oxide ointment applied to the lid margins after removal of the scales and crusts. 
Silver Nitrate, a 1 per cent, solution applied to raw surfaces in the ulcerative 
type. Ichthyol, gr. x to 5ij Ung. Zinc Oxide, is a useful application in stub- 



592 



BONE DISEASES — BRIGHT 'S DISEASE, ACUTE. 



born cases. Argyrol, in 20 per cent, solution, three drops instilled in eye 
thrice daily for the associated conjunctivitis. 



1$. Acidi Borici, gr. xxx 

Zinci Chlorid, gr. iss. 

Aqua Dest., q. s. ad oiij- 

M. Sig. — Place 5 drops in each eye 

t. i. d. as a lotion for eyelids. 



fy. Hydrarg. Oxid. Flav., gr. i. 

01. Amygd. Exp., TTjjvi. 

Petrolat. Alb., 3iij. 

m Ft. Ung. 
Sig. — Apply to lid margins after removing 
scales and crusts. 



Bone Diseases. 

Iodine in scrofulous bone affections is often of great service (W) ; should be 
used locally with Ferrous Iodide or Cod-liver Oil internally, nutritious diet, 
out-door exercise (Wa). Cod-liver Oil, in scrofulous affections, may be 
relied on if used perseveringly and accompanied by good hygienic conditions 
(Wa). Phenol by deep injection, has been used with success (Hueter). 
Phosphorus in as large doses as can be borne has a marked influence on the 
growth of bone, and has value in rachitic cases where there is a tendency to 
osteoporosis (W). [Compare Caries, Exostosis, Nodes, Periostitis, 
Rachitis, Spina Bifida, etc.] 

Breath, Fetid. 

Potassium Permang., gr. j to § j aquae rosae, as a wash for the mouth (B). 
Chlorine, as solution of chlorinated lime to remove fetor (B). Phenol, a 
dilute solution, as wash for the mouth ( W) . Camphor, is used as a corrective 
(R). Thymol, in solution, as a mouth-wash is very efficient in removing the 
odor of tobacco from the breath. Look for bad teeth, disordered digestion, 
and in very offensive cases for bronchiectasis or gangrenous lungs; cleanliness 
of teeth is essential. 



fy Calcis Chlorat, 3iij. 

Aquae Destillatae, 

Alcoholis, aa 5ij- 

Olei Rosae, njjiv. 

M. Sig. — A teaspoonful in a glassful of 

water as a lotion for the mouth. (B.) 



. Acidi Salicylici, 3 j- 

Liq. Ammonii Acetatis, § iij. 

Glycerini, 5 j- 

Aquae, q. s. ad oyi. 

M. Sig. — A teaspoonful every six hours. 
(Robinson.) 



Brighfs Disease, Acute. 

Aconite, should be given immediately on the appearance of the nephritis 
in scarlatina (R) ; as a diuretic, advocated (P). Strontium Lactate, is highly 
efficient and is much more useful in acute nephritis than in chronic (Da C). 
Pilocarpus, was formerly much used (Da C); large doses very depressant to 
the heart, by Tfl,v-x of the fluidextract every half-hour or hour will produce 
sweating; may be combined with tincture of Digitalis (Smith) ; or Pilocarpine 
Nitrate, to excite skin when symptoms urgent, gr. T V to \ for adult (B) ; the 
dose should be small at first; it is not a suitable drug for children (Y); I have 
latterly resumed its use, often with benefit (O). Jalap, the compound 
powder is the most generally useful purgative, used in the early morning to 
produce free watery evacuations when uremic symptoms supervene (B). 
Gallic Acid, checks albuminuria (B). [See Albuminuria, for formula.] 
Juniper, as diuretic; often aggravates (P). Diuretics, the stimulating ones, 



bright's disease, chronic. 



593 



which act on the secreting cells of the kidneys, are contraindicated; but this 
is not the case with those which simply favor the flow of water through the 
kidneys, and of such diuretics Water is the best (Y). Alkaline Salts, as 
Potassium Citrate, Sodium Benzoate, or Sodium Bicarbonate, may be usefully 
added to the water (O) . Diluents, as milk and Potassium Bitartrate in solution, 
should be used freely to relieve the congestion and remove obstructions from 
the tubules (B). Iron, after the acute symptoms have subsided, as a tonic, 
the most suitable preparation being Basham's mixture (the now official Liquor 
Ferri et Ammonii Acetatis) in §ss doses thrice daily (Da C). Poultices, 
large, of Unseed meal, made light and soft as possible, beneficial (Wa). 
Cupping, in lumbar region, ameliorates acute desquamative nephritis, and 
congestion of the kidney (B); cupping or leeches over the loins, diluents, 
and demulcents, with rest and antiphlogistic regimen, often suffice (Wa). 
Vapor-bath or Warm Pack, to increase the action of the skin Diet should 
be strictly milk until convalescence is established, when fruits may be 
given (O) ; salt should be withheld (O) ; a salt-free diet in cases where there 
is a tendency to dropsy (Strauss). Milk toast, barley water, strained oat- 
meal, gruel and other simple well prepared cereals may be used with 
advantage. The intake of water should be limited according to the amount 
of urine excreted and the extent of the edema. When the kidneys show signs 
of improvement the diet may be gradually increased by adding more cereal, 
rice potatoes, eggs and fruits, such as oranges, lemons and apples. [Compare 
Albuminuria, Hematuria, Scarlet Fever, Uremia.] 



1$. Fluidextr. Pilocarpi, §ss. 

Vini Ipecac, 5 jss. 

Mucil. Acaciae, 5j- 

Aq. Cinnamomi, ad §ij- 

M. Sig. — A teasp. every four hours until 

free diaphoresis. 



3$. Pulv. Jalapse Comp., oiv. 

Div. in chartulas no. iv. 

Sig. — One in water before breakfast. 



1$. Potassii Acetatis, 5 ijss. 

Infusi' Digitalis, giij. 

Infusi Juniperi, q. s. ad Syj. 

M. Sig. — A tablesp. every 2 to 4 hours 
as diuretic. 



]$. Liq. Ferri et Ammonii 

m Acetatis (U. S. P.), 5 viij. 

Sig. — A tablesp. thrice daily, as soon as 
hematuria disappears. 



Bright's Disease, Chronic. 

Nitroglycerin, to dilate the peripheral vessels, relieves the heart, dimin- 
ishes renal congestion and the excretion of albumin (B). Cod-liver Oil, is 
very useful (R). Turpentine, sometimes given in very small doses as a diu- 
retic, and to check hematuria (R) ; half-drop or drop doses every 2 to 4 hours 
very successful in dropsy with albuminous urine depending on non-desqua- 
mative disease of the kidneys. Jaborandi, is very satisfactory in uremia 
(B); large doses very depressant to the heart (Smith); ulxx of the fluid- 
extract ter in die if the urine decreases much (Da C). Iron, to correct 
anemia; the tincture of the Chloride preferred (B). Eucalyptus, in chronic 
desquamative nephritis, cautiously used, will improve (B). Elaterium, for 
the dropsy, as a derivative cathartic; must be cautiously used (R). Theo- 
cine, gr. iv thrice daily, powerfully diuretic in dropsy from renal disease 
(Meinertz). Potassium Bitartrate, to prevent dangerous accumulations in 
cellular tissue or important cavities, also to draw off effete matters; care 
must be used, as it is a brisk purgative and is weakening (R) ; in form of 
cream-of-tartar lemonade an agreeable diuretic (B). Jalap, the compound 
38 



594 BRONCHIECTASIS. 

powder occasionally as derivative cathartic, to relieve the kidneys (Da C). 
Bromides are useful in the convulsions (R). Potassium Iodide, has im- 
proved some cases, which were possibly due to syphilis (R). 

Diet. — The careful regulation of the diet is exceedingly important and its 
selection is based upon the functional efficiency of the kidney, non-protein 
nitrogen of the blood, condition of the heart and blood pressure, the diges- 
tion and weight of the patient. The excretion of salt and of nitrogen is 
impaired, hence these substances must be restricted in the diet and in some 
instances, the salt must be entirely withheld. "It has not been shown that 
fresh fish, poultry and meat (not rich in purins, as kidneys, sweetbreads, liver 
and shad roe) are any more harmful to the nephritic patient than are vege- 
table proteins, such as nuts, peas, beans and oatmeal; but some patients may 
tolerate vegetable proteins better. There is no special difference between 
red and white meat, though the latter may be more easily digested. Boiled 
meats are better than those cooked in other ways because some of the extrac- 
tives have been lost. For this reason meat soups should not be allowed to 
patients with nephritis, as they contain mostly meat extractives." (J. A. M. 
A., April 7, 191 7). Milk-cure, has been very successful; skim-milk alone for 
some time, then gradual addition of other diet (B). The Karell Treatment, 
first suggested by Phillippe Karell, in 1865, may be carried out as follows: 
"The patient receives 200 mils of milk, in four doses, at four-hour intervals 
during the day, beginning early in the morning. This treatment is con- 
tinued for about a week. The milk may be taken hot or cold, as the 
patient desires, but he is allowed no other fluid and no solid food. After 
this period of limited diet he is allowed one egg and a slice of dry toast a day, 
for 2 or 3 days; the food is then gradually increased during the next 2 
weeks by adding an egg, more bread, rice or other cereal, so that at the 
end of this period he is back to his ordinary diet, that is, the diet con- 
sidered correct for one in his condition. Whether or not a little meat 
should be allowed depends on the character of the nephritis and on the 
absence or presence of uremic symptoms. During this starvation period an 
enema or some vegetable cathartic should be used. If the patient suffers 
from extreme thirst, the amount of water allowed may be slightly increased, 
or if hunger becomes unendurable, he may be allowed a little more toast. 
If the edema is largely cardiac, he may be allowed a small amount of salt." 
(J. A. M. A., April 7, 191 7). Water, in large draughts as diuretic, when 
excretion of solids is deficient (Br); hot fomentations to lumbar region (B). 
Baths, warm and Turkish, when uremic symptoms and dropsy; discretion 
needful as baths may weaken (R) . Mineral Waters, especially the efferves- 
cent vichy and lithia waters, have many advocates. Decapsulation of the 
kidneys, done in 51 cases, with 9 cures, 22 improved satisfactorily, 7 deaths 
(Edebohls) ; these results are not corroborated, the mortality has been high, 
and when recovery from the operation has occurred the disease was not 
cured. [Compare Dropsy, Uremia.] 

Bronchiectasis. 

Hygienic. — Patient must live as much as possible in the outdoors with an 
abundance of good nourishing food, frequent cleansing of the mouth with 
mild antiseptic solutions. Postural Treatment consists in the assuming of 
such positions as the "knee chest" or Trendelenburg or with the chest hang- 



BRONCHITIS, ACUTE. 595 

ing over the side of the bed, to favor the discharge of secretions by gravity. 
Inhalations of creosote, phenol, menthol, turpentine, etc., have been used 
with varying benefit. Intratracheal Injections have given satisfactory re- 
sults. McPhedran recommends a drachm of the following solution injected 
twice daily, care being taken to introduce the tip of the nozzle of the syringe 
beyond the vocal cords: 

Menthol 10 parts 

Guaiacol 2 parts 

Olive Oil 88 parts 

Iodoform Emulsion, 2 to 10 per cent, is less irritating and is probably 
quite as effective (Id). 

Chlorine, in solution as a stimulant and deodorizer, or as inhalation to 
lessen fetor (Br). Oil of Cloves, Tfl,v-x hypodermically in olive oil once or 
twice daily, produces excellent results in controlling the excessive cough 
and expectoration (Hare). Palliation of the cough and expectoration, with 
care of the general health of the patient* is all that can be accomplished. 
[Compare Emphysema.] Surgery has been resorted to in a few instances 
with reported success, but the operation is too formidable and disastrous to 
recommend, except in a few rare cases. 

Bronchitis, Acute. 

Tartar Emetic, in the first stage, gr. ■£$; to T \, especially if cough is violent 
(B) ; gr. j to a quart of water, a teasp. of this every hour for the wheezing 
and cough of slight bronchitis in children (Smith); gr. J to J every 2 or 3 
hours (R). Ipecacuanha, as syrup when expectoration profuse and difficult 
to expel (R) ; in dry stage (P) ; when secretion is scanty and dry, but use Squill 
when the secretion, though copious, is difficult to expel (Br). Ammonium 
Chloride, when an expectorant is indicated; with the compound Mixture of 
Glycyrrhiza, an old and good remedy. Ammonium Benzoate gives good 
results in many cases, especially those of the lithemic diathesis (Coston). 
Ammonium Carbonate, when expectoration is profuse, and the condition low 
(R). Ammonium Acetate, from its sudorific action, is always indicated, 
especially in children (Dessau). [See formula below.] Opium, Morphine 
and Quinine combined, or Dover's powder, to abort an attack; also with 
expectorants to allay cough (B); in frequent and violent coughs, without 
obstructed oxidation; also to check excessive secretion (R); as sudorific, 
gr. x of Dover's powder very useful (P). Apomorphine, the Hydrochloride 
internally in doses of gr. -fa every 3 hours, is a good expectorant. Heroin, 
given with Ipecac, is particularly effective (Hyams) ; especially for the cough 
and dyspnea, proved effective in 99 per cent, of 700 cases (Grinewitsch). 
Codeine gr. f-f to check excessive dry cough. Phenol, a 5 per cent, solu- 
tion used with steam atomizer as spray, is promptly efficient in relieving the 
symptoms. Camphor, in oil by hypodermic injection in bronchitis from 
cold; the first injection acts like an expectorant, and after the fourth the 
expectoration ceases completely, even in the most serious cases (Alexander) ; 
has but slight value in the bronchitis of the emphysematous. Turpentine, 
o j of the oil to 5 iv of boiling water, the vapor of which as an irritant in- 
halation to provoke coughing and expulsion of mucus in cases so exhausted 
that expectorants fail (Murray). Cubeb, very useful, especially when 



596 



BRONCHITIS, CAPILLARY. 



secretion copious and system relaxed (P). Copaiba, after subsidence of 
the fever, the most serviceable expectorant, but nauseous (B). Counter- 
irritants, mustard as large poultice, with linseed or oatmeal, or both, very 
useful (R). Heat to chest by linseed poultices, of great service. Diet, 
should be light and in liquid form. [Compare Cough.] 

1$. Antim. et Potassii Tart, — gr. ij. ]$. Liq. Ammon. Acetatis, 5iv. 

Spt. Athens Nitrosi, 

Syr. Ipecac, aa 5 jss. 

Syr. Senegae, §j. 

Syr. Limonis, § j- 

M. Sig. — A teaspoonful every 3 hours 
for children. (Dessau.) 



Antim. et Potassii Tart.,... . gr. ij. 
Liq. Ammonii Acetatis, .... § iv. 

Spt. iEtheris Nitrosi, § j. 

Tinct. Aconiti, §ss. 

Syr. Simplicis, q. s. ad §vj. 

M. Sig. — A teaspoonful every 2 or 3 
hours. In first stage. 



1$. Codein. Sulph., gr. v. 

Syr. Ipecac, 5ij- 

Syr. Acid. Citric, § ij. 

Aqua dest., q. s. ad § iv. 

M. Sig. — A teaspoonful every third hour. 



1$. Syr. Ipecac, 5ij- 

Liq. Potassii Citratis, 5iv. 

Tinct. Opii Camphorat., 

Syr. Acaciae, aa 5 j. 

M. Sig. Tablesp. ter die. In 

stage of ordinary acute bronchitis. 

Costa.) 



first 
(Da 



Bronchitis, Capillary— Lobular Pneumonia. 



Ipecacuanha, as emetic, preferred to tartar emetic in capillary bronchitis 
of very young or very old (B) ; when expectoration profuse and difficult to 
expel (R) ; in very young infants should be used in place of antimony (M & P) . 
Squill, as expectorant, may be used with benefit (Wa). Ammonium Car- 
bonate, when expectoration profuse and strength diminishing; in severe 
bronchitis or broncho-pneumonia of children, especially when prostrate 
and livid (R) ; Ammonium Iodide, in small, rapid doses, often gives great 
relief to the catarrhal process (Da C) ; often gives the most astonishing relief 
(B). Ammonium Chloride, gr. ij every 2 hours, either alone or with Potas- 
sium Chlorate (Clymer). Serpentaria, in capillary bronchitis of children 
gives excellent results (B). Turpentine, one of the best stimulants when 
vital powers are depressed and peripheral circulation feeble (B). Camphor, 
to allay cough and promote expectoration (B). Hydrocyanic Acid, for 
cough and tendency to spasm. Mustard, as poultice or bath, useful (R); 
the most important part of the treatment (M & P); as pack is especially 
indicated when severe dyspnea, asphyxia, cyanosis, and great general 
prostration (Herzfeld); when made with the spirit of mustard 5j-ij with 
I pint each of alcohol and water, and the body of the child wrapped in this 
from neck to knees for J to J an hour it gives extraordinary relief (Id). 
Poultices, to encircle the whole chest in children (R) ; followed by a jacket 
of cotton wool around the chest. Steam, by inhalation, may be impregnated 
with sedatives, or Phenol; is of great importance (M & P). Quinine, in 
that form of capillary bronchitis occurring in tropical climates, and where 
marked debility (M & P). Stimulants, are often necessary, especially in the 
suffocative form, and where marked prostration (M & P). Emetics, are 
necessary when suffocative symptoms become prominent. [Compare 
Cough.1 



]$. Ammonii Iodidi, 5 j~ij : 

Ammonii Carbonat., 5ij - iij. 

Syr. Glycyrrhizae, 

Syr. Tolutani, aa. gij. 

M. Sig. — A teasp. every 2 or 3 hours. 



1$. Quininae Sulphatis, gr. vj. 

Ac Sulphurici Dil., ngxij. 

Syr. Simplicis, gss. 

Aquae, oijss. 

M. Sig. — A teasp. every 2 hours to child 
of 2 or 3 years. (M & P) 



BRONCHITIS, CHRONIC. 597 

Bronchitis, Chronic. 
Ammonium Chloride, with stimulating expectorants, such as Serpentaria, 
Sanguinaria or Eucalyptus (B); when secretion is thick and abundant the 
salt may be applied by an atomizer (R). Ammonium Benzoate is of signal 
service (Coston). Ammonium Iodide and other Iodides, with expectorants 
are very serviceable (B). Ammonia by inhalation, to lessen expectoration 
(R). Ethyl Iodide, by inhalation, is very valuable by reason of its local in- 
fluence, lUv-xx thrice daily (B). Strychnine, as a respiratory stimulant and 
to check the reflex vomiting (B); Squill, in chronic forms with tenacious 
sputa, but not when fever or acute inflammation (R). Opium, with expec- 
torants, to allay cough (B); when cough frequent and violent without any 
signs of obstructed oxidation, also to check excessive secretion (R) . Codeine, 
gr. | every 3 to 6 hours, when other opiates are not well borne (P). Morphine, 
gr. J with 5 grains of Dover's powder at bed-time, followed by whiskey on 
the next morning, used in more than 200 cases with excellent results (English). 
Apomorphine, small doses by the mouth as an expectorant (Br). Ichthyol, 
in pill or mixture, up to gr. xv daily, gives marvellous results (Brun). Sul- 
phur, in severe cases with abundant discharge, especially in cases of con- 
stitutional debility (R) . Adrenal Extract has given good results. Euphorbia 
Pilulifera, is very successful in asthmatic, chronic and advanced or sub- 
acute bronchitis (Dujardin-Beaumetz) ; §ss-j of the fluidextract thrice 
daily. Tar, diminishes the secretion and allays the cough (P) ; gr. ij in pill 
every 3 or 4 hours in chronic paroxysmal winter cough (R). Eucalyptus, 
valuable in chronic cases of broncho-pulmonary catarrh (B). Colchicum, 
in gouty subjects (R). Balsam of Peru, and that of Tolu, when there is 
copious secretion of pus (R). Phenol, by inhalation of the spray, 1 part to 
100 of water; may be combined with tincture of Iodine (R) ; a 5 per cent, solu- 
tion in steam atomizer as inhalation. Hydrastis, fluidextract, locally and 
internally (B); of great value internally and externally in chronic coryza 
(P) . Senega, especially in the aged (R) . Iodine, by inhalation, is sometimes 
used (R). Benzoin, 3j of the compound tincture on boiling water, as in- 
halation; eases cough and lessens expectoration (R); is sometimes used by 
atomization (B). Camphor, to allay cough and promote expectoration (B). 
Copaiba, when purulent secretion (R) ; for profuse secretion the best of all 
expectorants, but nauseous (B). Cubeb, when profuse expectoration, has 
similar remedial influence (B) . Terpin Hydrate, gave immediate and curative 
results in cases of long-standing and obstinate bronchitis, which had re- 
sisted all other treatment; gr. xlviij, in Glycerin, q. s. ut. ft. solutio, Syr. 
Lactucarii, q. s. ad gij, of which a teasp. every three hours (Boyland). 
Terebene, is very valuable; requires an equal weight of light magnesium 
carbonate to suspend it. Oleum Santali has been used with benefit in long 
standing chronic cases. Cod-liver Oil, a teaspoonful ter die, after meals, 
of great service, if continued (B); to control expectoration (R). Poultices, 
made large, of hot linseed meal to cover the chest, when congestion of lungs. 
Olive Oil, inunction to chest, has soothing and strengthening effects. Diet, 
nutritious, and stimulants necessary when great prostration; Alcohol is 
decidedly injurious, though bronchitics are prone to indulge in it (Auld). 
[Compare Cough, Emphysema.] 

1$. Fluidextr. Eucalypti, §j. 1$. Syrupi Scillae, % gss. 

Ammonii Chloridi, 5j- Tinct. Opii Camph.,'. 5ij< 

Ext. Glycyrrhizae, 3ij- Ammoniaci, 5ss. 

Syrupi Tolutani, § iij. Syrupi Tolutani, 5 x. 

M. Sig. — A teasp. 4 to 6 times daily. M. Sig — A teasp. p. r. n. 



598 



BRONCHORRHEA — BUBO. 



Bronchorrhea. 

Ammonium Iodide, often improves the condition, especially if used with 
Arsenic (B). Ammonium Benzoate is very efficient in aged cases with 
fetid expectoration (Coston). Copaiba, the most serviceable expectorant, 
but nauseous (B); when copious secretion of pus (R). Cubeb, has remedial 
effect in chronic bronchial affections with profuse expectoration (B). Asa- 
foetida, is of great benefit (B). Turpentine, an excellent remedy when fetid 
expectoration; may be used internally or by inhalation from atomizer. 
Terpin Hydrate, seems to be even more efficient than turpentine, in doses 
of gr. x-xx daily. Phenol, internally (Tflj), and by spray (gr. v ad § j aquae), 
often of great utility (Da C). Benzoin, by inhalation for its local influence. 
Eucalyptus, the oil of great utility (B) ; TTLij ter die on sugar, or see formula 
above. Petroleum, crude, in capsules, has been administered with rapid 
amelioration as the result (Blache). Iodine, as liniment, over front and 
back of chest (R). Spinal Ice-bag, to restrain excessive secretion (R). 
Quinine, and the Phosphates, also Cod-liver Oil, as restoratives (Wa). 
[Compare Bronchitis, Chronic, also Cough.] 



1$. Copaibae, 

Bals. Tolutan., 

Pulv. Acaciae, aa §ss. 

Ac. Sulph. Aromat., 5ss. 

Aquas Destillat., 5 vj. 

M. Sig. — A tablespoonful thrice or four 
times daily. 



fy Potassii Iodidi, 5j- 

Ac. Nitrici Dil., 5iij- 

Tinct. Belladonnae, 5j- 

Ac. Salicylici, 3 j- 

Aquae Camphorae, . . .q. s. ad §iv. 
M. Sig. — Dessertsp. in water 3 or 

times daily, for fetid bronchitis. 



Bruises. 

Arnica, the infusion very' useful as an external application for bruises, 
sprains, etc. (Wa). Aconite, the liniment locally to painful sprains and 
bruises (Wa). Capsicum, a strong tincture applied with gum, said to act 
like a charm on discolored bruises (R). Ichthyol, in 30 per cent, alcoholic- 
ethereal solution, applied twice daily, gives most satisfactory results (Charles') : 
a 20 per cent, ointment remarkably anodyne in severe contusion of the ankle 
(Ackerman). Oil of Bay, as stimulating liniment (P). Opium, the tincture 
3 j with Linimentum Saponis § j diligently rubbed in two or three times a 
day, affords great relief (Wa). [Compare Sprains.] 



Bubo. 

Mercury, necessary in the indurated buboes diagnostic of syphilis (Ricord) ; 
Calomel locally applied for indolent buboes refusing to heal after opening (H). 
Sulphides, are less useful in maturating buboes than in the case of ordinary 
boils or abscesses (R); to check suppuration (St). Iodoform, locally has 
proved useful (Wa). Iodine, applied to produce vesication around a bubo, 
relieves inflammation (R); freely every day, with rest and compression, to 
cause absorption (St). Silver Nitrate, lightly to surface, to stimulate 
indolent buboes (Wa). Nitric Acid, locally for indolent and broken bubo 
(R). Phenol, a 2 per cent, solution, by injection, used in 150 cases of buboes 
and other enlarged glands, with uniform success (Taylor). Ichthyol mixed 
with mercurial ointment, to stimulate granulation after operation, and re- 



BUNIONS — BURNS AND SCALDS. 599 

move lymphatic hypertrophies (Fuller). Hydrated Chloral in 10 per cent, 
solution, as a stimulant and antiseptic application (W). Pressure, by 
compressed sponge under a spica bandage, or by a shot bag, the best local 
treatment for indolent bubo (Keyes) ; in all cases cleanliness, rest in the re- 
cumbent posture, emollient poultices. Ice over the bubo greatly relieves 
(B). Surgical. Open freely when suppuration; if the pus is virulent the 
opened bubo is a chancroid and should be treated as such (Keyes) ; enucleation 
and curettement give good results as to rapid healing of the wound. Diet, 
should be generous with cod-liver oil in phagedenic bubo. Treatment 
of syphilitic bubo is that of general syphilis, local measures are useless. 
[Compare Chancroid, Syphilis.] 

Bunion. 

Iodine, as paint, or Emplastrum Hydrargyri, for indolent form, thick but 
not tender (D). Silver Nitrate, 5 j to the 5 locally when simple thickening 
and effusion. Lead-water and Laudanum, when inflamed. Benzoin, 
the compound tincture, when ulceration, as a stimulant application. Me- 
chanical contrivances, to draw the phalanges inward, may be needed if 
simple treatment proves insufficient. Operation may be necessary in 
order to cure (see text-books on surgery). Rest, fomentations and anti- 
arthritic remedies for thickened bunion. [Compare Bursitis.] 

Burns and Scalds. 

Lime-water and Linseed Oil, equal parts, as in the Carron Oil; or with 
Olive Oil containing 10 per cent, of Oil of Eucalyptus (Caird) ; a favorite and 
efficient application (P). Picric Acid, a saturated solution, Picric Acid 5, 
dissolved in Alcohol 80, then add Distilled Water 1000, applied on strips of 
sterilized gauze, gives better results than any other treatment (Power); 
in solutions of } to 5 per cent., the most reliable application (Maddock); 
a 4 per cent, aquo-alcoholic solution is the best of all applications for imme- 
diate use, relieving the pain and preventing infection (Teass); a 1 per cent, 
solution applied on gauze and covered with paraffin paper, cotton pad and a 
bandage, produced results which no other remedy approached in the treat- 
ment of the sufferers from the explosion on the U. S. S. Bennington. Iodine, 
the tincture has been used successfully even in most extensive lesions (Reclus) ; 
the tincture painted first around, then over the burned surface, followed by 
a sterile dressing, as an antiseptic, to prevent reinfection (Descomps). 
Thymol Iodide, j, Olive Oil ij, Vaseline viij, as ointment for extensive burns 
(Walton). Iodoform, as gauze or pomade, after cutting the bullae, and 
washing with a weak salt solution, the best treatment (Congress of Derma- 
tology, 1889). Sodium Bicarbonate or the Carbonate, a strong solution 
applied on compress, quickly relieves the pain and promotes healing. Bo- 
racic Acid, a saturated watery solution, used with great success (Lister). 
Lead Carbonate, as white lead paint, an excellent application to burns of 
small extent (B). Salicylic Acid, 3j to § viij 01. Oiivae, is an efficient 
local application (B). Normal Salt Solution, applied on cotton, gives great 
satisfaction (Keen) . Acetanilid, powdered and dusted over the surface is an 
excellent application. Ichthyol, a 6 per cent, ointment will often prove the 
most comfortable dressing (Bulkley) ; a 1 per cent, salve of Ichthyol with 
Vaselin, or a 2 to 10 per cent, aqueous solution in severe cases, speedily re- 



6oo 



BURSITIS — CALCULI, RENAL AND VESICAL. 



lieves the pain and promotes cicatrization (Lorenz) ; a 50 to 80 per cent, 
solution in all cases, gives most satisfactory results (Schutze). Resorcinol, 
a 1 or 2 per cent, solution hastens formation of epithelium (Hebra). Zinc 
Stearate with Acetanilid or Boric Acid, makes an excellent dressing. Cotton- 
wool, to allay pain and exclude air (P). Warm Bath, immerse for some days 
(R); exclusion of air the main indication (H). Paraffin has recently come 
into vogue as a protective covering in the treatment of burns. The vari- 
ous preparations and methods of application are described on page 362. 



Ifr. Ichthyolis, §j. 

Zinci Oxidi, §ij. 

Cretae Preparatae, giij. 

Amyli, Olei Lini, aa §iij. 

Aquas Calcis, §iv. 

M. Sig. — Apply on lint to burns of 
degree. 



2d 



1$. Olei Eucalypti, gjss. 

Olei Olivae, gxivss. 

Aquae Calcis, Oj. 

m M. # Sig. — Apply on lint and cover with 
oiled silk. An improved Carron Oil. 



Bursitis. 

Iodine, painted on outside, after removal of fluid by the aspirator (D); 
after blistering (Wa). Blisters, in rheumatic enlargement of bursas, are al- 
most indispensable for a rapid cure (Wa) . Fomentations, with rest, to relieve 
pain and swelling; if unavailing, a crucial incision into the bursa, care being 
taken not to open the capsule of the knee (D). Excision, when chronic, 
tumor hard, resisting other measures (C). [Compare Bunion.] 



Calculi, Renal and Vesical. 

Alkalies, especially Potassium salts, if excessive acidity of the urine; 
Sodium salts shoud not be used (B). Calcium Carbonate, in doses of gr. 
xv-xx thrice daily in plenty of pure water (Crof tan) ; as much as § ss have 
been given daily for months without bad effects (Von Noorden) ; acts against 
uratic calculi by binding the phosphates of the food and blood. Lime- 
water has been used with benefit, internally and injected into the bladder (P). 
Potassium Citrate, in large doses for bloody urine containing uric acid 
crystals (R); the Citrate and Carbonate are the most desirable solvents for 
uric acid gravel (Sir H. Thompson). Alkaline Mineral Waters, those rich 
in Potassium preferred, especially Vichy (B). Ammonium Benzoate, 
will prevent phosphatic calculi (B). Piperazin, as a solvent for uric 
acid and urate concretions, is far superior to other agents. Lead Acetate, 
gr. \ to the § of distilled water, injected into the bladder to prevent formation 
of phosphatic calculi, or a solution of Dilute HC1 Acid, Tfl.ij-iij to the § 
(Sir H. Thompson). Castor Oil, of value as a purgative (P). Calumba, 
to relieve the vomiting (P). Counter-irritants, as mustard-poultices, or 
turpentine stupes, to relieve the pain of the paroxysm (R). Anesthetics, 
for the same purpose (B). Antipyrine gr. xxiv, Laudanum gtt. x, Water 
§iij, injected into the rectum f hour before beginning lithotrity, rendered the 
crushing and evacuation of the stone absolutely painless, the bladder seeming 
non-sensitive to touch or tension (Chastelet). Morphine, hypodermically, 
as an anodyne and to relieve the vomiting (B). Hot Fomentations, to 
alleviate spasm and pain while calculus is passing. Diet, restrict the use of 
sugar in any form or combination, also fats and alcoholic beverages. Fresh, 



CALLOSITY — CANCER. 6oi 

green vegetables may be used freely, also skimmed milk or buttermilk. 
Mineral waters, preferably Vichy, Friedrichshall and Carlsbad. Frequent 
abstinence from animal food. Lemon- juice and soft water in large draughts, 
are useful. Surgical Measures. Lithotomy or Lithotrity for removal of a 
stone from the bladder. Solvents are of no use except for a very small cal- 
culus, and even then a considerable time must be occupied in the process. 
No operation in surgery more certainly safe, rapid, and successful than 
lithotrity (Sir H. Thompson). [Compare Colic, Lithiasis , Oxaluria, etc.] 

Magnesium Bcro-citrate. I Potassium Tartra-borate. 

1$. Magnesii Carbonat., 5j« ty- Potassii Bitartratis, partes iv. 

Sodii Biborat., Ac. Borici, partem j. 



Acidi Citrici, aa 5ij- 

Aquae Bullientis, § viij. 

M. Sig. — Tablespoonful 3 or 4 times 
daily. (B.) 



Aquae, partes x. 

By heating the above together, the salt 
is obtained as a powder, of which gr. xx 
in a large draught of water 3 or 4 times 
daily. 



Callosity. 

The first step, whatever the subsequent treatment, is to soften the callous 
place. Sodium Bicarbonate, Potassium Carbonate or Sodium Carbonate, 
one-half ounce to the gallon of hot water in which the part is soaked will 
accomplish this (Stelwagon), after which its removal can be facilitated by 
scraping with a dull curet or cutting it away with a sharp knife. Equally good 
results can be obtained if after softening a plaster is used containing 20 per 
cent, to 30 per cent, of Salicylic Acid. Frequently this softening process 
followed by various applications will have to be continued at intervals until 
the deeper layers of the skin are reached. Iodine painted over the parts every 
other day will relieve the pain to some extent and if kept up for some time 
will remove the growth. Lactic Acid may also be used for the same per- 
pose. Picric Acid 5 per cent, in alcohol painted twice daily over the lesion 
will gradually soften it. Salicylic Acid, a drachm to the ounce of petrolatum 
and the part tightly bandaged will soften the growth and produce a complete 
exfoliation of the skin. The same drug may be used in the form of Unna's 
Salicylic Acid Plaster 18 to 33 J per cent, strength. The #-ray is indicated. 

Cancer (See Epithelioma). 

Opium, stands first on the list of palliatives, allaying pain and quieting 
irritation (Wa); as powder applied to cancerous sores; also Morphine, dis- 
solved in glycerin, and spread on lint, very useful where there is much pain; 
Opium is also used in cancer of the stomach (R) ; Codeine, gr. T V to ^\, sl 
good hypnotic (P). Arsenic, internally in cancer of the stomach, diminishes 
pain and checks vomiting. Sodium Cacodylate, the salt of an organic arsen- 
ical compound, is a valuable palliative in carcinoma, arrests progress and 
improves the general condition of the patient (Payne). Belladonna, the 
extract locally and internally, of great benefit as a palliative for the severe 
pain (P). Phenol, undiluted, to the sore, and injected beneath it, limits 
and retards (B); pure, as anesthetic, with glycerin as application to fetid 
cancers (R). Citric Acid, 5j to § viij aquae, useful in allaying pain of 
cancerous ulcerations (Wa). Chloral, in 10-grain doses, 3 times a day, has 
relieved the pain of cancer (R). Bismuth, relieves pain and vomiting of 
gastric cancer (B). Iodoform, applied to diseased surface, relieves pain and 



6o2 CANCRUM ORIS. 

removes fetid odor (P). Resorcinol, 15 parts to 20 of Vaselin as an oint- 
ment twice daily after washing with a solution of Pot. Permanganate, has 
successfully stopped epithelioma (Antonio). Potassium Chlorate, in im- 
palpable powder, dusted on epithelioma, said to be curative (B). Chromic 
Tnoxide, a powerful escharotic (B). Caustics have never cured true mam- 
mary cancer, but many breasts are thereby destroyed for innocent swellings 
which could have been removed by a single incision (McGraw). Iron and 
Manganese, the Syrup of the Iodide, for resulting cachectic state (B). 
Acetone, locally, alter scraping out the ulcerating area, gives a period of 
comparative ease and comfort in inoperable carcinomata uteri (Maier); 
applied every third day after curetting, gives excellent results (Gellhorn); 
gives ease and comfort to inoperable cases (Tovey). Aspirin will control 
the pain of inoperable uterine carcinoma (Maier). Cauterization by the 
Paquelin knife is the most effective procedure in cases of inoperable uter- 
ine carcinoma (Id) ; should be done every 4 weeks to give the best results 
(Lomer). Toxins of erysipelas and b. prodigiosus have been extensively 
used by Dr. Coley (see Serums). Roentgen Rays are preferable to all 
other methods of treatment in superficial carcinoma involving a consid- 
erable area (Hyde); cured 36 cases of epithelioma (Pusey); a combina- 
tion of these rays and the Finsen rays promises well in deep-seated 
cancer, the former being penetrating and germicidal, the latter curative 
(Hopkins) ; their favorable effect on epitheliomata is indisputable (Schiff) ; 
they give the best results in round-cell sarcoma, 25-30 per cent, recover- 
ing (Pfahler); are palliative in all cases (Leonard). Radium Rays are 
reported as curative in a case of recurrent carcinoma of the lip and palate, 
in the clinic of Prof. Gussenbauer; also in a case of melanosarcoma and in 
other cases; are especially valuable in early epithelioma (Williams) ; are capa- 
ble of curing epithelioma of the skin (Macleod) ; are a most valuable agent in 
the treatment of inoperable carcinoma of the cervix and uterus (Shober). 
The value of radium is discussed at length in the preceding section of this 
book. Water Enemata, to relieve pain and straining in intestinal cancer 
(R). Operation. "It cannot be too strongly insisted that in the be- 
ginning cancer is a local disease curable by early and radical operation, 
that early diagnosis should be made, and that prompt operation is im- 
perative. Delay is not only disastrous, it is usually fatal. Certainly at 
least 50 per cent, of the cases of cancer I see are beyond operation when they 
are first brought to the hospital, they having sacrificed the golden moments 
during which cure was possible. Carcinomata demand early and wide exci- 
sion, with removal of implicated glands. If operation is early and thorough, 
and if certain regions are involved, a considerable proportion of cases can be 
cured. Carcinomata of the lip, the skin, and the mammary gland can often 
be cured. The operation must be radical. Recurrence almost certainly 
means that cancer cells have been left behind. Unless a wide area is re- 
moved cancer cells are sure to be left. After operation the #-rays should be 
used in hope of destroying cancer cells which have remained in the tissues. 
To use the rays lessens the danger of recurrence." (Da Costa). [Compare 
Uterine Cancer.] 

Cancrum Oris. 

Arsenic, in medicinal doses is an efficient remedy (R) . Salvarsan, 
has been employed with benefit (Nicoll). Boric Acid or Borax, in solution 



CARBUNCLE. 603 

as a mouth- wash. Nitric Acid is the best caustic for the worst forms 
of the disease (Wa). Potassium Chlorate, gr. xx-xl in 24 hours, has been 
strongly recommended (D). Operation. Administer chloroform and de- 
stroy the gangrenous area with a Paquelin cautery (Da Costa). After 
cauterization wash part every few hours with hydrogen peroxide and warm 
salt or boric acid solution and dress with compresses wet with Labarraque's 
solution (Blumer and MacFarlane). [Compare Aphthae, Stomatitis.] 

Carbuncle (See Furunculosis). 

Potassium Bitartrate in powder as a dressing, is a valuable antiseptic 
and absorbent, and is efficiently used (Lupo). Mercury, Corrosive Sub- 
limate, injected into tumor at several points, in doses of 2 drachms of a T V 
per cent, solution dividedly, has produced good results (Casson). Bella- 
donna, with Glycerin, as local application to relieve pain (P). Phenol, 
on lint, with Glycerin or Oil, into discharging sinues (R); or hypodermically 
into and around the sloughing tissues. Such a method does not promise 
success and necessitates dangerous delay (Da Costa). Ichthyol 5J SS > with 
Camphorated Cerate 5 j, applied thickly twice daily, rapidly lessens the pain 
and inflammation, favors elimination of the core, and hastens cicatrization 
(Felix). Silver Nitrate, the tip of a pencil of lunar caustic introduced into 
all the white spots of suppuration (Id) . Iodine, to produce vesication around 
carbuncle; reduces inflammation (R); part j of the tincture to iij aquae 
locally, has most striking effect (Wa); may be used with benefit internally 
or hypodermically (Cezard). Calcium Sulphide, gr. T V hourly or every 
two hours, of great service (R). Strapping, with plaster, concentrically from 
the border inward, leaving the centre free, will sometimes arrest extension (R). 
Collodion, as protective covering (P) ; as zone around base, leaving the centre 
exposed (Wa); Collodium Cantharidatum in a broad zone painted around 
the carbuncle, to relieve the tension (Ag). Ice, or Ice-bags or iced water on 
cloths in early stage, changing to warm fomentations as soon as suppuration 
has begun (Hebra). Dry Cups over the inflamed area, 6 times for 5 minutes 
each, with interval of 3 minutes between applications, gives most pleasing 
results (Moorhead) . Radium applied for \ to 1 hour twice daily for 5 days 
in a septic case from massive carbuncles, and in others, gave pronounced 
success (Shober). Extirpation by complete or partial excision and scraping, 
gives immediate relief to pain and removes the chance of septic poisoning 
(Parker); excision of the entire mass down to the deep fascia and laterally 
into healthy skin (Keen). Curettement of every necrotic pocket, after a 
free crucial incision, followed by trimming away the overlying skin, and 
applying a firm dressing. When the condition is too far advanced to admit 
of complete extirpation, give ether, make free crucial incisions, remove dead 
and necrosing tissue and also the points of the skin-flaps with the scissors 
and forceps, curet pockets, arrest hemorrhage by pressure and hot water, 
cauterize with pure carbolic acid, dust with iodoform, pack with iodoform 
gauze, and dress with hot antiseptic fomentations; cover the gauze with a 
piece of some impermeable material and lay a hot-water bag upon the 
dressing; every day, or several times a day, remove the dressings, wash with 
peroxid of hydrogen, irrigate with corrosive sublimate solution, dust with 
iodoform, and reapply the iodoform gauze and antiseptic fomentation; 
keep up this treatment until sloughs are separated, then dress with dry 



604 



CARIES CATARACT. 



antiseptic gauze (Da Costa). Diet should be very supporting, and stimu- 
lants may be used freely when the patient is debilitated; saline purges oc- 
casionally (Hill). Staphylococcic Vaccines have been largely used, with 
strikingly good results (Adamson). [Compare Anthrax, Boils.] 



fy Calcis Sulphurat., gr. iij. 

Sacckari Lactis, q. s. 

Triturat. et div. in chart, xxx. 

Sig. — One powder every 2 hours, to be 
taken dry on the tongue. 



1$. Tinct. Ferri Chloridi, § j. 

Potass. Chlorat., 5iij- 

Liq. Ammonii Acetat., 5 iij. 

Syrupi et Aquae, .... q. s. ad § viij. 

M. Sig. — Dessertsp. every 2 hours. 



Caries. 

Arsenic and Iodide of Iron in tuberculous cases. Phosphates, the best 
is Syrup of Calcium Lacto-phosphate (R). Iodine, locally, with iron or Cod- 
liver Oil internally (Wa). [See Bone.] Potassium Iodide, in syphilitic 
caries, holds the first place (Wa). Cod-liver Oil, to promote constructive 
metamorphosis (R) ; is most valuable in caries due to tuberculosis. "Locally, 
in all cases, insist on rest and at once secure drainage, enlarging the opening, 
if necessary, and inserting a tube, and even making additional openings; 
syringe often with antiseptic fluids and dress antiseptically. If the case is 
seen before spontaneous evacuation has occurred, open under strict anti- 
septic precautions. When a chronic sinus exists there arises the question of 
operation. Incomplete operations are worse than useless, for they may be 
followed by diffuse tuberculosis or pyemia. If the gouge is used, try to re- 
move all carious bone. The diseased bone is white, crumbles, and does not 
bleed; the non-carious bone is pink and vascular. Scrape away all granula- 
tions, swab the cavity with pure carbolic acid, and pack it with iodoform 
gauze. Instead of gouging away bone, there may be used the actual cautery, 
sulphuric acid, or hydrochloric acid. In servere cases excision is required 
and in some rare cases amputation may be necessary" (Da Costa) . Mechan- 
ical Contrivances, are necessary in most cases; Sayre's plaster jacket, Agnew's 
jacket of leather and steel, Taylor's apparatus, etc., are used in spinal 
caries to separate the diseased bones, and extend the spinal column. 
[Compare Necrosis.] 



Catalepsy. 

Turpentine, in enemas, and embrocations along the spine, affords the best 
chance of stopping the paroxysms (Wa). Apomorphine, gr. -£$ to y 1 ^, in the 
paroxysm; with the onset of nausea, consciousness returns and spasm ceases; 
in the intervals between the attacks the treatment should be that of hysteria 
(Gowers). Treatment must be essentially tonic and restorative (H); no 
constant line can be stated (A) ; external stimulation to arouse consciousness, 
by Ammonia, cold douches, Faradism, etc. [Compare Hysteria.] 



Cataract. 



Medicinal treatment, local or constitutional, is ineffectual against cararact. 
The refraction should be carefully tested and glasses ordered which give the 
most accurate vision. Atropine (gr. ss to 5 j) ma y De instilled in the eye to 
cause mydriasis and enable the patient to see through the transparent por- 



CATARRH, ACUTE NASAL. 605 

tion of the lens in cases where the opacity is central. Tinted Lenses which 
correct any existing refractive error should be worn. The general health 
should receive attention. Artificial Ripening is sometimes resorted to by mas- 
saging the lens directly or through the cornea. Boric Acid, as a lotion to 
allay any conjunctival irritation. Extraction is the operation performed in 
cases of hard cataract and Needling or Discission in soft cataract. 

Catarrh, Acute Nasal. 

Menthol, i or 2 parts dissolved in 20 of chloroform, of which a few drops 
in the hollow of the hand, the hands then rubbed together and placed before 
the face, the remedy being inhaled alternately through the nose and the 
mouth, will arrest the progress of a cold in its initial stages (Wunsche). 
Chloroform, by inhalation in small quantities, is an excellent nasal antiseptic, 
and is of great value in acute nasal catarrh. Sodium Salicylate, to abort a 
cold, gr. x bis die. Potassium Chlorate, in doses of eight or ten lozenges a day, 
will abort many a cold (R); a very good remedy in ordinary catarrh (P). 
Quinine, gr. x, with Morphine, gr. £, at incipiency, will often abort an 
acute coryza (B). Opium, at night, if taken early in the case, will often abort 
an attack of coryza; a glass of hot grog assists its action (R) ; Dover's powder 
in a full dose at the onset may abort (B). Codeine, is useful in common 
colds, as palliative (B). Camphor, as inhalation, the spirit in form of vapor 
(R); with Opium and Ammonium Carbonate as powder (see formula below), 
to break up or modify a cold (Beard). Tartar Emetic, gr. -fa to T V in the 
first stage (B) ; in acute catarrh of children often accompanied by vomiting and 
diarrhea (R). Pilocarpus, the fluidextract in doses of TTlx to xxx, every hah 
hour until profuse diaphoresis sets in, is one of the best modes of aborting a 
cold; or Pilocarpine Hydrochloride, gr. ^ in water at bed- time, will give 
prompt relief and cure in a few days (Wyss). Iodine, by inhalation in daily 
attacks with itching nose (R); 5ij -of the tincture with 5j oi Phenol inhaled 
from a sponge in the bottom of a wide-mouthed bottle placed in hot water (B) ; 
the tincture, by spray to the nares, will promptly abort a cold (Woodbury) . 
Urotropin in doses of gr. xv four times daily, is very effective for common 
colds, acting promptly and efficiently if begun early (Miller). Ipecacuanha, 
for acute nasal and bronchial catarrh, and ordinary colds in children (B). 
Cimicifuga, when headache, stiff muscles, dull aches, bone-pains, etc. (R) ; 
an excellent expectorant (B); rheumatic colds; neuralgic pains in jaw (P). 
Ichthyol, a 1 to 10 per cent, ointment with Vaselin (Lorenz); is especially 
applicable to catarrh of mucous membranes (Hoffman) ; by inhalation from 
hot water for ten minutes often aborts a beginning coryza (Unna). Zinc 
Stearate with Menthol, a very good insufflation in rhinitis. 

Aconite, in severe coryza with much chilliness, aching limbs, hot and dry 
skin, and quick pulse; also in catarrhs of children and that accompanying 
measles (R); in acute coryza (P); with Belladonna in ordinary colds with 
sore throat and high fever (B) ; in doses of Tfl.^ every J hour very useful for a 
commencing cold in the head (Smith). Belladonna, in acute nasal catarrh 
with profuse watery secretion, TTlv of tincture, then Tflj each hour (B). Nux 
Vomica has great effect upon a dry cold in the head (P). Cocaine, a 4 to 5 
per cent, solution locally as spray, to empty the engorged venous sinuses of 
the nasal mucous membrane by their contraction, which it induces; the 
fluidextract of Coca diluted with water is equally efficient if enough be used 



OOO CATARRH, CHRONIC NASAL. 

(Cohen). Chloral, 20 grains in §j of Castor Oil, applied with a soft mop, 
when the Schneiderian membrane is very irritable, checks the secretion of 
mucus and lulls the irritation and the head pains (Brodnax). Ammonium 
Chloride or Cubeb, in the dry, congestive stage of a cold in the head; Cubeb 
cigarettes may be smoked as a temporary palliative with great relief. Oil 
Inunctions, daily to the whole body, in cases of undue susceptibility to 
taking cold, will prevent the frequency of the attack (B). Baths, a warm 
foot-bath before going to bed; Turkish bath, at onset in coryza, may prove 
abortive, also useful later on; cold sponge-bath in cases of extreme sus- 
ceptibility, supplemented by occasional Turkish baths (R). [Compare 
Coughs, Hay-Fever, Influenza.] 

1$. Quininae Sulphatis, gr. xviij. j 3$. Mentholis, gr. iv. 



Liq. Arsenicalis (B. P.),. . . . npij. 

Liq. Atropine (B. P.), njjj. 

Ext. Gentianae, gr. xx. 



Cocainae, gr. iv 

Ol.Rosae Geran., gtt. 

Albolene, gj. 



Pulv. Acaciae, q. s. M. Sig.— Use in atomizer every 3 hours 



Ft. pil. no. xij. Sig. — One every 3, 4, or 
6 hours, for acute colds. (Whalen.) 



1$. Morph. Hydrochlor., gr. ij. 

Bismuthi Subnit., 5vj. 

Pulv. Acaciae, 5ij- 

M. Sig. — Use as snuff, \ to | the above 
in 24 hours. (Ferrier's Snuff.) 



for local nasal congestion. 



B). Camphorae, gr. 1. 

^Etheris, q. s. 

Dissolve to creamy consistence, then 
add— 

Ammonii Carbonat., gr. xl. 

Pulv. Opii, gr. x. 

Divide into thirty papers. 
One or two powders, according to age, 
twice or thrice daily. (Beard.) 



Catarrh, Chronic Nasal. 

Hydrastis, is of value in chronic coryza, also in ulceration of the septum 
or any other part of the nasal fossae, gtt. v of the tincture thrice daily inter- 
nally, and 5 j to § viij of water locally by syringe (P). Cocaine, is much used, 
but is only of temporary benefit; danger of inducing the cocaine habit. 
Resorcinol, the best of all applications; after cleansing the nose with D obeli's 
solution, use a 2 to 10 per cent, ointment in vaselin, also a spray every other 
day, of a 2 to 4 per cent, solution: it gives the same results as cocaine, but is 
slower in action and more lasting, and does not suppress the normal function 
of the mucous membrane, as the latter does. Zinc Stearate, makes an ex- 
cellent insufflating powder, 15 parts with 5 of Europhen in atrophic rhinitis 
(Gibb). Argyrol in 10 to 20 per cent, solution, is a valuable application 
(Holmes). Ichthyol, a 10 to 20 per cent, aqueous solution on pledget of 
cotton for 15 to 30 minutes, followed by a salve of the same, gives good re- 
sults in atrophic rhinitis (Douglass). Eucalyptus, has been employed with 
benefit (Wa). Bismuth, in powder with acacia, as in Ferrier's snuff (see 
formula above), or with tannin, calomel, etc., used by insufflation daily (Rob- 
inson) . Iodoform and Tannin, 1 of the former to 2 or 3 of the latter, carefully 
triturated and applied by an insufflator every other day only, is the very best 
of all applications (B) . Sodium Chloride or Phosphate, a teasp. to the pint 
of warm water as cleansing solution, or the Bicarbonate, in the same propor- 
tion. Potassium Permanganate, gr. j-x to the pint of warm water, as a 
deodorant solution when necessary. Phenol, in a 1 per cent, solution 
as spray, or inhalations of the vapor with that of Iodine from a bottle in hot 
water, vaporized by the warmth of the hand (B). Salicylic Acid, in weak 



CEREBRAL ANEMIA — CEREBRAL CONCUSSION. 



607 



solution, i to 500 of water, as a disinfectant and astringent injection, used 
with a retropharyngeal syringe, and followed by applications of powdered 
Calomel through a speculum upon the ulcerated parts of the mucous mem- 
brane (Massei). Cubeb, finely powdered and blown into the nares by an in- 
sufflator (B); may be smoked, and administered internally in teasp. doses 
(Wa) ; in freshly ground powder as a confection, in follicular disease of the 
nasopharyngeal space (Robinson). Ammoniacum, in the same condition, 
small doses, gr. j-iij, with Ipecac or Ammonium Carbonate, will lessen the 
amount of secretion (Robinson). Iodides, of Iron and Sodium, in catarrh 
of specific origin(B). Silver Nitrate, in powder, as alterative application, 
gr. x-xv to the § of menstruum, is often a useful adjunct to treatment, used 
once every 4 or 5 days (Robinson). Cod-liver Oil should be used in stru- 
mous subjects (R). Alum, in powder, dusted over the affected surface, is a 
useful application (B). Douche is dangerous, being likely to cause extension 
of the catarrh to the Eustachian tube and the middle ear; it has been very 
generally abandoned. Sprays by hand-ball atomizers, or compressed air 
apparatus, of warm solutions, Vaselin, etc., are used with considerable 
success (Cohen); the Hank's atomizing tubes, with a 2-ball rubber syringe, 
are very serviceable for office use, and for the application of Rumbold's 
hot Vaselin spray. [See formula below, also Dobell's Solution, page 534.] 
Vaccine. In chronic rhinitis an autogenous vaccine may be of distinct 
value, but only when an underlying factor, such as a malformation or ade- 
noids, has been removed, and only when used in conjunction with efficient 
local treatment (K). [Compare Ozena.] 



1$. Phenolis, njjx* 

Glycerini, 5 vj. 

Petrolati, § ij. 

M. Sig. — Warm and use as a spray every 
4 hours. (Rumbold.) 



1$. Ichthyolis, tojxI. 

Mentholis, gr. v. 

Petrolati, 5j. 

M. _ Sig. — Salve for the nose in atrophic 
rhinitis. (Douglass.) 



1$. Pulv. Argenti Nitrat., gr. vij. 

Pulv. Acaciae, 3 j- 

Bismuthi Subnitrat., 5iij- 

Triturat. Sig. — Apply with insufflator 
once in 4 or 5 days. (Robinson.) 



3$. Ext. Pini Canaden., ngxx. 

Glycerini, . Trgxxx. 

Aquae, q. s. ad Oj. 

M. Sig. — Use with post-nasal syringe. 



Cerebral Anemia. 

Arsenic is highly efficient in some hypochondriacal cases (B). Iron, 
the tincture of the Chloride, or mild chalybeate waters, in chronic cases from 
general anemia (B). Amyl Nitrite, in vaso-motor spasm; affords relief in 
sudden attacks (B). Chloral, in small doses with stimulants and warm baths 
(Ros) . Camphor, or other cerebral excitants, as Asafcetida, Valerian, Serpen- 
taria (B) ; the Monobromide in one- to five-grain doses (Hammond). Nitro- 
glycerin, Tflj of a 1 per cent, solution (P). Strychnine, stimulates the circu- 
lation generally; with Iron preparations as a tonic. [Compare Insomnia.] 



Cerebral Concussion. 

Warmth, to extremities, rest, expectant treatment, will suffice in mild 
cases (Ag). The indications are: to recover from insensibility and col- 
lapse; to prevent inflammation; to restore impaired faculties (D). In treat- 



608 CEREBRAL CONGESTION — CHANCROID. 

ing brain concussion bring about reaction by the administration of Aromatic 
Spirits of Ammonia (no alcohol, as this agent excites the brain) by pouring 
a fe^Y drops of Ammonia on a handkerchief and holding it near the nose, by 
surrounding the patient (who lies in bed with his head on a pillow) with hot 
bottles, by Hot Irrigation of the head, by the application of Mustard over the 
heart, and by the administration of Enemata of hot coffee or hot saline 
fluid (Da Costa). Rest, for some days or for some weeks, according to 
the case, insist on a very quiet life; for many weeks after a grave concussion 
a patient must be kept away from business and be watched, because of the 
possibility of an abscess of the brain arising, and because of the liability of 
such patients to develop hysteria, neurasthenia, or insanity (Id). Hypnotics, 
such as Chloral, Bromides, Trional, Veronal, etc., may be necessary for 
the sleeplessness following concussion. Diet, light, nutritious diet. 

Cerebral Congestion. 

Aconite, in the active form, renders important service (B); is much the 
best remedy in this condition (P). Belladonna, one of the best remedies in 
all hyperemic conditions of the brain or spinal cord (P). Gelsemium, 
Tfl.v of the fluidextract every two hours, very useful (B). Bromides, are very 
useful (B); must be used in full doses. Cathartics, lessen blood pressure 
(B), and act as derivatives. Free saline purgation is best. Chloral, when 
temperature high (B). Arsenic, sluggish, venous circulation, torpor (B). 
Venesection, will prevent injury to brain, not to be adopted as a matter 
of course; is contraindicated when anemia, aortic valvular disease, or in 
cases commencing with syncope (A). Water, cold douche to head, feet in 
warm water; ice and hot water alternately to head and nape of neck, often 
more effective than ice alone (B); hot water to head on flannels, mustard 
and hot water packing for 20 to 30 minutes around legs, when active con- 
gestion; protect bowels well (R). Diet, should be low, but not too low, until 
all fear of relapse is past; full animal diet should be avoided, also undiluted 
wines (A). [Compare Apoplexy, Coma.] 

Chancre. 

Constitutional Treatment with Salvarsan or Mercury should be started 
at once. [See articles on Salvarsan, Mercury, Syphilis.] Calomel, is used 
with equal parts of Bismuth as a dusting powder, or in the form of an oint- 
ment. Iodoform, heads the list of dry dressings; with Lycopodium, equal 
parts, or 1 to 2 of Zinc Oxide; 2 to 1 of Calomel (St). Hydrogen Dioxide, 
said to destroy the specific character; wash lesions thrice daily, and apply lint 
soaked in it (R). Caustics, should never be used unless chancre is attacked 
by phagedena (St). Dressings, are effective so far as the local trouble is 
concerned in the majority of cases, sometimes a piece of lint on the erosion will 
suffice (St). Cleanliness if absolute is the best treatment, the use of corro- 
sives only delays the healing process (Clark); of great importance; tepid 
salt solution locally frequently suffices for the local treatment of infecting 
chancre. [Compare Chancroid, Syphilis.] 

Chancroid. 

Hydrogen Peroxide, ordinary cases of chancroid are treated by spray- 
ing with peroxid of hydrogen, drying with cotton, touching each sore first 



CHAPPING OF HANDS AND FEET — CHILBLAINS. 609 

with pure carbolic acid and then with pure nitric acid, and dressing with 
black wash or dusting with iodoform or with calomel (Da Costa). Every 
few hours the patient soaks the penis in hot salt water (a teaspoonful of salt 
to a pint of water), sprays the sores with peroxid of hydrogen, dries with 
cotton, and dresses with black wash or dusts with iodoform or with calomel 
(Id). Mercury, the Acid Nitrate one of the best caustics; apply with a glass 
rod (B). Nitric Acid, fuming, as caustic (R) ; §j to 5viij aquae is an excellent 
dressing (St). Phenol, the pure acid as cautery to thoroughly destroy the 
germs, followed by Iodoform or other antiseptic drying powder (Ruggles). 
Ferri et Potassii Tartras is the specific enemy of phagedena (Ricord); 5 j to 
5vj aquae, internally, teasp. doses thrice daily; also locally (St). Ferrous 
Iodide, in sloughing phagedena, or simple chancroid in debilitated constitu- 
tions (B). Iodoform, powdered and dusted over the sore, allays pain, changes 
morbid action, and is antiseptic (R) ; i part to 2 of Lycopodium, or one of 
Tannic Acid; as stimulant and alterative (St) ; does no good except to relieve 
pain (Gross). Chloral, gr. iij ad 5j aquae, the best local application to relieve 
pain (Gross). Caustics, in severe cases, the white-hot iron strong Sulphuric 
Acid, pure Nitric Acid, pure Phenol, are effective in the order named (St). 
[Compare Bubo, Chancre.] 

Chapping of Hands and Feet. 

Soaking the feet or hands in hot water to which alkalies such as Sodium 
Bicarbonate, Sodium Bibenzoate, \ ounce to one gallon of water may be used 
to advantage before any applications are made. Almond Meal is well 
adapted to be used in place of soap. Compound Tincture of Benzoin, 20 to 
60 grains to the ounce, may be incorporated with advantage. Collodion 
applied directly to the part is of value owing to the protection it affords. 
Olive Oil may be rubbed in thoroughly twice daily. Picric Acid in 1 to 2 per 
cent, ointment is effective. Unguentum Aquae Rosae is sometimes efficient 
without any medication, though Boric Acid or Zinc Oxide, 20 to 60 grains to 
the ounce, may be incorporated with advantage. Soft Soaps or Tincture of 
Saponis Viridis should be used in preference to hard or medicated soaps. 

Chest-pains. 

Mustard Plaster is one of the most valuable local measures. Belladonna, 
as ointment, when tenderness is in the skin (R). Iodine, as oint. when pain 
is in muscles (myalgia) of chest, they being tender on pressure, while the skin 
may be pinched without pain (R). The tincture, painted on the painful area 
once or twice daily, is very efficacious. Strychnine, affords relief in functional 
irritability of the nervous system, manifested by wandering neuralgic pains 
(B). Cimicifuga, for intercostal rheumatism and pains under the breasts 
in women. Immobilization by strapping half of the chest with adhesive 
plaster is very efficacious in chest pains due to pleurisy. [Compare Myalgia, 
Neuralgia, Pleuritis, Pleurodynia, Pneumonia.] 



i/miuiams. 

Prevention of further exposure of the part is of the utmost importance, 
being necessary to always protect it on very cold days. In case of exten- 
39 



>IO 



CHLOASMA CHLOROSIS. 



sive chilblains, stimulants such as Digitalis and Strychnine are of value and 
care must be given to the general health. Arnica is a useful application. 
Tincture of Benzoin in glycerin, one part to four, is a very soothing application. 
Ichthyol in 10 per cent, solution or in vaselin is very efficacious and of still 
greater value in the form of a varnish. Iodin may be painted over the parts 
every other day. Picric Acid, i to 2 per cent, in alcohol or petrolatum, is also 
of value. 

fy Ichthyol, 5ij. 

Pulv. Camphorae, gr. x. 

Pulv. Tragacanth, gr. xx. 

Aquae Calcis, o ]*• 

Aquae, q. s. §ij. 

M. Sig. — Apply every 4 hours. (Davis.) 



Chloasma. Liver Spots. 

Chloasma is very frequently a manifestation of some internal disorder and 
is quite commonly associated with some uterine trouble or with Addison's 
or Graves' Disease, etc., and for this reason, care must be taken to make a 
thorough investigation and if possible to remedy the underlying factor; this 
is particularly true if due to any pelvic trouble. In the cases which are ap- 
parently idiopathic, the treatment is directed toward external channels 
though general tonics and building up of the health are sometimes of benefit. 
This is an extremely difficult condition not only to cure, but to prevent its 
further extension. In the treatment, it is often necessary to remove the 
superficial layers of the skin and destroy the pigment in the malpighian layer. 
Occasionally it is necessary to go even still deeper, but scar tissue is as ob- 
jectionable as the disease. All applications should at first be very mild, the 
strength gradually being increased. Tincture of Capsicum to produce super- 
ficial blistering is indicated, as is Tincture Cantharides. Both of these, how- 
ever, should be used with caution as they have been known to increase the 
pigmentation by the inflammatory process started. Mercuric Chloride has 
been used with considerable success. Sulphur is of value in the treatment of 
of this disease, particularly if carried over a long period of time. Salicylic 
Acid Paste not more than 10 per cent., may have the same beneficial effect. 
Trichloracetic Acid applied in small areas and after one to two minutes neu- 
tralized with cold water may be tried with little danger of scarring. Ex- 
posures to the rays of the various strong artificial lights have at times been 
valuable. 



fy Hydrarg. Ammoniat., 

Bismuth. Magister., aa 5ij- 

Amyli, 

Glycerin., aa 5ss. 

M. Sig. — Apply locally. 

(White.) 



1$. Hydrarg. Ammon., 

Sodii biboratis, aa oss. 

01. Rosmarin., . . . . : gtt. x. 

Unguent. Simpl., § j. 

M. Sig. — Apply locally. 

(Kaposi.) 



Chlorosis. 

Iron, combined with Arsenic or Strychnine, also occasional purgation and 
active exercise (R); the Iodide, when much torpor of the system, is often 
speedily efficacious (Wa) ; Iron is a specific in chlorosis, and acts best in the 
purest types. Hemogallol benefits cases which cannot tolerate inorganic iron 



CHOKING — CHOLERA ASIATICA. 6ll> 

(Porter). Manganese, the saccharated carbonate of iron and manganese 
(B); Arsenic, if Iron fails or disagrees (B). Ergot, in chlorotic amenorrhea 
(P). Nux Vomica, stimulates the blood-making organs, and may be com- 
bined with Iron; a very generally useful preparation is the syrup or elixir of 
Iron, Quinine, and Strychnine (B). Mecury, Calomel gr. -5V-3V ter die for a 
month, secures good blood, and is eminently valuable (Bridge). Hypo- 
phosphites, of Calcium or Sodium (R). Benzoin, has been used with ad- 
vantage (P). Sulphur, of great benefit in cases where Iron is of no effect; also 
to prepare the system for benefit from Iron (Schulz). Bone Marrow, has 
been used with benefit. Thymus Extract, has apparently been of service. 
Nuclein, is employed with success in some cases. Quinine Salicylate, as a 
gastro-intestinal antiseptic and disinfectant, preventing auto-toxemia upon 
which the disease so largely depends (Moore). Kumyss, is a valuable 
nutrient (Brush). Purgation, is very important, to prevent auto-infection 
from putrid intestinal decomposition, which is the true cause of this disease 
(Duclos) ; absorption of such products tending to impoverish the blood, and 
produce a " fecal anemia" (Sir A. Clark). Oils and Fats, as inunctions, after 
baths, of great benefit (B) . [Compare Anemia, Amenorrhea.] 

1$. Ferri Arsenatis, gr. ij. 11$. Ferri Sulph. Exsiccat, .... gr. xl. 

Extracti Cinchonae gr. xij. Quininae Sulphatis, gr. xx. 

Fiant pil. xij. Sig. — One pill after each Strychninae Sulphat., gr. ss. 

meal. (B.) | Ft. pil. xx. Sig. — One thrice daily. 

Choking. 

Potassium Bromide, benefits a curious affection, sometimes found in 
children who from their birth can swallow solids with ease, but choke at 
drinks (B). Oil of Cajuput, in one case of persistent choking sensation in the 
throat a few doses removed the symptom which had lasted several weeks 
(Hale). 

Cholera Asiatica. 

Prophylaxis. — Of all the quarantinable diseases cholera is the one in which 
personal prophylaxis is apparently of greatest influence in protection from 
infection (Stitt). In the prevalence of an epidemic water should be boiled, 
all food which cannot be heated barred, scrupulous cleanliness of hands, and 
all carriers isolated. Vaccination prophylaxis against cholera has been less 
used than has been the case with plague or typhoid fever. The anti-cholera 
sera have no practical value prophylactically and the same statement applies 
to the use of such sera in treatment of cholera (Stitt). Camphor, is to some 
extent an efficient remedy, checking intestinal secretion and allaying pain 
and spasm ( W) ; a drop or two of the saturated tincture, or gtt. v-x of the 
spirit with a little Opium every half -hour (B) ; gtt. iv-vj of strong spirit every 
ten minutes until symptoms abate, then hourly (R); the combination of 
camphor, opium, etc., known as Squibb 1 s Cholera Mixture (see page 613 for 
formula) is an efficient remedy at the inception. Opium with astringents, to 
control the diarrhea as early as possible (Tirard) ; Morphine hypodermically 
in the preliminary diarrhea (P) ; is of the greatest value even in collapse (R) ; 
dangerous when renal complications exist (P) ; is the principal ingredient in 
Chlorodyne, a remedy commonly used in India. In view of the fact that Koch 
had to employ opium for checking peristalsis and thus assisting in the in- 



6l2 CHOLERA ASIATIC A. 

fection of animals it would seem very undesirable to use this drug by mouth 
(StitO. Atropine as a sedative to the gastro-enteric branches of the vagus, 
which are greatly excited by the toxins of the disease (Harkin); used often 
with satisfaction (Waugh). Sulphuric Acid, has been used with advantage 
(W) ; with Opium, is very effective (B) ; two parts of the aromatic acid with 
one of Laudanum, of which Tfl,v-xx according to age, is one of the best pro- 
phylactics (McClellan) ; as lemonade, proved an efficient prophylactic in the 
insane department of the Philadelphia almshouse (Cur tin) ; is a most rational 
remedy, being injurious to the spirilla and also astringent. Calomel in 
small, repeated doses with Opium, has given satisfaction; as an intestinal 
antiseptic from the first onset of the disease (Tirard) ; some authorities recom- 
mend a laxative at the start to clear out the bowels, followed by small doses 
of Calomel and Opium every 2 hours. Calomel in large doses was used suc- 
cessfully by army surgeons, at southern military posts during the epidemic of 
1873. Salol, has done excellent service as an intestinal antiseptic, and pre- 
vents anuria (Hueppe); is peculiarly antagonistic to the comma bacillus 
(Lowenthal). Guaiacol, the Carbonate as an intestinal antiseptic has been 
used with benefit. Stryclinine as a prophylactic during the preliminary 
diarrhea, and as a stimulant when nearing collapse (B). Alcohol, small doses 
of iced brandy for vomiting (B). Cocaine with Creosote, as in the creosote 
compositus tablets of the manufacturers, 4 to 6 tablets absolutely controls 
the vomiting in the majority of cases (Braddock). Nitroglycerin and Digi- 
talis in dosage for effect, until the pulse can be felt at the wrist (Id). 
Permanganates, the Calcium salt J to 1 grain to the pint of water, rapidly 
increased to 4 or 6 grains to the pint, drank ad libitum, or the Potassium 
salt in pill gr. ij every | hour for 2 hours, then every \ hour until the stools 
become green and less copious, gave excellent results in the Campbell 
Hospital, Calcutta (Rogers). Spinal Ice-bag, for cramps (R). Saline 
Injections, into the veins have been successful in the collapse (B) ; Sodium 
Chloride, Sodium Carbonate, aa 3 j> Boiled Water quart j, makes a suitable 
injection, of which one to three quarts at ioo° F. may be slowly injected into 
a vein by gravitation, the effect being carefully watched (Mn) ; a hypertonic 
solution, 5ij of salt to the pint, 4 pints at a time intravenously, gave 23 cures 
out of 25 cases (Rogers): 1500 to 2000 mils of fluid during 20 to 30 minutes, 
intravenously, the best treatment for collapse (McLaughlin) ; Sodium Bicar- 
bonate a 2 per cent, solution intravenously in lieu of the salt solution for the 
acidosis (Id). Irrigation of the intestines with hot water and soap, using 1 
to 3 gallons at a time twice daily, also Hydrogen Peroxide with hot water to 
cleanse the stomach; the method used by me in Russia and at Hamburg, 
during the epidemic of 1892 (Elmer Lee): enterocylsis by 2 quarts of fluid 
thrown high into the bowel and repeated every two hours, containing Sodium 
Chloride 5j to the pint, or Tannic Acid, 5j~5j to the pint, have proved 
very satisfactory. Hypodermoclysis by a normal salt solution delivered 
slowly into the subcutaneous tissues, may be used conjointly with entero- 
clysis; it replaces lost fluid, stimulates in shock, and aids the elimination of the 
toxin (Kemp). Heat to the body is very essential. Absolute Rest, recum- 
bent position, no food, ice freely, enemata of warm milk, fresh air, friction 
and heat to abdomen, legs, and feet; no alcoholic stimulants, they are 
worse than useless. Food must be absolutely prohibited for 36 hours or 
longer. Treatment, a purely symptomatic and expectant treatment is the 
only one of any proved value (Mn). 



CHOLERA INFANTUM. 



613 



1$. Chloroformi, 5 .)'• 

Tinct. Opii, 
Spt. Camphorae, 

Tinct. Capsici, aa 5|ij- 

Alcoholis, q. s. ad gij. 

M. Sig. — 30 to 60 drops in water. 

(Squibb' s Cholera Mixture.) 



T$. Phenolis, gr.viij. 

Bismuthi Subnit., S ij- 

Mucil. Acaciae, 

Aquae Laurocerasi aa 5 j- 

M. Sig. — Teasp. every hour or two, for 
the vomiting and diarrhea. 



]$. Chlorali Hydrati, 5iij. 

Morphinae Sulph., gr. iv. 

Aquae Laurocerasi, 5j. 

M. Sig. — Fifteen to twenty drops as 
injection hypodermically. (B.) 



Cholera Infantum. 

Bismuth Subnitrate, in hourly doses of 3 to 6 grains, is regarded by many 
as almost a specific. Ipecacuanha, greenish stools with mucus and often 
blood (B). Mercury, gr. f of gray powder hourly of great service in infan- 
tile cholera with incessant sickness, profuse, almost continuous diarrhea, 
offensive and nearly colorless stools; a Starch injection, with a minute quan- 
tity of Laudanum, assists the gray powder, and should be given in urgent 
cases (R). Calomel, gr. iij-v dry on the tongue, for its antifermentive action 
in the small intestines which are inaccessible to irrigation ( Visanska) . Atro- 
pine as a sedative to the gastro-enteric branches of the vagus which are greatly 
excited by the toxin of the disease (Harkin) ; gr. -5^ hypodermically is very 
effective, especially as a stimulant in the collapse (Waugh). Zinc Phenol- 
sulphonate, gr. |-j, with a grain of Bismuth Subnitrate and one of saccha- 
rated pepsin or other digestive ferment, every \ hour until the danger is past; 
proved very effective in cases resisting other treatment (Id). Zinc Oxide 
with Bismuth and Pepsin, is very useful (B). Camphor, 3 j of the spirit in 
§iv of milk, very serviceable (B); an admirable remedy for summer and 
choleraic diarrhea (R) . Opium is generally necessary; enemata of Starch and 
Laudanum [see above under Mercury]. Morphine, hypodermically, in doses 
of gr. 2-J-q to 3V according to age, the latter dose for a child of one year, with 
5 or 6 drops of Ether, to be repeated in an hour, the most efficient treatment 
(E. Smith). Phenol, with Bismuth, may arrest the disorder promptly (Br). 
Lead Acetate, is one of the most useful astringents in this complaint (Br). 
Potassium Bromide, when due to nervous irritation or cerebral congestion 
(B). Tannic Acid, 3 SS to the pint of cold water, as intestinal injection after 
lavage, to precipitate proteid toxins (Visanska). Magnesium Sulphate, gr. 
v, with TTlJ of laudanum, in solution every 2 hours for a child one year old 
(Visanska). Silver Nitrate, is beneficial after the acute symptoms have 
passed (B). Caffeine, when due to nervous irritation (R). Alcohol, in 
grave cases, with tendency to collapse, gtt. x-xx of brandy with milk every 
30 to 60 minutes. Lavage of the stomach and colon with normal salt solution 
should be done at once (Visanska). Spice Poultice, composed of Cloves, 
Ginger and Cinnamon, mixed with brandy or whiskey, applied to the abdo- 
men. Mustard Bath in collapse, also as mustard plaster over the heart, and 
ether hypodermically (Smith). Diet, farinaceous food a common cause; no 
food, not even milk, in the acute stage when the digestion is inactive. Kumyss 
is the best food (Brush) ; milk and lime-water (R) ; no starches or fats (B) ; 
drinks freely to keep the vessels filled and prevent paralysis of the heart 



614 



CHOLERA SIMPLEX — CHORDEE. 



(Meinert). Milk in any form should be absolutely prohibited in infantile 
summer diarrhea, it being the best medium to favor the growth of the bac- 
teria (Hoag). 



IV Hydrarg. Chlor. Mitis, gr. T V- 

Bismuthi Subnitrat., gr. ij-v. 

In powder every half hour for the vomit- 
ing and purging. 



fy. Plumbi Acetat., gr. xxiv. 

Opii Pulveris, gr. xij. 

Camphoras, 5ss. 

Sacch. Lactis, q. s. 

Triturat. et div. in chart, xij. 
Sig. — One powder every hour. (B.) 



B^. Hydrarg. Chlor. Mitis, gr. £. 

Plumb. Acetatis, gr. f. 

Opii Pulveris, gr. T Vi 

Ft. pulv. no. j. Repeat every half -hour 
or hour for the acute gastric symptoms. 



Cholera Simplex. 



Camphor, an admirable remedy (R). Salol, is highly efficient. Salo- 
phen, is equally so. Copper Salts, have been given (R) . Arsenic, for vomit- 
ing; also for collapse in later stages (R). Chloral, hypodermically with Mor- 
phine, is the most efficient treatment (B). [See C. Asiatica for formula]; 
for the cramps Chloral § j inLinim. Saponis § iv to vj, applied to the abdomen 
with friction (Da C). Opium, gr. | to \ every 2, 4, or 6 hours, in the early 
stage (P). Morphine, gr. \ to \ hypodermically, is very useful (B). 
Phenol, with Bismuth is very effective (B). Lead, the Acetate in the early 
stages (R). Calumba, as anti-emetic, of great value (P). Ipecacuanha, has 
been used with much advantage (Wa). Sumbul, said to have proved suc- 
cessful (P). Mustard, as a plaster applied to the abdomen. Cajuput Oil, 
much used in India for choleraic affections (P) . Alcohol, as iced brandy in 
small doses for vomiting (B); the value of stimulants is justly doubted; if 
given, should be largely diluted (Wa). [Compare Cholera Asiatica and 
Infantum.] 



Chordee. 

Aconite, gtt. j of the tincture hourly, will relieve chordee (R). Bella- 
donna, combined with Camphor or Opium, gives the best results of remedies 
administered internally (St). Camphor, 5j doses of the spirit will relieve 
(R). Morphine, hypodermically, the one sure remedy; should be injected 
at bedtime (St). Cocaine, a few drops of a 4 per cent, solution, locally to 
the glans; or injected into the urethra, promptly relieves chordee. Diet, 
should be plain, even low, no stimulants; copious draughts of barley-water, or 
Unseed tea. 



1$. Sodii Bromid., 5iv. 

• Tr. Belladonna, 3ij. 

Tr. Opii. Camphorat, §j. 

Syr. Zingiberis, §ij. 

Aqua Dest., q. s. ad 5vj. 

, M. Sig. — Two teaspoonfuls in a \ glass 
water 3d hour. 



1$. Opii Pulveris, gr. xij. 

Camphorae, gr. xxiv. 

Sacch. Alb., q. s. 

Fiant capsular xij. 

Sig. — One at bedtime, to be repeated in 
2 hours if required. (Sturgis.) 



CHOREA. 615 

Chorea. 

Antipyrine, is the only medicine from which cures may confidently be 
anticipated (McCall Anderson); is successfully used to combat excitability 
of the motor nerve centres (W) ; may be given in 2 grain doses every 3 hours 
to very young children (Whitla). Acetanilid, used with benefit, in both mild 
and grave forms of chorea (Id). Exalgin, with Citrate of Iron and Quinine 
after meals (Dana); is believed by many to have specific power over chorea, 
given in doses of 2 grains thrice daily and gradually increased to 3 grains 
five times a day. Arsenic, is one of the most certain remedies, but large 
doses are required and are well borne (B) ; TTliij of Fowler's solution thrice 
daily for a child of 7 years, gradually increased to Til x thrice daily, and may 
be continued for several weeks (Whitla) ; is very successful in uncomplicated 
cases (R). Sodium Cacodylate, the salt of an arsenical compound, in daily 
doses of gr. §-§ (Lannois). Magnesium Sulphate, in 25 per cent, solution, 
by intraspinal injection, has remarkable effects as a sedative, and causes dis- 
appearance of the disease within a few days (Marinesco) . Cannabis, 
TUij-viij of the tincture as per age, every 3 or 4 hours, has a rapid sedative 
effect on the convulsive movements (Burton). Zinc Sulphate, in doses of 2 or 
3 grains gradually increased to 8 grains, is next in value to arsenic (Whitla) ; in 
large and increasing doses is very useful (R) ; has action similar to that of Ar- 
senic, but is inferior (B). Hyoscyamine, yj-j grain thrice daily, gradually 
increased, has cured cases which have resisted all other remedies (Da C). 
Duboisine is equally efficient; the Solanaceae are suitable for nervous, delicate 
children. Trional gives prompt relief (Meade) ; gives good results (Voelcker) . 
Veronal is highly recommended as a sedative in chorea minor (Berg). As- 
pirin is an excellent remedy (Gorges). Chloretone, J grain ter die increased 
by J grain daily until 2 grains ter die reached, then gradually decreased, has 
given good results (Orton); used in 24 cases with great satisfaction (Taylor). 
Chloral, contributes to cure by inducing quiet sleep (R); in gradually in- 
creasing doses is of the greatest service, as it has an almost absolute power to 
suspend or control spasm during its deep hypnotic action (Gairdner). Chlo- 
ralformamide, may be pushed with greater safety, and excellent results have 
followed its use (Whitla). Physostigma, is recommended (R) ; is of doubtful 
benefit (B); cures the disease in 5 or 6 days with doses of T V grain of Physos- 
tigmine twice daily hypodermically (Reiss). Calcium Chloride, has done 
good in strumous subjects (B). Cimicifuga, is a very valuable remedy in 
cases due to menstrual derangement (P) ; when there is a rheumatic history 
(R). Strychnine, in doses gradually increasing to the toxic (Tr); minute 
doses, gr. -gV to -fo, have been highly useful when chorea is due to fright or 
commencing puberty (B). Iron, large doses in anemic cases, about the time 
of puberty (B). Chalybeate waters often relieve or cure. Arsenic generally 
better, unless anemia coexists (R) . Valerian, aids to restrain the movements 
(R) ; useful when from worms (P) . Chloroform, inhalations often of great 
service in severe cases (R). Morphine, with Chloral hypodermically, in 
large doses for severe cases (Tr); when the movements prevent sleep (R). 
Musk, has been given (R). Cod-liver Oil, when nutrition is low (R). 
Alcohol is very useful in cases marked by wasting, also in the paralytic form; 
is best given in the form of port wine (Voelcker). Water, by cold affusion to 
head and spine, cold baths are important (B); tepid water first, cold should 
not be used if rheumatism or fever or pain in the joints (R). Electricity, 



6i6 



CHOROIDITIS — CLIMACTERIC DISORDERS . 



static, is useful in some forms (B) ; the constant current used in 20 cases, all 
recovering (Benedict); a galvanic chain around the neck and down the 
back, is reported serviceable. Rest in bed is essential (Perry). 



I£. Chlorali Hydrati, 5iv. 

Tinct. Hyoscyami, 
Syr. Limonis, aa Si- 
Aquae Cinnamomi, §iv. 

M. Sig. — A teasp. 3 or. 4 times daily, 

according to age. 



1$. Zinci Oxidi, gr. iij-vj. 

Sacchari Albi, gr. lxxv. 

M. et. div. in pulv. no. vj. 
Sig. — One powder thrice daily. 

(Bamberger.) 



1$. Tinct. Ferri Chloridi, 5 j. 

Liq. Acidi Arsenosi, 5ij- 

Syr. Limonis, g jss. 

Aquae, q. s. ad Sviij. 

M. Sig. — A teasp. thrice daily after 

meals, gradually increased and effects 

watched. 



1$. Arseni Trioxidi, gr. 5V-F0 

Ferri Reducti, gr. j-iij. 

Quininae Sulph., gr. ij-v. 

In pill or capsule, thrice daily. (Sachs.) 



Choroiditis. 

Mercury by inunction in acute cases due to syphilis, or in the form of the 
Protiodide by mouth in ascending doses. Potassium Iodide to aid in the 
absorption of exudates and opacities in the vitreous. Atropine (gr. j to 3 i j 
Aqua) instilled in eye thrice daily, rest of eyes and protection from light by 
dark glasses. Sweat Baths in the acute form are very useful. Opiates and 
Moist Warm Compresses seem to relieve pain in the suppurative form. The 
following is useful in the later stages of the syphilitic form, or in cases of 
doubtful origin. 

1$. Hydrarg. Chlor. Corr., gr. j. 

Potassii lodid., 5iv. 

Syr. Sarsap. Comp., § j. 

Aqua Dest., q. s. ad. giij- 

M. Sig. — Teaspoonful in water after meals. 

Chyluria. 

Thymol, in doses of 1 grain, gradually increased to 5 grains, cured two 
cases of chyluria due to filariae in the blood (Laurie). Sodium Benzoate, in 
doses of 5j thrice daily, gave promising results, but the after-history of the 
cases was not obtained (Mackenzie). Potassium Iodide, in large doses, has 
checked the discharge for a time in several cases (Lewis). Gallic Acid, in 
doses of 5 Hj, always affords some benefit (Id). Ferric Chloride, large doses 
of the tincture do some good (Id). Treatment, is unsatisfactory; no remedy 
appears to possess any constant effect (Whitla) ; drugs have no influence 
whatever in stopping the lymphorrhagia, the best results are obtained by 
absolute rest in bed, elevating the pelvis, restricting the amount of food and 
fluid — especially fatty food, and gentle purgation (Mn). 



Climacteric Disorders. 

Aconite, for nervous palpitations, and restlessness or "fidgets"; gtt. j 
hourly (R). Cimicifuga, for distressed headache (R). Amyl Nitrite, in 
small doses when the " heats" predominate, followed by cold, clammy, pale 



COCCYGODYNIA — COLIC, INTESTINAL. 617 

skin (R). Ergot, for the flooding, gr. ij of the extract in fresh pill every hour 
until relieved; Cannabis may be well combined with it. Cannabis, is 
used in the headaches of the menopause, with uniformly good results. 
Picrotoxin is a valuable remedy for the vasomotor disorders. Iron, for 
flutterings of the heart, with fullness of head, heat and weight on the ver- 
tex, frequent flushings, and hot and cold perspirations; large doses of the 
Chloride thrice daily (R). Nux Vomica, Opium and Belladonna, when the 
symptoms described above under Iron are limited to the head and face (R). 
Ammonia, Raspail's sedative lotion to painful part of the head in climacteric 
headaches (R). Potassium Bromide, for the despondency, with sleeplessness 
and irritability, often also with heats, flushings, perspirations (R). Potas- 
sium Iodide with Nitroglycerin, for high blood pressure, a not infrequent cause 
of nervous or mental symptoms at the menopause. Zinc Valerate for hyster- 
ical symptoms (R) . Physostigma, the extract gr. -^ every \ hour for 7 to 8 
doses, for flatulence and a sensation of fluttering at the pit of the stomach 
(Smith). Camphor, for drowsiness and headache ; Eau-de-cologne, saturated 
with camphor, rubber on the head (R) . Change of air and scene, when other 
treatment only partially successful (R). Warm Bath, to promote free per- 
spiration; at oo° to 95 F. for an hour, once a week, will correct many of the 
symptoms (R). [Compare Menorrhagia, Metrorrhagia.] 

Coccygodynia. 

Chloroform, injected as deeply as possible about the seat of greatest pain 
(B). Electricity, has cured one severe case of 12 years' standing, and helped 
others. Surgical treatment the only resource in rebellious and painful cases 
(Ros). Nott extirpated the coccyx; Simpson performed subcutaneous 
section of muscles and ligaments; Goodell removed the bone, after first treat- 
ing the case as the local expression of a general neurosis. 

Coldness. 

Strychnine, for cold hands and feet (R). Cold Baths, with friction to the 
skin, nightly for cold feet (R). Chloral, in small doses daily, will counteract 
the coldness of the feet and hands in certain cases of anemia, hysteria, etc. 
(Cherchevsky). Spinal Ice-bag, is often efficiently employed in general 
coldness of the surface, and persistent coldness of the hands and feet (R). 
Cocaine or Atropine, will raise the body-temperature. 

Colic, Intestinal. 

Nux Vomica, quickly subdues abdominal cramps and spasms (P) . Bella- 
donna, especially in children (R) . Chamomile Oil, Tftiv-vj, in colicky attacks 
of hysterical women (P). Chloral, sometimes relieves (R). Chloroform, 
effective in flatulent colic; also useful in hepatic and saturnine (B) ; often used 
combined with Opium (D). Potassium Bromide in a peculiar form of colic 
in young children (R); given in Anise- or Peppermint-water is of greater 
efficacy for the colic of infants than the opium preparations in general use, and 
perfectly safe (B). Asafoetida, no better remedy in flatulent colic of infants; 
teasp. doses of the emulsion (B) . Morphine, gr. \-\ hypodermically, repeated 



6l8 COLIC, LEAD — COLIC, RENAL AND HEPATIC. 

in 15 minutes, gives more relief than any other remedy in all forms of colic 
(B) ; frequent small doses (P). Essential Oils, especially those of Cloves and 
Cinnamon (R); of Anise, Cardamom, etc. Oil of Rue in flatulent colic of 
children (P). Magnesium, the Carbonate with Opium and Asafcetida, as in 
Dewees's Carminative, the dose being TTUx for an infant 2 to 4 weeks old. 
Ammonia, in spasm of intestinal canal and in colic of children or infants from 
bad feeding (R). Lime Water, for young children who eject milk in lumpy 
masses, with colic and flatulence (R) . Water, hot fomentations to ease pain 
(R) ; a copious enema of warm water often gives immediate relief . [Compare 
Calculi, Gall-stones.] 

1$. Ext. Gentianae, 1^. Camphorae, 

Rhei, aa 5 j- Capsici, 

Ft. pill. xx. Sig. — One or two pills thrice Zingiberis, aa gr. ij. 

daily for tendency to colic. Ft. pil. xij. Sig. — One pill as required. 

Colic, Lead. 

Alum, singularly, is the best remedy (B) ; gr. x hourly (R) ; converts the 
poisonous salt of lead in the system into a comparatively innocuous sulphate; 
5jss-iv daily with Tfl.xl-1 Tinct. Opii, and an occasional dose of Castor or 
Croton Oil to procure one or two motions daily (Wa). Opium, gives more 
relief than any other remedy, gr. f to \ of Morphine hypodermically (B) ; gr. 
ij-iv of Opium, with a moderate dose of Castor Oil (P). Sulphuric Acid, 
diluted well, as a prophylactic, and is useful in the treatment of the disease 
(B) ; considered remarkably efficient when used in association with repeated 
Sulphur baths ( Wa) . Calomel, a full dose, with or without Opium, followed 
in a few hours by Castor Oil and a Turpentine enema, often affords speedy 
and marked relief (Wa). Magnesium Sulphate, for the constipation, and to 
remove the poison from the system; should be combined with Potassium 
Iodide, 5 j of the former thrice daily and about two hours after having given 
gr. v-x of the Iodide; this treatment dissolves the lead in the tissues, causes 
its elimination by the intestinal mucus, renders it insoluble after it has entered 
the intestinal canal, and quickly removes it from the body (Br). Atropine, 
g r - too) with Potassium Iodide, gr. v, gives excellent results in the treatment 
of lead-poisoning, the former relieving the colic and pain in the head in the 
most rapid manner, keeping the bowels open freely, assisting in the return of 
the bodily powers, and aiding in the removal of the lead by the Iodide 
(Humphreys). [Compare Poisoning by Lead.] 



1$. Aluminis, 5ij- 

Ac. Sulphurici Dil., 5j- 

Syr. Limonis, 5 j. 

Aquae, giij. 



1$. Magnesii Sulphatis, §j. 

Ac. Sulphurici Dil., Si- 
Aquae, §iv. 

M. Sig. — Tablesp. every 3 hours (B) ; or 



M. Sig. — Tablesp. every hour or two for ! thrice daily, each time preceded by a 5- to 
lead colic. (B.) \ 10-grain dose of Potassium Iodide. (Br.) 

Colic, Renal and Hepatic. 

Ether, inhaled in paroxysms of hepatic colic (R). Chloroform, by in- 
halation in renal and biliary colic, inferior only to Morphine injection, 
superior to Opium, warm baths, etc.; two or three administrations will be 
required (R). [See also Colic, Intestinal.] Counter-irritation, flying 
blisters for renal colic (R) . Opium, small doses with Spt. Chloroformi every 



COLLAPSE — COMA. 6lQ 

five or ten minutes until the pain gives way, or Morphine hypodermically 
(R). Atropine, gr. T J-g- to t }-q, may be combined with morphine with advan- 
tage because of its antispasmodic action. Turpentine, has been given with 
benefit in biliary colic (R). Glycerin, in doses of 5v-vij in hepatic colic 
brings the attacks to an end; doses of 5j~iv daily, in a little alkaline water, 
prevented recurrences (Ferrand). Water, warm baths to ease the pain (R). 
Aliment, withhold all starches and fats; Alkaline mineral waters are useful 
(B). [Compare Gall-stones.] 

Collapse. 

Drugs. — The more we know of shock and collapse, the less we pin our 
faith to drugs (Bastedo). If we employ them, we must not let the stress of 
the emergency lead us into giving them in too large doses. In such an 
emergency we have seen drugs administered in amounts that might have 
proved fatal to a healthy person; and it seemed as if the patient might have 
died from the drugs rather than from the collapse (Id). 

Camphor, 3 ss of a 10 per cent, solution in oil, hypodermically into each 
forearm, in the collapse of pneumonia (Schilling) ; hypodermic injections of 
camphor are used for the purpose of excitation in collapse. Ether, by mouth, 
inhalation, or hypodermically, is of great service. Ammonia, in desperate 
cases when the hypodermic method is the only available route (Whitla). 
Brandy, or other alcoholic stimulant, by mouth if the patient can swallow, if 
not then by the bowel or hypodermically (Id). Digitalis, the tincture as a 
cardiac stimulant, but being slow of action. Strophanthin given intravenously 
in dose of gr. t -J-q hi 5 j _ ij of normal salt solution is more efficient when a 
prompt stimulant in cardiac emergency is required. Strychnine, or Nux 
Vomica, for impending cardiac failure, is very efficient. [Compare the 
articles on Heart Affections and Syncope.] Caffeine has a good effect in 
many cases of failing circulation. Atropine is of great value in sudden col- 
lapse with subnormal temperature, loss of arterial tension and copious sweat- 
ing (W). Epinephrine hypodermically, for the vaso-motor collapse of cocaine 
or chloroform poisoning (Miles) ; TTLx-xv of the solution intravenously will 
often save life in severe cardiac and vascular collapse (John); is the most 
active remedy (Kothe); 24 mgr. hypodermically every. hour is employed 
successfully in many cases of severe collapse in connection with scarlet fever, 
pneumonia and typhoid fever (Kirchheim). Pituitrin has a more lasting 
effect but its repeated use may result in vasodilation (Wiggers). Musk of 
good quality, is an efficient cardiac stimulant. Electricity to the phrenic 
nerve, or an interrupted current through the upper extremities (Whitla). 
Transfusion, or a warm saline solution by subcutaneous injection, when 
collapse is associated with extensive hemorrhage; or an Esmarch bandage 
to the limbs, or the tourniquet to the femoral artery, to keep the blood out of 
the lower extremities (Id). Heat to the surface and over the cardiac region. 
Counterirritation, by mustard to the spine, nape of the neck, and calves of the 
legs. Affusion, of cold water alternating with hot (P). [Compare Exhaus- 
tion, Shock, Syncope.] 

Coma. 

Alkalies are antagonistic to the acid toxins of diabetes, and should be 
given at once in enormous doses when the prodromes of coma appear (Elliot) ; 
Sodium Bicarbonate, 100 grains in a pint of milk 3 or 4 times daily, or 200 



620 CONDYLOMATA — DIPHTHERITIC CONJUNCTIVITIS. 

grains at one subcutaneous injection (White). Croton Oil, as a purgative, 
TTlJ or J every hour, mixed with a little butter or lard and conveyed to "the 
back of the tongue (R). Oxygen, by inhalation, is generally applicable in 
coma. Potassium Bitartrate, free purging therewith, often removes coma, 
convulsions, and other symptoms due to poisoned blood (R). Blisters, in 
the comatose condition, large blisters or mustard poultices should be applied 
in quick succession to different parts of the body — chest, abdomen, thighs, 
and calves often very valuable in the critical condition near the end of an 
acute illness (R). Cold Douche, for stupor of drunkenness or of opium 
poisoning; may have to be repeated if relapses occur; it should be kept up for 
a long time if pulse and breathing improve or are no worse (R). Mustard, 
as poultice to the feet and ankles in the coma of narcotic poisoning (P). 
Saline Solution, the normal salt solution by injection, will sometimes relieve 
diabetic coma temporarily (Fagge). Exercise, in coma from opium-poison- 
ing the patient should be persistently walked about. [Compare Cerebral 
Congestion, Uremia, and Poisoning by Narcotics.] 

Condylomata. 

Nitric Acid, §j in Oj aquas, as wash, frequently used (R). Mercury, 
Calomel dusted over, after washing with a solution of Chlorinated Soda 
(Ricord) ; the Nitrate locally, or a 20 per cent, oleate (R). Zinc, the Chloride, 
Iodide or Nitrate as local applications (R). Arsenic Trioxide, as a caustic 
(R). Phenol, as a mild escharotic (B). Chromic Trioxide, gr. c in 5j 
aquae dest. a good local application (B). [Compare Syphilis, Warts.] 

Conjunctivitis, Acute Catarrhal. 

Zinc Chloride (gr. \ to §j) or Sulphate (gr. j to 5 j) as an astringent 
collyrium every 3 hours, with ice locally in the earlier stages. Sodium 
Borate (gr. v to 5 j) as a lotion every 4 hours is also useful. Boric Acid 
(gr. x to § j) is very useful and may be combined with aqua, camph., 
equal parts. Sodium Chloride, in the form of normal salt solution as a 
cleansing solution used frequently is also of value. Glycerite of Tannin 
(20 per cent.) applied to the lids in the later stages. Glycerite of Boroglycerin 
applied to the lids by the physician, is also useful. Silver Nitrate (gr. j 
to v to the ounce) applied to the lid by the physician is of distinct value in the 
more severe forms. Argyrol (in 20 per cent, sol.) is of value in the presence of a 
purulent exudate, 3 drops of the solution being instilled in the conjunctival 
sac every 3 hours. This should not be continued over a long period of time 
because of the possibility of permanently staining the tissues. Petrolatum 
or Boric Acid Ointment is applied to the edges of the lids at night to prevent 
them from becoming glued together during sleep. 

I£. Acidi Borici, gr. xl. 

Sodii Chlor., gr. vj. 

Aqua Camph., 

Aqua Dest., aa 5 i j. 

M. Sig. — Lotion for eye every 2 hours in eye cup or dropper. 

Diphtheritic Conjunctivitis. 

Isolation is important. General precautions for the prevention of the 
spread of the infection should be carried out as in gonorrheal conjunctivitis. 



CONJUNCTIVITIS GRANULAR CONJUNCTIVITIS. 62 1 

Normal salt soJution or boric acid (saturated sol.) as a cleansing lotion every 
three hours is useful. Cold Compresses, applied cautiously, because of the 
enfeebled circulation. Later Hot Compresses are indicated. Nitrate of 
Silver applied after separation of the membranes or the slough, beginning 
with a weak solution. This is to be stopped if the membranes or deep in- 
filtrations once more develop (Fuchs). Frequent separation of the lids from 
the eyeball is a useful procedure to prevent adhesions, or a pledget of cotton 
saturated with oil, may be placed between the two surfaces. Atropine is 
indicated if the cornea becomes ulcerated. Antitoxin, indicated in all cases, 
and its early and vigorous use is of great importance. 

Conjunctivitis, Gonorrheal. 

Prophylaxis. Precautions must be taken to prevent infection of the eyes 
of the physician, nurses and attendants through spurting of the discharge 
during examination. Protecting glasses should be worn and the hands 
frequently disinfected. Sponges used for cleansing the eye should be burned. 
The non-affected eye should be protected from infection. Iced compresses 
used continuously, day and night, until the swollen condition of the lids be- 
comes lessened and the purulent discharge appears. Should the cornea become 
cloudy, Heat should be substituted for the cold. Boric Acid, a saturated 
solution to irrigate the conjunctival sac every two hours. Silver Nitrate 
(gr. ij to x to 5 j) applied to the lids once daily when pus is present. Bichlo- 
ride of Mercury, i : 10,000, Normal Salt Solution or Potassium Permanga- 
nate 1:500, are useful solutions to irrigate the conjunctival sac. Atropine 
(1 per cent, sol.) one drop in the eye every 2 hours if the cornea becomes ulcer- 
ated or hazy. Argyrol, in 20 per cent, solution, a few drops in the eye every 
3 hours is of value. Leeches to the temple if the pain is severe in the early 
stages. Canthotomy may be performed if the lids become so swollen as to 
prevent separation of the lids. Glycerite of Tannin, in 20 per cent, solution, 
is painted on the lids in the later stages. Isolation, cleanliness and frequent 
irrigation are factors of prime importance in the treatment of this disease. 

Granular Conjunctivitis (Trachoma). 

Hygienic Measures should be instituted to prevent the spread of the 
infection. Copper Sulphate, the solid crystal lightly touched to the lids once 
every other day, followed by a Boric Acid Lotion and Cold Compresses, is 
of distinct service. This should be continued for a prolonged period of time 
(months). Nitrate of Silver in 1 per cent, solution carefully applied is 
also of service. Alum, the stick may be applied to the everted lids. 
Glycerite of Tannin, in 20 per cent, solution, in the later stages used alter- 
nately with Glycerite of Boroglycerine is of value. Zinc Sulphate (gr. j to 
5 j aqua) combined with a saturated solution of boric acid as a lotion t.i.d. 
for continued use by the patient. Atropine, in 1 per cent, solution, if the 
cornea becomes ulcerated. Dark Glasses to relieve the photophobia. Jeque- 
rity, a freshly made infusion, 3 or 4 drops in the eye once daily, may be used, 
stronger solutions being used as the treatment progresses. All applications 
eventually lose their effect and should be changed from time to time. Treat- 
ment should be continued until the conjunctival hypertrophy has completely 
disappeared, otherwise relapses are frequent. The granules may be removed 
by the operation of expression. 



622 CONJUNCTIVITIS — CONSTIPATION. 

Conjunctivitis, Phlyctenular. 

Boric Acid, a saturated solution to irrigate the eyes thoroughly several 
times a day. Mercury, the yellow oxide ointment, a small amount deposited 
in the conjunctival sac and rubbed about with the lids closed, twice daily, 
is of great service. Calomel, finely powdered, dusted upon the lesions once 
daily, is also useful. Cold Compresses are of value if the cornea is not in- 
volved. Calomel and a saline purge is indicated early in the disease and the 
diet should be strictly regulated. Hygienic measures, fresh air, and frequent 
bathing are also aids in the treatment. The nose and throat should receive 
attention and adenoids or diseased tonsils removed and nasal defects relieved. 
Syrup of Ferri Iodide, Arsenic, in the form of Fowler's solution, Syr. 
Hydriodic Acid, Cod-liver Oil or other tonics may be advantageously given. 

Constipation. 

Nux Vomica, gtt. j-ij of tincture, twice or thrice daily (R) ; gtt. v-x in 
glass of cold water bfore breakfast and dinner, often overcomes the most 
obstinate constipation (P) ; especially useful when great fecal accumulations 
from torpor of bowel (B). Strychnine has power to stimulate peristalsis, 
and should be given with all agents for intestinal evacuation (Pettey). 
Castor Oil is a mild and efficient cathartic (B) ; especially for children (Little). 
Sulphur, gr. x with Confectio Sennae, often succeeds after other remedies 
fail (R); sulphurous mineral waters (B); or Sulphates in purgative waters; 
frequent small doses (R). Podophyllum, the most generally used cathartic 
when secretion deficient (B) ; gr. j 1 ^ to -J- night and morning when constipation 
with nervous and bilious headaches (P). Senna, as in the Pulvis Gly- 
cyrrhizae Compos., which may be taken in doses of a teasp. to a tablesp. 
as required, and kept up for months (Goodell). Agar-agar, in \ oz. doses 
morning and evening, brings regular movements after 2 or 3 days (Gom- 
pertz). Phenolphthalein, gr. j-ij, is a very satisfactory laxative for habitual 
constipation; an efficient, unirritating and pleasant laxative for occasional 
use (Kohn). Mercury, Calomel or gray powder as a cathartic (R). Hydras- 
tis, very valuable, when constipation is referable to a sluggish liver. Mag- 
nesium, the Bicarbonate, a useful and mild aperient (R). Ipecacuauha, gr. j 
every morning, fasting, when great torpor of bowel (R). Turpentine, in 
purely atonic constipation, with gaseous distention of colon, has triumphed 
when all other remedies failed (P) . Physostigma, very effective in intestinal 
torpor (B). Stillingia, Tfl.x of fluidextract in habitual constipation (B). 
Ammonium Chloride, in the so-called bilious state with constipation (B). 
Arsenic, TTlij of Fowler's solution often overcome constipation (R). Bella- 
donna, gr. \ of the extract at night, in habitual constipation (B) ; gr. |-| once 
a day, especially when dyspepsia (R) ; acts directly on the bowel as a stimu- 
lant (P). Croton Oil, the most efficient cathartic, when simple impaction 
without inflammation; gtt. j-ij (B), when evacuations of blackened feces (R). 
Cascara Sagrada, the fluidextract in doses of 5 j, produces large, soft evacua- 
tions without griping, and leaves behind it a laxative influence. Frangula, 
in similar doses, is equally efficient, but if from a fresh bark may produce 
griping. Cathartics, especially Confectio Sennas, Pil. Rhei Compos., Pil. 
Aloes, the Comp. Cathartic Pill, as well as those above (B) ; purgation as usu- 
ally practiced was denounced by the editor of the Lancet, October 1, 1870. 



CONVALESCENCE — CONVULSIONS . 



623 



Saline Waters, are usefur(B) ; Pullna, Friedrichschall, or Hunyadi, the first 
two with milk, are good for children (R). Enemata, of soap-suds and salt 
or a pint of cold water (B) ; or Turpentine, Castor Oil aa § ss to Oss-j of gruel 
(P); the habitual use of warm enemata increases torpor of the bowels (R). 
Aliment, important in habitual constipation; corn bread, cracked wheat, 
oatmeal, bread of unbolted flour, fruits, green corn, tomatoes, and celery; 
J dozen each of almonds and raisins day. Water, a glass of cold water 
before breakfast may overcome habitual constipation (B); drinking largely of 
water is a most beneficial measure in cases of chronic constipation. Smoking 
a cigar or pipe after breakfast (R) ; tobacco smokers rarely suffer from consti- 
pation. [Compare Intestinal Obstruction.] 



]$. Ext. Colocynth. Co., gr. xij. 

Ext. Belladonnae Fol., gr. ij. 

Ext. Gentianae, gr. vj. 

Olei Cari, gtt. iij. 

Ft. pil. vj. Sig. — One pill at bedtime. 

1$. Podophylli Resinae, gr. ij. 

Quininae Sulphatis, 

Ext. Aloes, aa gr. viij. 

Fellis Bovis, gr. xvj. 

Ft. pil. no. xvj. Sig. — One or two at bed- 
time. m4 ■ (Goodell.) 

]$. Fluidextr. Cascara. Sagrad., . 5j. 

Fluidextr. Belladonnas, 5j- 

Tinct. Nucis Vom, 5ij- 

Syrupi et Aquas, aa ad § iv. 

M. Sig. — Teasp. thrice daily in obstinate 

constipation. (Clarke.) 



Castor Oil Emulsion. 
B). 01. Ricini, 

Glycerini, aa §j. 

Tinct. Aurantii, 5ij- 

Tinct. Senegae, 5 j- 

Aq. Cinnamomi,.. . .q. s. ad §iv. 
M. ft. emulsum. Sig. — A tablespoonful 
or two for children, according to age; §ij-iv 
for adults. 



V- 



M 



Artificial Hunyadi Water. 
Magnesii Sulphatis, 

Sodii Sulphatis, aa §ss. 

Potas. Sulphatis, gr. ij. 

Sodii Bicarbonatis, . gr. viij. 

Sodii Chloridi, gr. xx. 

Aquae, q. s. ad 5 viij. 

. Sig. — A winegl. before berakfast. 



Convalescence. 

Lime, as Lime-water, or the Carbonate, in convalescence from serious 
disease (R). Iron and Arsenic, to combat the anemia of post-febrile states 
Cod-liver Oil and other fats (R). Sodium Glycocholate, to promote the 
digestion of fats, in convalescence from typhoid and other exhausting diseases 
(Keown).- Alcohol before and during meals (R). Bitters, especially Gentian 
and Calumba (B); the latter especially when stomach weak (R). Eucalyp- 
tus, a serviceable tonic (B). Coca, 5 ss— ij of the fluidextract at a dose (B). 
Guarana, gr. xv~3j may be given (B). Seabaths, valuable in many cases 
(R). Bone Marrow, gives great satisfaction in anemic cases. Diet, requires 
the most careful attention; the prevalent error of giving food difficult of diges- 
tion too early must be guarded against, especially in intestinal and gastric 
disorders; the strictest moderation should be enjoined. Milk is a valuable 
food. The symptoms must be watched closely, and combated by appropriate 
medication. Fresh Air, in abundance; well ventilated sleeping quarters are 
essential. [Compare Adynamia for Tonic Prescriptions, also Anemia.] 



Convulsions. 

General Directions. — In all cases a horizontal posture, fresh air, clothing 
loose; a plug of soft wood or a cork between the teeth, to prevent biting the 
tongue; sprinkle the face and chest with cold water. Epileptic. — The general 



624 



CONVULSIONS, INFANTILE — CORNEAL OPACITIES. 



directions above will usually suffice. Hysterical. — The diagnostic peculiari- 
ties are: pupils not dilated but are sensitive to light, no wounding of tongue, 
face not livid, pulse usually normal. Infantile. — Administer some antispas- 
modic as Ether, alone or combined with Belladonna; then search for any me- 
chanical cause, as a pin in a dress, etc.; foreign body in nose or ear, intestinal 
worms, etc., etc.; lance the gums if dentition the cause (A). Solanum Caro- 
linense, has a good reputation in the southern states for epilepsy and other 
convulsive affections, and has rendered excellent service in my hands (Napier) ; 
a tincture is prepared by bruising the berries and steeping them in whiskey, 
of which the dose is 3j> repeated until drowsiness is produced. Amyl 
Nitrite is quick and powerful but fugacious, the remedy when convulsions 
must be controlled immediately (W). Chloroform the most efficient anes- 
thetic, to be used when prompt action is desired (W). Chloral is useful in 
all types if severe enough to threaten life (W). Bromides when a persistent 
action is desired (W). Veratrum Viride, Norwood's tincture, in io-minim 
doses hypodermically every 10 minutes for 3 doses, promptly checks con- 
vulsions due to chronic Bright 's disease (Landis). [Compare Albuminueia, 
Epilepsy, Hysteria, Puerperal Convulsions, Uremia.] 



Convulsions, Infantile. 

Belladonna is of the highest value in certain congestive forms, as in fits 
due to the irritation of teething, or those referable to whooping-cough (P). 
Valerian, has been successfully used in convulsions from the worms to which 
it is fatal (P). Potassium Bromide, in all forms of convulsions in children 
(R) ; children bear it in large doses, gr. v thrice daily or of tener for a child a 
year old, in convulsions from teething (Br.) Chloral, in large doses, gr. v, 
by mouth or rectum (Br); best used as a suppository rather than by liquid 
injection, and is often very useful (R) ; it gives better results than any other 
agent. Chloroform inhalations are of great service (R); useful in all forms 
(B) ; should be used to arrest the convulsion and prevent recurrence (Smith). 
Asafoetida, in the convulsions of teething, a small portion in an enema, 
appears to mitigate them (Wa). Opium, efficient but dangerous in young 
children. Veratrum Viride, has been employed successfully (R). Amyl 
Nitrite, gtt. v, with gr. J of Morphine, was used in one case as a last resort 
after five hours' convulsions in a child 18 months, and resulted in producing 
quiet sleep (Engel) . Hot Baths, are important with cold affusions or ice to 
the head (B). Spinal Ice-bag, may be very efficient (R). 



1$. Chlorali Hydrati, gr. v. 

Lactis, 5j. 

M. Sig. — As rectal injection. Or the 
dose of hydrated chloral may be made into a 
suppository with cacao-butter and inserted 
well up into the rectum. 



1$. Sodii Bromidi, 

Chlorali Hydrati, 

Sodii Bicarb., aa gr. viij. 

Aquae, §j. 

M. Sig. — A teaspoonful every hour to a 
child under four months old. 



Corneal Opacities. 

Mercury, the ointment of the yellow oxide, a small amount placed in the 
conjunctival sac and the cornea gently massaged through the closed lid, will 
promote adsorption of superficial corneal opacities of recent origin. Dionin 
(2 to 5 per cent.) one drop in the eye once or twice daily is also of service. 



CORNEA, ULCER OF — COUGH. 625 

This is also useful in cases of deeper corneal infiltration in which there has 
been no actual destruction of the substantia propria and little if any super- 
ficial ulceration. Potassium Iodide (5 to 10 drops of a saturated solution) 
taken internally t. i. d. may be of service. Iridectomy for artificial pupil 
may be performed if the opacity is dense and in the pupillary path, the 
coloboma being made opposite a clear part of the cornea. Tattooing with 
India ink may be performed to remove the disfigurement of a large scar. 

Cornea, Ulcer of. 

Atropine Sulphate (1 per cent.) one drop instilled in the affected eye thrice 
daily, or oftener, to dilate the pupil. This drug seems to have a beneficial 
effect upon the cornea itself, and acts favorably upon the ulcer by diminish- 
ing any accompanying iritis. By maintaining mydriasis, the danger of pro- 
lapse of the iris, in case perforation ensues, is reduced to a minimum. Eserine 
(gr. j-f 5 j) may be substituted for atropine for the same reason when the ulcer 
is peripheral and deep. Bandage, with pressure, is indicated when the ulcer 
is clean and no discharge is present. Attention should be paid to diet, fresh 
air and hygienic surroundings, to improve the general tone of the system, and 
tonics administered when necessary. Foreign bodies should be removed and 
other local irritating conditions relieved. Any existing conjunctivitis or 
dacryocystitis should receive attention. Boric Acid lotion or any bland 
colly rium is useful to allay any accompanying conjunctival irritation. 
Smoked glasses may be used to afford protection from the light. Hot com- 
presses, applied several times daily, favor healing of the ulcer. Tincture 
of Iodine carefully applied to the ulcer after anesthetizing the cornea is useful 
in infected cases. Phenol, Trichloracetic Acid or the actual cautery may also 
be used for this purpose. Argyrol (20 per cent.) three drops in the affected 
eye thrice daily is a useful procedure. Ethylhydrocuprein Hydrochloride 
(1 per cent.) one drop in the eye every 2 or 3 hours is of distinct benefit in 
pneumococcic ulcers. In stubborn cases which resist treatment, the ulcer 
may be curetted and one of the above mentioned caustics applied. This will 
tend to limit spreading. Operative treatment may be required should a 
large hypopyon develop or perforation occur. 

Corns (See Callosity) . 
Cough. 

Nux Vomica, in laryngeal cough of neurotic origin, drop doses of the 
tincture every five minutes; is promptly efficient (Macfarlan); has specific 
action on the pneumo-gastric, and is one of the most efficient remedies in 
cough of any kind, whether from bronchitis, pneumonia, phthisis or em- 
physema, but especially in nervous coughs and periodic coughs which come 
on in the evening and stay all night {Jour. de. Med.). Opium, in some form, 
is much used in cough-mixtures; Morphine and Glycerin applied to fauces 
(B); moderate doses are useful in irritative affections of the air-passages to 
allay irritation and hypersecretion, but it may do even fatal mischief in cases 
where secretion is copious and expulsory power feeble (P) ; opiates inadmissi- 
ble when with copious expectoration there is any indication of bronchial 
congestion (Wa). Codeine, is often efficient in cough (Br); of particular 
40 



626 COUGH. 

value in i-gr. doses; is slightly expectorant, does not nauseate or cause vomit- 
ing, or affect the appetite; is far the best agent for the cough of phthisis when 
morphine is not well borne (Kobler). Apomorphine Hydrochloride, very 
valuable in cough where there is persistent hacking without expectoration, 
or with difficult expectoration; the dose is only gr. ^ to T V in the 24 hours; 
solution rapidly alters unless a few drops of Hydrochloric Acid are added 
(Stocquardt). Heroin is indicated in coughs of all kinds, whatever their 
cause (Hyams) ; is very satisfactory in laryngeal cough (Campbell) ; is one 
of the most toxic members of the morphine group (Cohen) . Dionin is efficient 
in irritative cough, especially in that of phthisis and heart affections (Salz- 
mann); has sedative and analgesic action with no ill effects (Scherer). 
Iodine, by inhalation, for children in hoarse, hollow cough, wheezing (R) ; the 
tincture, 5-10 drops, inhaled from boiling water for five minutes at bedtime, 
often gives most signal relief in the irritating cough of phthisis. Dilute 
Hydrocyanic Acid, for nervous, irritable cough and cough of phthisis, also 
mother's sympathetic cough (B) ; no more certain palliative for simple, ner- 
vous cough due to irritable state of the system (S); a valuable adjunct to 
ordinary remedies in cough of phthisis (Wa). Prunus Virginiana, has some 
influence, due to its Hydrocyanic Acid; is much used in cough mixtures (P). 
Ipecacuanha, the fid. extr. for troublesome night-cough (B) ; in obstinate win- 
ter-cough, with wheezing, the wine as spray to fauces, efficacious (R); in 
coughs of childhood, Ipecac is one of the most generally serviceable expecto- 
rants we can use (Wa). 

Oil of Cloves TH. v-x in olive oil hypodermically once or twice daily, controls 
the excessive cough and expectoration of phthisis and bronchiectasis (Hare). 
Lobelia, dry cough, continued tickling sensation, even in sleep (P). San- 
guinaria, combined with Hyoscyamus, in nervous, spasmodic cough (P). 
Senega, as a stimulant expectorant in the cough of chronic bronchitis and 
subacute chest affections. Gelsemium, excessive irritability of the respira- 
tory centre (R); often remarkably relieves convulsive or spasmodic, reflex 
and nervous coughs (B). Menthol, a few crystals warmed in a spoon and 
the vapor inhaled, or inhale from a few drops of a 40 to 50 per cent, alcoholic 
solution (Saenger). Asafoetida, its value due to the sulphur in it (Garrod); 
very serviceable in after-cough from habit, and in mother's sympathetic 
whooping-cough (B). Phenol, as spray, a 5 per cent, solution in a steam 
atomizer will often prevent as well as cure a cough from cold. Valerian, in 
asthma tical and hysterical coughs (P). Chloroform, with Morphine and 
molasses in paroxysmal dry cough; may be painted on throat also (R); in 
irritable reflex cough, the vapor of a teaspoonful of the spirit may be inhaled 
from the surface of hot water, and repeated every five minutes for four or 
five times (B); the inhalation of small quantities of chloroform gives the 
greatest possible relief in the irritable cough of phthisis (Spencer Wells). 
Chloral, in convulsive coughs, ameliorates symptoms after hypnotic effect 
(Wa). Camphor, equal parts of Camphor and Chloral triturated together 
are said to allay spasmodic cough when painted over larynx (B). Glycerite 
of Tannin, applied to throat when chronically inflamed and so producing 
cough; often the cases with children (R). Squill, in catarrhal cough, should 
not be employed until active inflammation has subsided ( Wa) ; the syrup or 
vinegar of Squill is the best preparation for cough with tickling in the throat 
(P). Terpin Hydrate, in bronchial cough, and night-cough from habit, is 
very efficient in a 2 grain dose at bedtime, repeated early in the morning 



COXALGIA. 



627 



(Boyland). Aconite, irritable, tickling throat-cough; short dry cough of 
asthmatics, with anxious look and full strong pulse (P). Belladonna, often 
useful; no indications (R); internally and externally as plaster to the chest, 
very serviceable in spasmodic and nervous coughs (Wa). Hyoscyamus, very 
useful in spasmodic tickling night coughs (P). Alum, internally in spasmodic 
cough; gr. x to §j aquae as spray, in chronic cough also (R). Potassium 
Bromide, serviceable in various reflex coughs (uterine, renal, etc)., and in 
cough of phthisis it is occasionally ameliorative as a gargle (B) . Cubeb, 5 ss-j 
of the tinct. in half-glass of Linseed tea thrice daily, often cures like a charm 
the coughs of chronic catarrh, of emphysema, or acute catarrh, or following 
an attack of influenza (R). Cod-liver Oil, in chronic coughs (R). Lactu- 
carium, the syrup as vehicle in cough-mixtures (B). Pix, Tar-water in 
winter cough, especially when paroxysmal (R) ; allays the cough of bronchitis 
and phthisis (P); the Plaster as rubefacient and counter-irritant in chronic 
coughs (Wa). The frequency and violence of nervous coughs may be con- 
trolled by a determined effort of the patient's will. [Compare Bronchitis, 
Pertussis, Phthisis.] 



Prescriptions for Cough Mixture. 



]$. Spiritus iEtheris Nitrosi, 3ij- 

Vini Ipecac, § ss. 

Tinct. Opii Deodorat., 5j- 

Syrupi Tolutani, q. s. ad 5ij. 

M. Sig. — A teaspoonful twice or thrice 

daily. (Bowditch.) 



]$. Ammonii chloridi, 5 j- 

Ammonii carbonatis, 5j. 

Ammonii Bromidi, 5 j- 

Fluidextracti Glycyrrhizae, . . 5 iv. 

Aqua destillatae, . . . . q. s. ad qv). 
M. Sig. — Dessertspoonful every 4 hours. 

(Hare.) 



3. 



Elixir Terpin. Hydrat. et Heroin, 

or 
Elixir Terpin. Hydrat. et 

Codein, § iv. 



M. Sig. — A teaspoonful 
water every 3 or 4 hours. 



glass 



1$. Mist. Glycyrrh. Co., gij. 

Syr. Pruni Virginianae, 

Syr. Tolutani, aa § j. 

M. Sig. — Half teaspoonful 3 or 4 times 
daily for infants, teaspoonful doses at 1 to 
2 years, larger doses for older children. 



1$. Tinct. Opii Deodorat., 

Vini Antimonii, aa 5ss. 

Fluidextr. Valerianae, 

Syr. Simplicis, aa 5ij- 

Aquae, 5jss. 

M. Sig. — A teaspoonful every hour or 
two until cough controlled. For children of 
4 years and upward. (Meigs 6° Pepper.) 



1$. Acidi Hydrocyanici Dilute, . . njxlviii. 
Syrupi Pruni Virginianae,. ... 5iij. 
M. Sig. — A teasp. every 3 hours for 
irritable cough. 



Coxalgia. 



Antituberculosis treatment is applied in all cases. Rest, in incipient 
cases; Da Costa states " the patient is placed upon a solid mattress and exten- 
sion is applied. In children under ten years of age a weight of from 3 to 5 
pounds is used; in individuals between ten and twenty a weight of from 5 to 
8 pounds is used. A long splint is often applied to the sound side to keep 
the patient recumbent and horizontal. A cradle is employed to hold up the 
bed-clothing. The object of extension is to overcome muscular spasm and 
so put the part in a condition of physiological rest. Extension in a mild case 
must be continued for three months after the symptoms have disappeared, 



628 



CROUP, CATARRHAL — CROUP, MEMBRANOUS. 



and in a severe case the period must be six months. The weight is gradually 
taken off; if symptoms recur, the weight is reapplied; if they do not recur, 
apply a traction splint or a plaster dressing, put a high-heeled boot on the 
sound limb, and send the patient out on crutches. The general treatment 
is tonic and restorative." Counterirritation, by blisters around the hip, with 
perfect rest in the straight posture, Cod-liver Oil, etc. (D). Ferrous Iodide, 
in scrofulous diseases of the joints, with Cod-liver Oil and nutritious diet 
(Wa). Iodoform, very successfully used by many continental practitioners 
in scrofulous diseases of the joints (Wa). Cod -liver Oil, the remedy on 
which most reliance is to be placed (R). [Compare Abscess, Caries, 
Suppuration, Synovitis.] 

Croup, Catarrhal. 



Aconite, valuable (R) ; has been employed with the best results (P) ; gtt. \ 
to j every half hour, until an impression is made on the fever movement, 
then every hour or two (B). Hot Water, applications beneath the chin and 
along the whole course of the larynx (Wa). Hot fomentations or turpen- 
tine stupe to throat (El); hot bath, 95°-io2° F., in the paroxysm, a good 
method (M &P). Potassium Bromide, locally, a solution by atomization, 
has proved highly efficient in spasmodic croup (Wa). Lobelia, has been 
used with occasional success (P). Ipecacuanha, the syrup or fluidextract as 
an emetic at the outset (El) ; is a slower emetic than tartar emetic (P) ; the 
syrup to vomiting during the paroxysm, and TTlv-x every 2 or 3 hours next 
day (M & P). [Compare Laryngismus Stridulus.] 



1$. Potassii Citratis, 5 j- 

Syr. Ipecac, 5ij- 

Tr. Opii Deodorat., gtt. xij. 

Syr. Simplicis, 3ij- 

Aquae, Bjss. 

M. Sig. — Teaspoonful every 2 or 3 hours 
at 6 months old when cough frequent and 
harassing. (M. & P.) 



fy Tinct. Belladon. Fol., gtt. iv. 

Tinct. Opii Camph., gtt. 1. 

Aluminis (pulv.), gr. vj. 

Syr. Acaciae, 5ss. 

Aquae, §jss. 

M. Sig. — Teaspoonful every 2 or 3 hours 
at 6 months old when cough frequent and 
harassing. (M. & P.) 



Croup, Membranous — Laryngeal Diphtheria. 

Antitoxin, has reduced the mortality in laryngeal diphtheria from 73 to 27 
per cent.; under its influence the membrane loosens and clears off rapidly 
(Washbourn); even after its use symptoms of laryngeal obstruction may 
develop (Tirard). See article on Diphtheria Antitoxin. Mercury, a 
remedy of established value, gr. ss-j of Calomel, with gr. -J— J of Ipecac, accord- 
ing to age every 2 hours, with local and other general measures, especially 
the use of a hot (7o°-75°) and moist atmosphere (Wa). Ipecacuanha, as 
emetic, the wine in doses of 3 j, repeated at short intervals until vomiting is 
induced (Tirard); inferior to Mercury (B); in severe cases vomiting should 
be caused 2 or 3 times a day, and should be commenced early (R) ; Apomor- 
phine, effective, but highly dangerous (B). Senega, is considered a valuable 
auxiliary (P) ; has been employed (R). Quinine, in full doses is highly useful 
(B). Ferric Chloride, may be combined with the preceding, in doses of 3-5 
drops of the tincture at the same age (M & P) ; the combination makes a 
highly antiseptic gargle. Phenol, 5 ij of a 5 per cent, solution, with Creosote, 
5jr an d powdered Acacia 3ij, rubbed together and put into a bronchitis 
kettle with a pint of water, the vapor to be constantly inhaled (Tirard). 



CYANOSIS — CYSTITIS ACUTE. 629 

Sulphurous Acid, as spray, hourly or more frequently (R). Tannin, a 5 per 
cent, spray, several times a day for 15 or 20 minutes at a time (R). 
Hydrogen Dioxide, the solution, 1 in 4 of water, copiously sprayed over the 
nose, throat, mouth, etc., to destroy the membranes and prevent their repro- 
duction. Iodine, the tincture externally, affords great relief. Water, as 
warm bath, hot fomentations or compresses to the throat; watery vapor in 
room. Steam inhalations, with a few drops of Iodine or Bromine. Diet, 
water only in small quantities during attack; supporting diet may be re- 
quired afterward. Intubation, is preferable to tracheotomy whenever prac- 
ticable (Tirard). Tracheotomy, is justifiable if intubation fails or if facilities 
for intubation are not available. [Compare Laryngitis, Diphtheria.] 

Cyanosis. 

Amyl Nitrite, by inhalation, often gives marked relief when due to spasm. 
Oxygen, by inhalation in the cyanosis of asphyxia from toxic gases or due to 
opium and chloroform narcosis. Venesection is of service when associated 
with dilatation of right heart. Treatment must depend on the nature of the 
lesion or disease giving rise to the cyanotic condition (A). [Compare 
Asphyxia, Asthma, Dyspnea, Heart Affections.] 

Cystitis, Acute. 

Belladonna, is a good remedy in almost every form of vesical irritation 
(G); very useful in recent catarrh from chill, with pain (P). Cantharis, in 
large doses causes inflammation of the urinary tract, but gtt. j of the tincture 
every hour will often relieve vesical catarrh (Smith); in small doses con- 
tinued very efficient (B) ; gtt. j-v of the tincture thrice daily, when bladder 
is irritable, its sphincter weak, and pain along the urethra (P); may be em- 
ployed in cystitis with benefit (R) ; in small doses the best remedy for acute 
cystitis. Aconite, for febrile symptoms (P). Quinine, often useful for 
acute symptoms (B). Iodoform, in suppository for painful cystitis (R). 
Opium, a rectal injection of Starch and Laudanum will subdue pain and 
prevent the frequent micturition (R) ; dangerous if the kidneys are diseased 
(P). Alkalies, the Citrates and Bicarbonates if urine is highly acid; stop 
when it becomes alkaline (R). Urotropin, an excellent urinary antiseptic. 
Uriform relieves some of the most distressing symptoms and aids in curing 
the disease. Sodium Salicylate is one of the most effective drugs (Dixon). 
Salol in emulsion or with milk, is of service. Argyrol, a 1 to 1000 solution 
by irrigation, followed by a 5 to 10 per cent, solution injected into the 
bladder and retained five minutes (Small). Mercurol, a 1 per cent, solution 
freshly prepared, as wash for the bladder, highly successful. Cannabis, an 
excellent anodyne in all bladder cases, having specific effect on that organ. 
Vaccine, acute or subacute cystitis following catheterization after labor or 
surgical operations or occurring in children is usually caused by a member of 
the group of colon bacilli (K). Exceptionally the infection may be due to 
another micro-organism, either alone or in conjunction with Bacillus coli (K). 
Treatment with an autogenous vaccine may be of distinct aid in lessening 
the symptoms and in reducing the amount of pus (K). The initial adult 
dose of Bacillus coli vaccine should be about from 50,000,000 to 100,000,000 
bacilli (K). Rest in horizontal posture, mucilaginous drink, hot f omenta- 



630 



CYSTITIS, CHRONIC. 



tions and hip-baths, laxatives for the bowels, light food. Milk-diet often 
necessary, especially in children. [Compare Bladder Irritable, Calculi, 
Dysuria, Enuresis, Hematuria.] 



]$. Atropinae Sulphatis, gr. j. 

Acidi Acetici, gtt. xx. 

Alcoholis, 

Aquae, aa gss. 

M. Sig. — Four drops in a winegl. of 
water before each meal. (G.). 



1$. Opii Pulveris, gr. xij. 

Camphorae, gr. xxx. 

Ext. Belladonnae Fol., gr. iij. 

01. Theobrom., q. s. 

M. et div. in supposit. no: vj. 
Sig. — One to be used at bed-time. 



Cystitis, Chronic. 

Benzoic Acid, and the Benzoates, in chronic cystitis from any cause, when 
urine is alkaline (B) ; has some balsamic character, and is useful in some cases 
of chronic cystitis; gr. xxiv in the day at least, in pills made with Glycerin 
(Thompson). Sodii Benzoas, 5j in Tinct. Gelsemii 3ij-iij, and water to 
§vj, makes an excellent wash for painful cystitis of old men with enlarged 
prostate; a fluidounce should be warmed and injected and retained 20 to 30 
minutes (Copeland). Alkalies, when urine is acid; the Liq. Pot. Hydrox. 
with Hyoscyamus as an anodyne, preferred notwithstanding its chemical 
incompatibility, to control painful and frequent micturition (Thompson); 
Bicarbonates or Citrates better, as the strong reaction of liq. potassae unfits 
it to be given in doses sufficiently large to affect in any great degree the reac- 
tion of the urine (R). Buchu, is probably the most efficient of the urino- 
genital remedies, the fluidextract in doses of Tfl.x-5j (B); the best drug in 
chronic cystitis, especially when the catarrh implicates the ureters or the 
kidneys themselves, producing considerable muco-purulent discharge (P). 
Uva Ursi, is decidedly effective (P); is less so than Buchu (B). Copaiba, is 
very useful by virtue of its local action on the mucous membrane, but objec- 
tionable for its nauseous taste and resulting gastric disturbance (B). Cubeb, 
is often useful from its stimulating effect (P). Urotropin as a urinary anti- 
septic, gives the best bactericidal results (Sachs) ; cured 40 per cent, and re- 
markably improved the rest, of 54 cases due to bacterial invasion (Goldberg). 
Turpentine has been useful in many cases (R); when cystitis is due to ure- 
thral inflammation or prostatic disease (B). Juniper, the oil is indicated 
under the same conditions as is Turpentine (B). Eucalyptus, there is no 
more efficient remedy in chronic cystitis than this (B); the oxygenated oil of 
Merck is best, in doses of 3 drops on sugar every 6 or 8 hours. Salicylic Acid, 
in large doses, either internally or by injection into the bladder, is most effi- 
cient (B); the acid or Salicylates often useful to prevent decomposition (P). 
Salol, proves an efficient disinfectant, as its constituents are excreted with 
the urine. Camphoric Acid, in J to 3 per cent, solution in hot water, as injec- 
tion, has cured several cases. Phenol and Phenolsulphonates, as urinary 
disinfectants (R). Iodoform, gjss of a 10 per cent, emulsion in glycerin, 
diluted with 5 j or more of some non-irritant fluid, by intravesical injection 
every second day, is uniformly beneficial in obstinate cases not due to special 
complication (Frendenburg) . Picric Acid, a solution instilled into the empty 
bladder is most efficient in tuberculous cystitis (Guillou). Ergotin hypoder- 
mically, increases the contractile power of the bladder, and enables it to 
empty itself more perfectly. Silver Nitrate solution by intravesical injec- 
tion after washing out the bladder with warm water, gr. ij to the § of dis- 
tilled water (Ricord); gr. j in §iv to begin with, increased gradually to gr. 



CYSTS — DEAFNESS. 63 1 

f to the 5 at most (Thompson); stronger solutions are advocated by Pro- 
fessor Richardson of New Orleans, and Professor Gardiner of McGill College, 
Montreal; in the writer's experience a solution of gr. v to the % used as a 
vesical wash, has been promptly efficient in curing many cases which resisted 
other treatment for months, — it sometimes produces serious symptoms, and 
it is therefore well to have a neutralizing solution of Sodium Chloride on hand 
for use if required. Other Injections, which may be used to wash out the 
bladder are, — Lead Acetate, gr. j to §iv of warm water, once daily; Nitric 
Acid, dilute, Tflj-ij to 5j of water; Tannic Acid, gr. j to §j; Borax, §j in 
§ ij of glycerin and 5 ij of water, of which § ss in § iv of warm water for one 
injection; Quinine, gr. j-ij to § j of water, with a drop of Acetic Acid. All 
injections must be used with great care, not more than § ij forced in at once 
and that very slowly; use flexible catheter, warm solutions, and a rubber 
injecting-bottle with a long nozzle and stop-cock (Thompson) ; washing the 
bladder is of great value (R). Evacuation of the urine, some of which is 
often retained in the bladder, is a matter of great importance. [Compare 
Bladder Irritable, Calculus, Dysuria, Enuresis, Hematuria.] 

1$. Hexamethylenamina, 5ij- 

Ft. capsules no. xxiv. 

Sig. — One capsule 4th hour. 

Cysts. 

Surgical Treatment is necessary for most cysts. For the technic for 
removal of cysts the reader is referred to books on surgery. 

Deafness. 

Quinine, often causes deafness (Brown-Sequard). Tannin, the glycerite 
as application for throat deafness (R). Gelsemium, the tincture, TTixv-xx, 
repeated 2 or 3 times a day, is often useful in the treatment of nervous deaf- 
ness, and seems to have an influence on the organ of hearing similar to that 
of Nux Vomica on the organ of sight. Thiosinamin for deafness due to 
thickening of the drum or fixation of the aural bones. Fibrolysin by injec- 
tion into the arm has given considerable satisfaction by improving deafness 
(Snowman). Potassium Bromide in 20-grain doses thrice daily is sometimes 
beneficial in Meniere's disease (O). Salicylates are recommended in the 
same affection (O). Nitroglycerin in very small doses at first, gradually in- 
creased, in cases where there is increased arterial tension, sometimes acts very 
satisfactorily (O). Colchicum, when from gout in ear (A). Cantharides, as 
ointment; gr. xxx ad § j Adipis, below and behind the ear bis die, with altera- 
tive mercurial treatment, in deafness from thickened tympanum (Wa). 
Gargles, in throat-deafness are of great value; of Potassium Nitrate, or 
Borax, in sthenic cases; tincture of Capsicum added in nervous forms; of 
Hydrargyrum Bichloride when from secondary syphilis (Wa). Water, wash- 
ing in "warm water, in deafness from general debility (Toynbee). Faradiza- 
tion of the ear in nervous deafness, in which slight results only to be expected 
from the treatment (R); demands the utmost caution (Wa). Inflation, by 
the Politzer bag, or Eustachian catheter, in throat deafness. Remove wax 
from the external canal. 



DELIRIUM DELIRIUM TREMENS. 



Delirium. 



Belladonna, in delirium of typhus and other fevers (R); in severe forms 
of delirium (P). Hyoscyamus, in delirium of typhus; for the mild, less 
inflammatory form, with hallucinations, nervous excitement, little cerebral 
congestion (P). Stramonium, in wild and furious delirium of puerperal 
mania, with general restlessness and suicidal or destructive tendency (Wa); 
no drug deserving of more confidence in the greater number of maniacal cases 
(Cullen). Opium, in traumatic delirium, as a rectal injection, combined 
with Tartar Emetic in fevers; or better still Morphine hypodermically. 
Laudanum in low, muttering delirium (R); is regarded with suspicion (P). 
Cannabis, the extract in doses of gr. J-§ in nocturnal delirium occurring in 
softening of the brain (Wa). Potassium Bromide, in delirium resembling 
delirium tremens (R). Camphor Monobromide, useful in rambling delirium 
(Wa). Camphor, in 20 grain doses, every 2 or 3 hours, especially in low 
muttering delirium (R). Chloral, in violent delirium of fevers (R). [See 
Fever.] Water, the cold douche in maniacal delirium; place patient in warm 
bath during application (R). [Compare Cerebral Congestion, Fever, 
Mania.] 

Delirium Tremens. 

Chloral, at outset (R) ; very successful, but dangerous to old drunkards or 
when heart disease exists (B); the experience of inebriate asylum physicians 
does not bear out the teaching that chloral is very dangerous to old alcoholic 
subjects when under the stimulus of acute alcoholic intoxication, it being by 
them commonly given in 30-grain doses every 3 or 4 hours until sleep is 
induced, without apparent danger. Belladonna, of proven efficacy when 
congestion of the brain (P); useful for the insomnia when coma vigil, cold 
surface, cyanosis (B). Hyoscyamus, in some forms admirable (P). 
Scopolamine, is a useful drug in delirium tremens, and in other affections in 
which tremor is a marked symptom (Weatherly). Ergot in 3 doses of the 
fluidextract, every 4 hours, proves of greater value than any other drug 
(Ranson); and has reduced the mortality from 51 to 30 per cent. (Id). 
Opium, cautiously, if at all (B); as rectal injection, hypodermically or with 
spirits; if patient strong, delirium boisterous, and pulse full, add Tartar 
Emetic or Aconite (R) . Apomorphine or some other hypnotic to induce sleep, 
instead of using physical restraint (Douglas). Potassium Bromide 3j 
every 4 to 6 hours in the " horrors" preceding Delirium (B); bromides are of 
less value in the delirium, and in subsequent attacks (R) ; a mixture of Potas- 
sium Bromide and Hydrated Chloral in solution, gr. xxx of each every 2 hours 
until sleep is secured, is very efficient in strong subjects; Ammonium Bromide 
has been used with very good results (Wa). Veronal or Medinal, acts 
promptly as a hypnotic (Krug). Cannabis, gr. ss-j of extract, one of the 
least dangerous and most useful hypnotics (P). Capsicum, to induce sleep 
in early stages, gr. xx-xxx in a bolus with honey, repeated after three hours 
(R) ; in 20-30 gr. doses has remarkable success (P) ; the tincture in 5 ss doses 
every three hours of great benefit (Wa). Caffeine is a physiological antago- 
nist to alcohol (Hall) ; Coffee is often very useful in delirium tremens (P) . 
Digitalis, 3ss of tincture repeated in 4 to 6 hours (P), a tablesp. of the infu- 
sion every 4 hours in pale subjects, where anemia of brain, with effusion and 



DEMENTIA PARALYTICA — DENGUE. 



633 



edema (B) ; has cured many cases promptly without producing any unfavor- 
able symptoms; its safety and efficacy are alike questionable (Wa); is very 
dangerous treatment (Br) ; the evidence of the value and safety of the remedy 
is too strong to be overlooked (W). Quinine, with a mineral acid to restore 
digestion, in the " horrors," and in adynamic states (B); gr. j two or three 
times daily as a tonic, the best agent to produce nervous tranquillity (Anstie). 
Ammonium Carbonate, when anemia of brain and feeble heart-action (B). 
Alcohol, of undoubted use where failure of stomach to appropriate food (B); 
in some form is necessary, as its sudden withdrawal aggravates this condition 
and frequently causes it (Douglas) ; is best omitted entirely from the treat- 
ment, the experience in inebriate asylums showing that cases recover more 
rapidly and surely without alcohol. Water, about 6o° with ice to head, to 
reduce temperature in the hyperpyrexia (R). Treatment, should tend to 
nourishment and establishing of digestion; concentrated liquid food with 
moderate use of stimulants (H). Diet and Hygiene, the immediate source 
of danger is exhaustion, hence animalized and nutritious, digestible diet 
should be used in fluid form, small quantities frequently repeated; beef- tea, 
soups, yolk of eggs, warm milk, cocoa, cayenne pepper or stimulants in soups; 
coffee, to still nervous excitement; hot baths and wet pack to eliminate the 
poison, a quiet, dark room. Kumyss is a valuable nutrient. [Compare 
Alcoholism, Poisoning by Alcohol.] 



1$. Tinct. Capsici, 

Fluidextr. Lupulini, aa 5j. 

Mucil. Acaciae, 5ss. 

Aquae Cinnamomi, ojss. 

M. Sig. — Dessertsp. as required for the 
wakefulness and excitement which precede 
an attack of delirium tremens. 



1$. Chlorali Hydrati, 5 vj. 

Fluidextr. Conii, 5iij- 

Fluidextr. Hyoscyami, 5iv. 

Mucil. Acaciae, 5ij- 

Aquae Menth. Virid, ad §ij. 

M. Sig. — Teaspoonful in water after 

each meal, to prevent delirium tremens. 



Dementia Paralytica. 

Physostigma, has seemed to retard the progress of the disease in some few 
cases (B). Paraldehyde, in one or two drachm doses as a calmative and 
hypnotic, is as efficient as Chloral and without danger (B). Tonics, may be 
used, though treatment is only palliative; Calcium Lactophosphate, Cod- 
liver Oil, etc. ; no remedies have hitherto been of any avail. 



Dengue. 

Prophylaxis. — This would seem to rest entirely upon the question of des- 
truction of mosquitoes and prevention of the mosquito from biting a patient 
(Stitt). In dengue the virus is apparently in the blood for 4 or 5 days 
so that screening of patients is necessitated for a longer period than for 
yellow fever (Id). Phenacetine may be given for the headache and back- 
ache. Opium, in some form for the pains and nocturnal restlessness. Sali- 
cylic Acid or Salicylates, for the pains in joints and muscles. Phenol, as 
lotion, a 4 per cent, solution for the itching, or Camphorated Oil. Bella- 
donna, confers great relief, Tllx-xv of the tincture may be given every hour 
for two or three doses (Fayrer). Aconite, with salines and Nitrous Ether, 
during the pyrexia, which may be so high that cold sponging or the cold 
bath may be required. Bitter Tonics, as Gentian or Calumba, with Quinine 



634 DENTITION — DERMATITIS HERPETIFORMIS. 

and a mineral acid or Strychnine during convalescence. Hydrotherapy, cold 
sponges are of value for sleeplessness. Treatment is entirely symptomatic. 

Dentition. 

Belladonna, in convulsions of dentition, rarely fails to relieve (P). Hyos- 
cyamus, to alleviate pain and subdue irritation; better than Opium for chil- 
dren (P). Potassium Bromide, for irritability and convulsions in teething 
(R). Calumba, excellent for the accompanying vomiting and diarrhea (P). 
Rhubarb, with Soda, internally for the aphthae, with perfect cleanliness of 
the mouth and a wash of Borax or Potassium Chlorate in Glycerin, gr. x to 
the g (E. Smith). Castor Oil, for the diarrhea of dentition to clear out the 
bowels, then a mixture of Chalk and Catechu, or Zinc Oxide gr. j to the dose, 
with gtt. j of Laudanum if required to reduce peristalsis (Id). Lancing the 
Gums to relieve tension when gum is actually swollen; should not be in- 
dulged in indiscriminately. 



B;. Potassii Bromidi, 3j- 

Olei Anisi, ttjnj. 

Mucil. Acaciae, 



Sodii Bromidi, Sodii Bicarb., 

Chlorali Hydrati, aa gr. xx. 

Aq. Menth. Viridis, gjss. 



Aq. Menth. Pip., aa 5 j. Syr. Zingiberis, gss. 

M. Sig. — Teasp. every half-hour until ! M. Sig. — Half-teasp. to a dessertspoon- 
the child is relieved. (B.) | ful, according to age. 

Dermatitis Herpetiformis. 

" As this disease is looked upon to be partly neurotic in origin, to effect a 
successful cure it is necessary to keep in view the avoidance or correction of 
any factor detrimental to the nervous equilibrium" (Stelwagon). 

Diet should be full, plainly cooked with no fried foods or rich dessert. 
Alcohol in any form should be absolutely prohibited. Bowels should be 
kept open and Magnesium Sulphate or other laxatives given at frequent 
intervals. Tonics in the form of Iron, Quinine and Strychnia are indicated. 
The blebs, if large, should be opened and the contents carefully evacuated. 
Arsenic in the form of Arsenous Acid, grain t -J-q to jfc t. i. d. or Fowler's 
Solution, Tfl.ij to v, t. i. d. is very frequently of value. Autoserum Injections 
in extreme cases should be tried as the reports of various observers have been 
sufficiently good to warrant a trial. Cod -liver Oil in persons of depressed 
general nutrition is a remedy of value (Stelwagon). Emetine has been ad- 
vised by Engmann and Davis, but in the few cases in which I have tried it, 
it has not proved of any benefit. Ichthyol in an aqueous solution, io per 
cent., is of value, particularly when combined with i per cent, carbolic acid. 
Laundry Starch, a teacupful to the basin of cool water, will often give tem- 
porary relief. Liquor Carbonis Detergens or the Tinctura Picis Mineralis 
Comp. is of great value in this disease, from io to 50 per cent, in water, 
applied every three or four hours. Lysol, 1 ounce to a half tub of water will 
give temporary relief from the intense itching. Salicin is used in 5 to 15 
grain doses. Salvarsan, in some cases has been used with beneficial results. 
Sodium Cacodylate, gr. i\ to 3 gr. every two to five days is very valuable 
and is now being extensively used. Sulphur, 10 to 30 grains to the ounce 
of petrolatum, is of value, particularly if Carbolic Acid is added. Tar is a 



DERMATITIS MEDICAMENTOSA — DERMATITIS SEBORRHCEICA. 635 

very efficient remedy if it can be used where the odor is not objectionable. 
Thyroid Extract has been recommended as having a favorable influence 
(Sutton). For further drugs and treatment of this disease, refer to Eczema. 

Dermatitis Medicamentosa. Drug Eruption. 

Eruptions caused by the ingestion or absorption of certain drugs. It is 
necessary to first ascertain the cause and withdraw the particular drug which 
is producing the eruption. Frequently this means will be sufficient in the 
milder cases to effect a speedy cure. See page 663. 

In others, the withdrawal of the drug, free purgatives, with mild soothing 
remedies, such as lotions containing Boric Acid, Zinc Oxide and Powdered 
Calamine will prove sufficient. Calomel, 1 to 2 grains in divided doses, is 
indicated followed by Salts in the morning. Castor Oil may be used in 
severe cases to produce purging. Laxative medicines or waters are indicated 
through the course of the trouble as it is of the utmost importance that the 
intestinal tract be kept as free as possible. Phenol, 5 minims to the ounce, 
is indicated in all cases where there is itching. For further treatment, see 
Eczema. 

Dermatitis, Occupational. Trade Dermatitis. 

Obviously, it is of prime importance to remove the cause but this is not 
always possible as the patient may be trained in only one line of work which 
is probably his sole means of livelihood. It very frequently happens that 
with this type of eruption, the patient may have worked in the same material 
for many years when suddenly there develops this form of eruption. Un- 
fortunately, after it has once been produced, there is always the danger of a 
recurrence. 

Eruptions are quite common in leather and dye workers and among those 
who work among chemicals. Photographers and tanners frequently have 
it and an excellent way to prevent the eruption has been suggested by Da 
Costa: Three parts of petrolatum are mixed with one part of lanolin. This 
mixture is melted on a water-bath or stove and when melted and thoroughly 
mixed, 10 to 15 drops of 90 per cent, carbolic acid are added to every 400 
grammes of the mixture. This represents 5 drops of acid to 4 grammes 
of ointment. The material is placed into a glass or earthenware jar and 
allowed to solidify until ready for use. The workman cleanses his hands 
and arms thoroughly with soap and water, rinses with warm water and, 
while the parts are still moist, applies the ointment. He rubs it over the 
whole exposed area for about 2 or 3 minutes. He then takes a clean cloth 
and wipes the skin entirely dry. For further treatment, see Eczema. 

Dermatitis Seborrhoeica. 

< As the eruption of seborrhceic dermatitis is at times very similar to that 
of Eczema and as the underlying factors in both may be the same, the treat- 
ment of this disease is that described under the head of Eczema. Particular 
attention must be paid to ascertaining the cause, and if possible remove it; 
the bowels should be kept open, the diet restricted and of a plain nourish- 



636 DERMATITIS SOLARE — DERMATITIS VENANATA. 

ing type. General tonics may be indicated and at times nerve sedatives. 
For washing the hands, Almond Meal may take the place of soap. Bismuth 
Subnitrate is of considerable value. See prescription (page 656). Boric 
Acid is largely used in acute cases, a saturated solution in water or \ to 1 
drachm to the ounce of petrolatum. In the subacute conditions, Calomel 
and Hydrarg/ Ammoniata, 10 to 20 grains, to the ounce of Petrolatum are 
of value. Carbolic Acid is the most efficacious drug in abating the itching. 
In the chronic type, Chrysarobin, 5 to 10 grains in chloroform or in petro- 
latum, is of value. One of our most valuable drugs is Powdered Calamine. 
See prescription (page 656). Diachylon Ointment, a lead preparation, may 
be tried in the subacute stage. For this condition, Ichthyol is of considerable 
value; for the acute condition, highly diluted, and full strength for the 
chronic. Lysol, 4 drachms to the tub of water usually affords temporary re- 
lief. Picric Acid, 1 to 2 per cent, in alcohol, painted over small areas may 
be of some value in the chronic cases. In the chronic conditions, Resorcin, 
5 to 30 grains to the ounce in water or an ointment base is of value. Zinc 
Oxide is of special value in many cases, either used in combination with 
other drugs or in the form of Zinc Oxide Ointment. [See Eczema.] 

Dermatitis Solare. Sun Burn. 

Boric Acid and Zinc Oxide are both useful as dusting powders. Carbol- 
ized Vaseline, 5 minims to the ounce, is of considerable value. Greaseless 
Creams, such as prepared by several well-known drug firms, are extremely 
soothing. Witch Hazel applied frequently will allay the burning and itch- 
ing, particularly if covered with talcum powder. For further treatment, 
see Acute Eczema. 

]$. Tine, of Benzoin, f5jss. 

Phenolis, tt£v. 

Ung. Aquae Rosas, q.s. 5 j- 

M. Sig. — Apply frequently. 

Dermatitis Venanata. 

Inflammation of the skin due to the external irritation from plants, strong 
alkalies, acids and other drugs. It is necessary, if possible, to first ascertain 
the cause and effect its removal. Boric Acid, (Saturated Solution), may be 
used, especially on the face. Calamine -Zinc Oxide Lotion as given on page 
656 is particularly soothing, especially when applied to the face. Fluidextract 
of Grindelia Robusta was formerly very extensively used by the writer in the 
strength of 4 drachms to 4 ounces of water, but the Potassium Permanganate 
Solution has replaced it in Dispensary work. Liquor Plumbi Subacetatis 
Dilutum, in full strength or diluted 50 per cent, in water, is also of great value. 
Olive Oil should be applied for twelve hours on saturated cloths if the lotions 
have caked and become hard and stiff. The parts can then be washed with 
water and green soap and the remedy reapplied. Phenol may be added to 
any of these lotions, 5 grains to the ounce, to allay the itching. Potassium 
Permanganate, 10 to 20 grains to the ounce of water, has proved one of the 
most efficacious methods for treating ivy poisoning. Cloths should be 
soaked in it and applied fresh every three or four hours. For the staining 



DHOBIE ITCH— DIABETES MELLITUS. 



637 



of the skin which results, dilute Oxalic Acid will remove. Sodium Bicar- 
bonate, 30 grains to the ounce of water, is sometimes of value. Sodium 
Hyposulphite, 10 to 40 grains to the ounce, is used at times. If the vesicles 
are large, they should be opened with a sterile needle. 



Dhobie Itch. 

Chrysarobin, 5 to 10 grains to the ounce of petrolatum, may be applied 
twice daily but in certain susceptible patients may produce a marked derma- 
titis and be very painful. Salicylic Acid, 5 to 10 grains to the ounce of 
petrolatum, is useful at times. Silver Nitrate, 2 per cent, solution in 
alcohol, applied daily is of some value. Tincture of Iodine painted on 
every day or every other day is of value but may produce considerable 
inflammation to the surrounding parts. If inflammation from the use of 
any of the above drugs is marked, the following lotions may be applied. 



1$. Bismuthi Subnitratis, 5vj. 

Phenolis, tt^xx. 

Liq. Plumbi Subacetatis Dil. , § ij. 

Aquae, q. s. ad §iv. 

M. Sig. — Apply every 3 hours. 



. Pulvis Calaminae, 

Pulvis Zinci Oxidi, aa 5iv. 

Glycerini, 5 iv. 

Alcoholis, §i. 

Aquae, q. s. ad § iv. 

M. Sig. — Apply every 3 hours. 



Diabetes Insipidus. 

Opium, large doses necessary, gr. vj-xij a day (B) ; combined with Gallic 
Acid, the most generally useful remedy (W). Ergot has cured many cases, 
the fluidextract in doses of 5ss-j thrice daily (Da C); one of the most effi- 
cient remedies (B); is the most useful remedy (R), but if used in large doses 
or long continued, symptoms of ergotism appear and the drug has to be 
stopped (Ralfe). Adrenal Extract, has given good results. Nitroglycerin, 
has been employed with good results (Id). Arsenic, improves the general 
condition and given with other special remedies it greatly increases their 
power (Id). Iron and Strychnine are very useful for tonic effects (Da C). 
Valerian, in large, increasing doses (R) ; restrains the flow of urine but does 
not cure (B). Sodium Salicylate, in small doses, very effective in some cases. 
Potassium Iodide is curative in many cases of syphilitic origin (B). Alum 
has produced good results (B). Pilocarpus, is used successfully to reduce 
the quantity of urine (B). Krameria lessens the quantity of urine (P). 
Diet, a dry diet beneficial (B), but is very difficult to carry out. A salt-free 
diet is recommended (Strauss). 



Diabetes Mellitus. 

Dietetic Treatment* — Allen has defined diabetes as a "specific deficiency 
of the power of assimilating food." In our present conception of the treat- 

* The treatment of diabetes is discussed in detail in the excellent book by Dr. E. P. 
Joslin, "The Treatment of Diabetes Mellitus," Lea & Febiger, Philadelphia, 19 16. An 
excellent summary of the treatment is contained in the Therapeutic Section of the Journal 
of the American Medical Association for September 30, October 7, and October 14, 1916, 
from which the writer has drawn freely in the compilation of this section. 



638 DIABETES MELL1TUS. 

ment of this metabolic disorder it is important to remember that the dietetic 
treatment is paramount and the drug treatment of least importance. The 
recognition that there is a lowered functional capacity not only for the assimi- 
lation of carbohydrates, but also for proteins and fats is the basis for what- 
ever dietetic restrictions are instituted. The object of the treatment, there- 
fore, should be the supplying of a diet below the assimilation limit, thereby 
resting what Allen emphasizes as the underlying cause, namely, a weakened 
pancreatic function. ' The diabetic who constantly indulges in dietetic 
excesses tends to progressively weaken pancreatic function and become 
progressively worse. A diabetic who is given a diet within the tolerance 
limit will gradually manifest an increase in the tolerance and an improvement 
in the condition. Allen, who has studied the question of the treatment of 
diabetes extensively, has formulated a plan of treatment which may be 
outlined as follows: (1) A preliminary fast until the urine is free from sugar. 
(2) Following the fast, carbohydrate food is gradually added, at first in the 
form of green vegetables. (3) Coincident with the addition of carbohydrate, 
or in place of it, if the carbohydrate tolerance is very low, protein is added to 
the diet in small but gradually increasing amounts until glycosuria occurs, 
or a sufficient amount of protein is taken to cover the basal requirement. 
(4) The addition of fats in small amounts during the time of addition of 
carbohydrates and protein. Subsequently, a sufficient amount of fat is 
added to make up the fuel requirements of the body, provided this amount 
can be tolerated without the appearance of glycosuria or acidosis. (5) 
Frequent urine examinations are made, either by the medical attendant or 
by the patient himself, and the appearance of glucose is taken as an indica- 
tion for a fast of sufficient length to cause a cessation of the glycosuria. Feed- 
ing is subsequently begun with not more than one-half of the carbohydrate 
contained in the diet at the time of the appearance of glycosuria. Subse- 
quent carbohydrate increase is made very gradually. (6) At intervals, the 
patient is fasted for a day or else takes a greatly restricted diet. (7) Body 
fat is reduced to a minimum and the adult diabetic is not allowed to gain 
weight; children may gain, but the gain must not be adipose tissue. (8) Active 
daily exercise carried to the point of healthy fatigue is advocated. The 
length of time of the preliminary fast is usually less than five days, although 
in exceptional instances it may be as long as eight or ten days. During this 
time water is allowed freely and tea or coffee (without sugar or cream) in 
moderate amounts. Alcohol, in the form of whiskey, from 1 to 2 ounces 
daily is given by some, but is not considered an essential in the treatment. 
Rest in bed may be necessary for weak patients, but the more vigorous ones 
may exercise with benefit, and in some instances it seems that the duration of 
the fast may be shortened thereby. If during the fast, symptoms referable 
to severe and progressive acidosis occur the fast must be temporarily termi- 
nated and the acidosis treated. The fast is terminated and feeding cau- 
tiously begun when the urine is sugar free for twenty-four hours. Two 
essentials for the preparation of the diet are a scale for the weighing of the 
food and a knowledge of the percentage values of the food principles in the 
different types of food. The latter has been tabulated in a practical form 
by Joslin and is reproduced herewith: 



DIABETES MELLITUS. 



639 



Joslin's Diet Table. 
Strict Diet— Meats, Fish, Broths, Gelatin, Eggs, Butter, Olive Oil, Coffee, Tea and 

Cracked Cocoa. 
Foods Arranged Approximately According to Percentage of Carbohydrates. 

Vegetables. 



S Per Cent. 



10 Per Cent. 



15 Per Cent. 



20 Per Cent. 



Lettuce 


Onions 


Green peas 


Potatoes 


Spinach 


Mushrooms 


Artichokes 


Shell beans 


Cauliflower 


Squash 


Parsnips 


Baked beans 


Sauerkraut 


Turnip 


Canned lima beans 


Green corn 


String beans 


Carrots 




Boiled rice 


Celery 


Okra 




Boiled macaroni 


Asparagus 


Beets 






Cucumbers 








Brussels sprouts 








Sorrel 








Endive 








Dandelions 








Swiss chard 








Sea kale 








Tomatoes 








Rhubarb 








Egg plant 








Leeks 








Beet greens 








Watercress 








Cabbage 








Radishes 








Pumpkin 








Kohlrabi 








Broccoli 








Vegetable marrow 









Fruits. 



Ripe olives (20 per 


Lemons 


Apples 


Plums 


cent, fat) 


Oranges 


Pears 


Bananas 


Grapefruit 


Cranberries 


Apricots 
Blueberries 






Strawberries 






Blackberriers 


Cherries 






Gooseberries 


Currants 






Peaches 


Raspberries 






Pineapple 


Huckleberries 






Watermelon 







Nuts. 



Butternuts 
Pignolias 


Brazil nuts 
Black walnuts 
Hickory- 
Pecans 
Filberts 


Almonds 
Walnuts (Eng.) 
Beechnuts 
Pistachios 
Pinenuts 


Peanuts 


40 Per Cent. 




Chestnuts 


Miscellaneous . — Uns we< 
pickles, clams, oysters 
roe 


r Cent. 

Jtened and unspiced 

, scallops, liver, fish 


Reckon actually available carbohydrates 
in vegetables of 5 per cent, group as 3 
per cent., of 10 per cent, group as 6 
per cent. 



640 DIABETES MELLITUS. 

Thirty gm. or 1 ounce, of each of the following contain approximately: 



Oatmeal, dry weight 

Meat (uncooked) . . . . , 

Meat (cooked) 

Broth 

Potato 

Bacon (cooked) 

Cream, 40 per cent 

Cream, 20 per cent 

Milk 

Bread 

Butter 

Egg (one) 

Brazil nuts 

Orange (one) 

Grapefruit (one) 

Vegetables, 5 and 10 per cent, groups 



Protein, 
Gm. 


Fat, 
Gm. 


Carbo- 
hydrates, 
Gm. 


5 


2 


20 


6 


2 





8 


3 


O 


0.7 





O 


1 





6 


5 


IS 





1 


12 


1 


1 


6 


1 


1 


1 


2 


3 





18 





25 





6 


5 





5 


20 


2 








10 








10 


0.5 





1 



Calo- 
ries. 



40 

60 

3 

30 

155 

120 

60 

20 

90 

240 

75 

210 

40 

40 

6 



1 gm. protein, 4 calories. 

1 gm. fat, 9 calories. 

6.25 gm. protein contain 1 gm. nitrogen. 

30 grams (gm.) or cubic centimeters (c.c), 1 ounce. 

A patient "at rest" requires from 25 to 30 calories per kilogram body weight. 

1 gm. carbohydrate, 4 calories. 

1 gm. alcohol, 7 calories. 

1 kilogram, 2.2 pounds. $ 



The day the feeding is started the patient is given from 1 50 to 200 gm. of 

the vegetables of the 5 per cent, group. These so called "green vegetables" 
contain a very small quantity of available carbohydrate (approximately 5 gm.) 
and only traces of protein and fat. Their bulk serves to fill the stomach and 
allay, to a certain extent, the hunger, and by their residue tends to prevent 
constipation. If no glycosuria occurs 5 gm. of carbohydrate are added every 
day until 20 gm. are given, then every other day until the patient is receiv- 
ing as much as 3 gm. of carbohydrate per kilogram of body weight in 24 
hours (Joslin). After the first day or two carbohydrates may be given in 
the form of vegetables of the 10 per cent, group, followed subsequently by 
those of the 15 and 20 per cent, groups. Fruits are then added and ulti- 
mately if glycosuria has not supervened, bread and oatmeal. Ordinary 
bread is but seldom included in the dietary of the diabetic. There are on 
the market a large number of brands of "gluten" and "diabetic" flour which 
contain relatively little carbohydrate and much protein. Bread made from 
such flour, provided the composition is accurately known, may be eaten. 
These special brands of flour, however, are expensive and many are fraudu- 
lent. The patient's longing for bread may, in a measure, be satisfied by 
bran biscuits. These contain no carbohydrate and serve as a convenient 
vehicle for the administration of butter or other fats. The bulky residue 
fills the stomach and relieves constipation. The appearance of glucose in 
the urine means that the patient's assimilative limits have been exceeded 
and a fast must be instituted until the glycosuria ceases. Following the 
fast, the carbohydrate ration should be diminished by one-half and not in- 
creased beyond this amount for some days and then very cautiously. The 



DIABETES MELLITUS. 641 

amount should be kept well within the limit of tolerance previously deter- 
mined for a considerable period of time. Subsequently, if there is reason to 
suppose the patient can assimilate more carbohydrate, the limit of tolerance 
may again be determined by gradual addition of carbohydrate, even to a 
point in excess of the former tolerance. The addition of protein to the diet 
may be made in most cases during the period when the carbohydrate toler- 
ance is being tested. At first one egg, then two, three, four eggs, and lean 
meat until the patient receives about i gm. of protein per kilogram of body 
weight. Later this may be increased to i^ gm. and in children 2 gm. of 
protein per kilogram. In exceptionally severe cases of diabetes it may be 
necessary to test the protein tolerance by feeding exclusively protein foods 
until glycosuria appears; in the same way the carbohydrate tolerance is 
tested. The fats are added to the diet when the amount of protein fed has 
reached 1 gm. per kilogram body weight. These are added in increasing 
amounts (25 gm. a day) until the caloric requirement of from 25 to 40 calories 
per kilogram of body weight is covered by the total food intake. Patients 
who are exercising require a higher caloric intake than when resting, and 
growing children up to as much as 50 or 60 calories per kilogram, depending 
on the age. The caloric intake should eventually be such that a progressive 
loss of weight does not occur. On the other hand, the patient must not 
gain in weight, or, more correctly, he must not gain in adipose tissue, though 
muscular development is allowable. Fat, besides that obtained in the eggs 
and meat fed, may be supplied in the form of bacon, cream, olive oil or butter. 
If acidosis appears, it is advisable to substitute olive oil for butter and cream 
or to use washed butter. Weekly Fast Days. — For a long time it has been rec- 
ognized that days of partial or complete fasting are of benefit to the diabetic. 
Joslin's rule is to fast all patients once a week whose tolerance for carbohydrates 
is less than 20 gm. When the tolerance is between 20 and 50 gm., 5 per 
cent, green vegetables and one-half the usual quantity of protein and fat are 
allowed on the fast days; when the tolerance is between 50 and 100 gm. of 
carbohydrates, the 10 and 15 per cent, vegetables are allowed as well. If 
the tolerance is more than 100 gm. of carbohydrate, the carbohydrate intake 
is halved on the weekly fast days. The treatment of Acidosis is seldom 
necessary with proper diet regulations, because under these conditions the 
development of acidosis of a serious grade is unusual. A few patients do 
develop a severe acidosis during the fasting period and the indications are 
to break the fast by allowing a diet strictly of green vegetables. In such 
cases subsequent fasting frequently causes acidosis to disappear. The 
dietetic treatment outlined above, however, usually prevents any tendency 
toward progressive acidosis. In order to check acidosis temporarily, espe- 
cially if it threatens life, it may be necessary to administer alkalies. This is 
accomplished by giving sodium bicarbonate by mouth, intravenously or 
subcutaneously (rarely). A half to one dram is given by mouth every 3 
or 4 hours until the evidences of acidosis lessen (the estimation of the carbon 
dioxid tension of the alveolar air is extremely simple with the use of the 
Marriott apparatus and is recommended as the easiest and most reliable 
method of estimating the degree of acidosis and the influence of alkali 
therapy). If the patient is unable to retain the alkalies by mouth or has 
approaching coma, the intravenous injection is used. For this purpose a 4 
per cent, solution of sodium bicarbonate may be used and as much as 500 
mils at one time is injected slowly. The injection may be repeated as often 

41 



642 DIARRHEA. 

as the symptoms would indicate or dependent upon the concentration of the 
carbon dioxid tension of the alveolar air. 

Diarrhea. 

Castor Oil, in cathartic dose for diarrhea due to irritating material in the 
intestinal canal, as undigested food or irritant secretions, no remedy more 
useful (B) ; makes a good preparatory treatment for other medication. Bis- 
muth Subgallate, gr. xx-xxx every 2 or 3 hours, does good service. Bis- 
muth Subnitrate, is effective, requires large doses, gr. xxx-lx every 3 or 4 
hours; is especially indicated when desire for stool is felt immediately after 
eating (B); gr. j hourly with milk, sometimes with gr. £ of gray powder in 
various forms of infantile diarrhea (R). Bismuth and Ammonium Citrate, 
in diarrhea without irritation but rather relaxation of the intestinal mucous 
membrane. Bismuth Salicylate, is highly praised in the diarrhea of phthisis 
and in that of typhoid. Sodium Salicylate, gr. ij every 2 to 4 hours to a 
child of 9 months, is almost specific for the diarrhea and sickness of young 
children (Dixon). Mercury in the diarrhea of children with bad digestion, 
flatulent distention and clay-colored, pasty, stinking motions, gr. j of the 
Bichloride to 5 viij of water in doses of 3 j every hour; or still better Hydrarg. 
cum Creta, gr. § every hour or two, will restore the natural bilious color and 
limit the number of the stools (R) ; Calomel in minute doses, gr. -fa to 12 
every half hour, is useful in the diarrhea and dysentery (ileo-colitis) of 
children, when there is much irritability of the stomach (B) ; in mucous 
diarrhea, gr. j of the Bichloride to a quart of water, in doses of 5 j every hour 
(A. A. Smith). Mineral Acids, when painless, watery stools, light-colored 
and alkaline (B). Sulphuric Acid, in summer and choleraic diarrhea; small 
doses in the chronic form and in the straining diarrhea of children (R). 
Magnesium Sulphate, a teaspoonful in a wineglass of water every 3 hours 
when intestinal inflammation (B) ; very efficient in acute diarrhea of soldiers. 

Nitrous Acid is specific in serous diarrhea and the sudden, acute form of 
hot climates (Hope) ; as in Hope's mixture (see formula below) a very efficient 
remedy in serous diarrhea with disordered secretion of the liver and other 
glands of the alimentary canal (W) . Tannalbin, is useful in the acute form, 
but especially in chronic diarrheas (Einhorn); also in that of phthisis (Gale). 
Haematoxylon, is devoid of irritating qualities and is well adapted to the 
diarrheas of young children. Calumba, in diarrhea due to relaxation of the 
mucous membrane and not dependent on inflammation (B). Gambir, in 
atonic diarrhea and in that following withdrawal of morphine or opium from 
habitues, also in the diarrhea of children; in the latter the tincture with 
Chalk-mixture is very serviceable. Kino, in atonic diarrhea; the tincture 
in doses of 5 j for the diarrhea resulting from the disuse of opium or morphine. 
Opium, is commonly used, but is best when evacuations are very watery, 
combined with mineral Acids or with Lead Acetate (B); with Starch as an 
injection in severe cases (R); the best form is the camphorated tinct. 3 i j for 
an adult, followed by 5j every 2 hours for 3 or 4 doses. Codeine, gr. ss-j 
answers most satisfactorily in the milder forms of diarrhea and leaves no 
unpleasant after-effects (Braithwaite). 

Camphor, in summer diarrhea and the preliminary diarrhea of Asiatic 
cholera (B); useful in many forms (P). Ipecacuanha, in summer diarrhea 
and dysentery of children with greenish stools (B); hourly drop-doses of the 



DIARRHEA. 



643 



wine, especially if vomiting (R) ; when from nervous irritation, especially in 
young children (P). Podophyllum, in chronic, with high-colored motions 
and cutting pains, also in morning diarrhea (R) ; gr. ^\ to -^ with occasional 
doses of Aconite, for vomiting and diarrhea of gastro-enteritis and prolapse 
of rectum (P). Nux Vomica, a very useful adjunct to other remedies (B); 
is often of much service in the epidemic form of the disease (P). Zinc Salts, 
are very efficient in the summer diarrhea of children (B). Alkalies, Mistura 
Cretae in sour-smelling stools (B); Sodium, Potassium or Magnesium Bicar- 
bonates when acid canal (R). Calcium Carbonate, as Chalk-mixture, in 
the later stages, also in the diarrhea of typhoid or phthisis (R) ; may be com- 
bined with Opium and with vegetable astringents. Lead Acetate, with 
Opium as an injection (R); is excellent in all forms (B). Calcium Chloride 
inhibits peristalsis and is indicated in diarrhea accompanying hysteria or 
any form of nervous irritability (McCallum). Salol, is very emcient in 
acute diarrhea due to action of microbes. Rosorcinol, gives very marked 
satisfaction in the diarrhea of children. Thymol, gr. xx to 5 ij in 24 hours in 
divided doses for adults, is a very emcient internal antiseptic in all cases of 
diarrhea, especially that of phthisis, teething children, and chronic diarrhea 
(Martini) ; avoid alcohol in any form with or after thymol, lest poisoning 
result. Phenol, is very useful in fermentative diarrhea especially combined 
with Bismuth in cholera nostras and cholera infantum (B). Rhubarb 
as a purgative in the early stage to get rid of irritant, afterwards it checks 
the diarrhea (R) ; when torrefied it has no purgative power, but its astringency 
is retained. Silver Nitrate, in diarrhea of children, with white, pasty, and 
offensive stools; combined with Opium the most effective remedy for that of 
phthisis and typhoid (B). Copper Sulphate, the most effective astringent 
in chronic diarrhea and that of phthisis (B). Ergot, in persistent, chronic 
diarrhea (B). Iodine, one or two drops of tincture in diarrhea from atony 
of mucous membrane (B). Lactic Bacillus Preparations give most striking 
results in the acute gastro-enteritis of infants (Metchnikoff). Hypoder- 
moclysis to replace fluid in the vessels in excessive watery diarrhea (Kemp), 
Diet, should consist of light bland food; gruel, rice, arrowroot, whey, barley- 
water, in recent cases; in chronic cases the most digestible but nutritious 
food, as fresh fish, game, raw eggs, rice, mucilaginous drinks ; Milk and Lime- 
water or Soda-water very useful; also raw meat pulp; avoid beef, pork, veal, 
and much starchy food. In most forms of diarrhea in children it is wise to 
cut off milk and substitute some artificial food (R). [Compare Dysentery, 
Cholera.] 



3$. Acidi Nitrosi, 5 j. 

Misturae Camphor as, Sviij. 

Misce et adde — 

Tinct. Opii,. tt^xL 

Sig. — One-fourth part every 3 or 4 hours. 
(Hope's Mixture original formula.) 



Ifc. Ac. Nitrici Diluti, 5ij- 

Tinct. Camphorae, 

Tinct. Opii, aa 3 j- 

Syr. Zingiberis, 5iv. 

Aq. JMenthse Pip.,. . .q. s. ad gvj. 
M. Sig. — Tablesp. doses to be used after 
a cathartic. (Hope's Mixture as modified by 
Thompson.) 



]$. Tinct. Opii Deodorat., ttjjx. 

Bismuthi Subcarb., 5 jss. 

Syrupi Zingiberis, 5vj. 

Mist Cretae, q. s. ad §iv. 

M. et fiat emulsum. Sig. — A teaspoon- 
ful every 2 or 3 hours, for a child of one year 
old, when the stools are acid and green. 

(Goodhart.) 



1$. Tinct. Opii Camph., 

Tinct. Gambir Comp.,..aa 5iij. 

Mist. Cretae, 5*. 

M. Sig. — A teaspoonful four or five 
times daily for children. 



644 DIPHTHERIA — DROPSY. 

Diphtheria. 

See article on Diphtheria under Serums and Vaccines p. 431. 

Local Applications. Hydrogen Dioxide, a 3 per cent, solution as gargle 
at short intervals; it is much more powerful against young bacilli than against 
those of two days old, and hence its value is especially available at the very 
outset of the disease, and as a prophylactic during epidemics (Traugott). 
Thymol, 5 j in Glycerin § j and Water § iij, is the best agent for use as a gargle 
(Da C). Toluene, with Menthol, Creolin, etc., as in Loeffler's Solution, which 
is applied on a swab of cotton every 3 hours for 4 or 5 days, after cleansing 
the surface ; is highly efficient for destroying the bacilli and preventing absorp- 
tion of toxin (Loeffler). Boracic Acid, in solution as gargle, ranks next best 
after Thymol (Da C). Sulphur and Alum, equal parts, powdered and blown 
into the throat at the moment of deep inspiration, as often as asphyxia is 
threatened, are efficient (Jones); Sulphur is a very old and efficient local 
remedy in diphtheria, the flowers (sublimed sulphur) rubbed up with water 
as a gargle, or blown upon the throat through a quill, was the method of Dr. 
Field, who had a great reputation in England some years ago for curing this 
disease (Lancet). Trypsin, is a good solvent of the false membrane; of all 
remedies used with the spray-atomizer it has given me the largest percentage 
of recoveries (Fruitnight). Sodium Sulphite, 5j to §j, aquae, locally, an 
easily managed application (B); an injection for nares in nasal diphtheria 
(Da C). Phenol, as a spray, a 5 per cent, solution in the atomizer cup; 
locally to the fauces, to remove fetor and destroy disease-germs (B); the 
strong acid in Glycerin as caustic on a mop or brush (W). Ferric Chloride, 
as solution painted on or applied by spray to the throat (R). Chloral, a 
dilute solution in glycerin and water makes an excellent local application for 
the throat; internally may be used as a symptomatic remedy in the early 
stages, but not when the heart is weak. Alcohol, is probably as good a local 
antiseptic as any; diluted with equal parts of water, by hand-ball atomizer 
every J hour; is the prince of antiseptics. Tannin, a 5 per cent, solution as 
spray (R). [Compare Croup Membraneous.] 

3$. Ung. Iodoform! (1 in 10), rubbed in over I fy Potassii Chloratis, gr. lxxx. 

swollen glands every 3 hours. Tinct. Ferri Chloridi, ttjcIx. 



(Grant-Bey.) 



]$. Mentholis, 10 gm. 

Toluene, q. s. ad 36 mils. 

Dein adde — 

Creolini,. 2 mils. 

Liq. Ferri Chloridi, 4 mils. 

Alcoholis, q. s. ad 100 mils. 

Sig. — To be applied by cotton swab every 
3 hours for 4 or 5 days. 

(Loeerffl's Solution.) 



Glycerini, 5 ij- 

Aqua? Destil., q. s. ad 5 viij. 

M. Sig. — 5ss as a gargle; for children 
of 2 to 6 years 5j every hour internally. 

(Jacobi.) 



fy Tinct. Ferri Chloridi, 5 j. 

Syrupi Tolutani, 

Liq. Potassii Citratis, . . . .aa §ijss. 
M. Sig. — Teasp. to dessertsp. according 
to age, every 3 hours; 5j = W* of the 
tincture. (Anderson.) 



Dropsy. 

Arsenic, in dropsy from feebleness of heart, and in old age (B). Digitalis, 
one of the best remedies, especially in cardiac dropsy, when scanty urine 



DROPSY 



645 



and venous engorgement; has high rank as a diuretic under these conditions. 
Apocynum Cannabinum, actively diuretic (P) . Diuretin has been employed 
with marked benefit in both cardiac and renal dropsy, in hepatic cirrhosis, 
and in various diseases of the heart and kidneys accompanied by edema: gr. 
xv several times daily, in aqueous solution, avoiding acids or acid vegetable 
juices. Caffeine, the Citrate in 5-grain doses is eminently diuretic. Hydrar- 
gyrum, a classical pill in dropsy with dyspnea from cardiac disease, is the 
combination of Dr. Baillie, containing Mercury, Digitalis, Squill (see for- 
mula below); Calomel in doses of gr. ss-ij is eminently diuretic, especially 
in cardiac dropsy, but by many it is thought to act by aiding the action of 
other diuretics. Juniper, largely used as a diuretic in cardiac and renal 
dropsy (B); esteemed in post-scarlatinal dropsy (R). Iron, purgative chaly- 
beate waters (B) : the Liquor Ferri et Ammonii Acetatis (Basham's Mixture), 
in anemic dropsy (Da C). Pilocarpus, very valuable in renal dropsy when 
secretion of urine is much reduced or suppressed (B). Jalap, the compound 
Jalap powder, gr. xv-xx, with 3 iij of Potas. Bitart. and a little Ginger, early 
in the morning, 2 or 3 times a week, no hydragogue superior in dropsy from 
Bright's disease (Wa). Colchicum, as a hydragogue in hepatic and cardiac 
dropsy when patient is vigorous, also in post-scarlatinal dropsy (B). Sco- 
parius, esteemed by English physicians (B) ; is most useful in cardiac dropsy; 
Cullen found it the most certain diuretic ; diluents should be freely used with 
it (P). Squill, in cardiac dropsy; cautiously if from kidney disease; if anemic 
add Iron (R). Copaiba, gives good results, especially in ascites. Potassium 
Bitartrate and Acetate, are very certain as diuretics when largely diluted with 
water, as cream-of- tartar lemonade; indicated in desquamative nephritis, 
and in general dropsy from valvular disease of the heart (R). Elaterium, of 
unquestionable value as a derivative in many passive forms of dropsy, 
though many fear it (P). Acupuncture, or better still, incisions from J to an 
inch long, one over each external malleolus generally sufficient; a hot sponge, 
moistened with weak phenol solution kept to incisions (R). Aliment, dry 
diet is of advantage in dropsy of serous cavities (B); should be light in 
acute dropsies; nourishing in chronic. Water not injurious but beneficial 
as drink. Warm baths, tapping for alleviation in incurable cases. A moder- 
ately warm, dry atmosphere. Skim-milk diet said to be of great value in 
renal dropsy. For the milk cure of Karell see article on Bright's Disease. 
[Compare Ascites, Hydrocele, Hydrocephalus, Hydrothorax.] 



fy Pulv. Scillae, _ 

Pulv. Digitalis, aa 5ss. 

Potassii Nitratis, 5j- 

M. Fiat massa et div. in pil. xxx. 
Sig. — One pill thrice daily. 

1$. Elaterini, gr. j. 

Spt. Athens Nitrosi, §ij. 

Tinct. Scillae, 

Tinct. Colchici, aa §ss. 

Syr. Simplicis, 5j. 

M. Sig. — A teaspoonful 3 or 4 times 
daily, for hepatic and cardiac dropsy in 
sthenic subjects. 



Py. Pulv. Digitalis, gr. j-jss. 

Pulv. Scillae, gr. j. 

Hydrarg. cum Creta vel 

Pil. Hydrargyri, gr. j-iij. 

Ft. pil. no. j. Mitte tales xxiv. 

Sig. — One pill thrice daily. (Baillie.) 

If/,. Potassii Acetatis, 3vss. 

Spt. iEtheris Nitrosi, 5ij- 

Aquae, q. s. ad § viij. 

M. Sig. — Tablesp. every 3 or 4 hours. 

fy Aceti Scillae, gss. 

Infusi Digitalis, q. s. ad §iv. 

M. Sig. — A tablesp. 2 or 3 times daily. 



646 DUODENAL CATARRH — DYSENTERY, AMEBIC. 

Duodenal Catarrh. 

Salol, is the most efficient remedy. Sodium Phosphate, 5j four times 
daily, extremely efficient in catarrhal conditions of the duodenum and bile- 
ducts, resulting in jaundice, etc. (B). Vichy Water, in similar conditions, 
probably owes its efficacy to the Sodium Phosphate contained in it (B). 
Potassium Dichromate, in doses of gr. -fa-it tw0 or three times a day, is an 
excellent remedy in so-called duodenal dyspepsia, manifested by a bitter 
taste, coated tongue, pale stools, vomiting of glairy fluid and dull pain in 
right hypochondrium. Arsenic, has been used with success in jaundice from 
catarrh of bile-ducts after duodenal catarrh (B). Aurum salts will often 
remove duodenal catarrh and that of the bile-ducts, also in jaundice there- 
from (B). Podophyllum, in catarrhal and malarial duodenitis. Nitro- 
muriatic Acid, internally in mucous duodenitis; also as bath to right hypo- 
chondrium, 3iij to gal. j, temp, of bath 96 F. (B). Aliment, no starches or 
fats; milk, eggs, oysters, beef -broth, broiled or raw beef steak, white-fish (B); 
the diet should be exclusively animal in order to let the stomach deal with it. 
[Compare Biliousness, Jaundice.] 

Dysentery, Amebic. 

Prophylaxis. — The main consideration is a knowledge of the importance 
of the carrier problem, the stools of all persons preparing food in localities 
where amebic dysentery is prevalent should therefore be examined for the 
4 nucleated cyst of the pathogenic ameba. It must be remembered that 
while emetine controls the dysenteric manifestations of amebiasis it does 
not seem to cause the disappearance of the parasite, so that patients who 
have amebic dysentery tend to become carriers (Stitt). Ipecacuanha is 
highly valued in India and Burmah (Goldsmith); its use is most common in 
tropical climates (W); is considered specific in India, but the non-emetic 
preparation has proved disappointing (Blackham); invaluable in the treat- 
ment of amebic dysentery (Rogers) ; the powdered Brazilian root should be 
used (Vedder); 25 to 30 grains given nightly, after 25 grains of hydrated 
chloral, is very efficient in the amebic form, preventing hepatic abscess 
(Rogers). " The Emetine treatment may now be considered as the specific 
one for amebic dysentery. In Brazilian ipecac about 72 per cent, of the total 
alkaloids is emetine so that it is better than Carthagena ipecac which contains 
only about 40 per cent, of emetine. Emetine was recommended for dysen- 
tery as long ago as 181 7, but owing to the impossibility of differentiating 
between bacillary and amebic dysentery, until recently, this method of 
treatment was little advocated. It is usual to give from J to f grain of eme- 
tine hydrochloride, dissolved in sterile saline, by hypodermic injection into 
the subcutaneous tissues. Some now give as high as 1 grain daily for about 
10 days, but Vedder prefers J grain repeated 3 times daily. In these doses 
there is practically no nausea" (Stitt). Silver Nitrate, in solution gr. xx-xxx 
to the pint, 3 or 4 pints carefully injected once in 3 or 4 days, the remedy of 
greatest value (KiefTer) ; a solution of 1 in 1000 as antiseptic wash daily, up 
to 60 washes in series, entirely successful in many cases of the recurrent form 
of tropical dysentery, having lasted from 1 to 5 years (Gallay, Surgeon- 
Major for French Colonies). Creolin in \ to 1 per cent, solution as injection 
twice daily, has many advantages and ranks next to silver nitrate (Kieffer). 



DYSENTERY, BACILLARY — DYSIDROSIS POMPHOLYX. 647 

Quinine, warm solutions of i in 5000 to 1 in 1000, by rectal injection for 
amebic dysentery (Ty); is amebicide not bactericide. Acetozone, solution 
of 1 in 1000 as injection for amebic dysentery, is both amebicide and bac- 
tericide (Strong). Methylene Blue, gr. ix in Oij of warm saturated solution 
of Boric Acid, a very successful injection in sigmoid cases due to amebae 
(Goldsmith); internally may be of service in amebic cases, being partially 
excreted in the feces (Armstrong). Cold Water enemata are better than 
tepid ones, injections should be either cold or hot to wake up reaction (Kieffer). 
Colostomy was done on an old and bad case of amebic dysentery, the colon 
then irrigated daily with a weak solution of hydrogen peroxide, resulting in 
immediate relief from pain and finally complete cure (Barbat). 

Dysentery, Bacillary. 

Prophylaxis. — "The ease with which water closet seats may be contami- 
nated should make us pay great attention to their disinfection during an 
outbreak of bacillary dysentery. The same applies to the bed clothes of 
such patients sent out for laundering. Great care should be given to the 
washing of one's hands prior to eating. The greatest care must be taken 
with rectal tubes when used for treatment. It is better to make an invari- 
able rule to confine the use of a single tube to a single patient, as the rubber 
tubes are difficult to disinfect other than by boiling and such treatment, 
especially in the tropics, soon ruins the tube" (Stitt). The Vaccination 
against dysentery does not seem to have made much headway owing to the 
very severe reactions following injections of killed cultures of the Shiga 
bacillus (Id) . In the treatment Rest in Bed, and if seen early a preliminary 
course of calomel and a saline is important. The Saline Treatment, sodium 
sulphate 60 grains every 3 hours until the dysenteric stoo]s disappear, 
is highly recommended (Buchanan). The Serum Treatment is considered 
by some to render the best results. The best known serums are those of 
Shiga, Dopter and that prepared by the Lister Institute (Stitt). In the use 
of the serum Shiga recommends a dose of 10 mils for a mild case or two injec- 
tions of 10 mils at intervals of 10 hours for cases of medium severity, while in 
very toxic cases he uses 60 mils in 3 daily doses of 20 mils each (Stitt). Large 
doses, 80 to 120 mils of a polyvalent serum subcutaneously or intramuscularly 
is recommended by Willmore and Savage. Diet should consist of albumin 
and barley water, tea sweetened with lactose and meat juice. Enemata of 
solutions of the organic silver compound are used in chronic forms of the 
disease. 

Dysidrosis, Pompholyx. 

As this condition is frequently of nervous origin, attention must be paid 
to sedatives, etc., and in many cases, to the administration of tonics such as 
Iron, Quinine and Strychnine. Cod-liver Oil and Iron are often extremely 
useful in debilitated subjects with frequent recurrences (Stelwagon). 

Mild lotions will cure an attack in a comparatively short time but where 
it has become extensive with purulent infection, it may be necessary to de- 
nude the upper layers of the skin. Diachylon Ointment applied for 4 or 
5 days will accomplish this purpose, to be followed by some soothing lotion. 
Resorcin, 20 to 30 per cent., may be employed to macerate the superficial 
layer of the skin. Salicylic Acid, 5 to 10 per cent., in petrolatum, will 
accomplish the same purpose. 



648 DYSMENORRHEA. 



1$. Bismuthi Subnitratis, 5vj. 

Phenolis, ttjjxx 

Liq. Plumbi Subacetatis Dil, . 5 ij- 

Aquas, giv 

M. Sig. — Apply locally. 



1$. Pulvis Calaminae, 

Pulvis Zinci Oxidi, aa 5iv. 

Glycerini, 3iv. 

Alcoholis, 5 3. 

Aquae, q. s. ad *>iv. 

M. Sig. — Apply locally as required. 
(For further treatment of an extensive case, see Eczema.) 



Dysmenorrhea. 

Ammonia, the Aromatic Spirit in doses of 5j every 4 hours or oftener, a 
thoroughly trustworthy remedy, and should be used in place of the alcoholic 
stimulants generally prescribed (Illingworth) . Ammonium Acetate, has 
remarkable power over many forms of dysmenorrhea; the Liq. Ammonii 
Acetatis, in % ss doses, with gr. J of Ipecac, every 2 or 3 hours, to keep up the 
action of the skin until the flow is well established (E). Antipyrine, as an 
analgesic, is efficient. Acetanilid, is equally efficient for the pain. Cimici- 
fuga, relieves pain in the congestive variety and is decidedly useful (P); is 
said to be very efficient (R); is valuable (Wa). Sodium Bromide, 40 grains 
in a pint of hot salt solution per rectum, gave me splendid results (Kelly). 
Opium, necessary when pain is very severe; one hypodermic of Morphine at 
each period is often sufficient (Wa). Codeine, when Morphine is not well 
borne, has given very complete satisfaction in several cases; gr. \ to \ morn- 
ing and evening (Oliver). Dionin gives good results as an analgesic (Frankl). 
Cotarnine Hydrochloride, is an excellent remedy, having anodyne and hemo- 
static action (Gottschalk). Gelsemium, Tfl,v-x of the fluidextract every 2 
hours, in the neuralgic form, to relieve pain (B). Sodium Borate, in the 
membranous form, has been used with great benefit combined with Ext. 
Belladonnas (Wa). Camphor, is my favorite remedy, gr. x in mucilage and 
Cinnamon-water; repeat the dose in an hour or two if necessary (Dewees). 
Guaiacum, is very useful (P); drachm doses of the ammoniated tincture 
in the neuralgic or rheumatic forms (B). Cannabis is very useful as 
a palliative in painful menstruation (B) ; gr. ss-j thrice daily to relieve the 
pain (R). Nux Vomica, in neuralgic form; Syrup or Elixir of Iron, Quinine 
and Strychnine (B). Apiol, neuralgic form (B) ; as emmenagogue, night and 
morning, for several days near the period (Wa). Belladonna, in neuralgic 
or spasmodic forms, dark and fetid discharge, crampy pain, and cold chills; 
a suppository or mild injection together with internal administration, 
will relieve (P); in neuralgic dysmenorrhea it will permanently relieve (B). 
Aconite, a valuable remedy when commenced early (P); for the congestive 
form in plethoric subjects (B). Arsenic, gtt. iij-x of Fowler's sol. with gtt. 
x of Tinct. Digitalis, ter die between the periods, gives excellent results 
(A thill); indicated when copious membranous discharge from bowels and 
uterus (R). Hydrastinine, has been used with benefit. [See under Menor- 
rhagia.] Chloralformamide, in one dose of gr. xxx, to prevent an impending- 
attack, has been of service. Chloroform, as the liniment on a flannel 
wrung out of hot water, or by inhalation as an anesthetic when pains very 
severe; sometimes exerts a permanent influence (Wa). Ergot, given when 
the molimen begins, is useful in the congestive form (B). Amyl Nitrite, 
may be inhaled with benefit in the neuralgic variety, especially in chlorotic 
girls (Wa). Ichthyol with Glycerin, on vaginal tampons, also saline ape- 
rients, in the inflammatory cases. Electricity, in neuralgic, a galvanic cur- 
rent; in congestive, the inverse current (B). Croton-chloral, in neuralgic 



DYSPEPSIA. 



649 



form (R). Iron, if depending on anemia (B). Cajuput Oil, said to relieve 
the pain (R). Rue and Sumbul, are reported useful (P). Emetic, of 
Ipecac, with warm covering in bed, feet in hot water, hot ginger tea, Liquor 
Ammonii Acetatis; if pain very severe, a suppository of Morphine and 
Belladonna per rectum; best to avoid anodynes (E). Accessories, spinal 
ice-bag, when scanty discharge; when menorrhagic, hot water spinal-bag; 
sitz-baths, either hot or cold, or cold alone, during intervals. An ice-bag 
over the sacrum is preferred to any other application. 



1$. Ext. Belladonna? FoL, gr. iv. 

Ext. Stramonii, 

Ext. Hyoscyami, aa gr. v. 

Quininae Sulphatis, gr. xl. 

Fiant pil. no. xx. Sig. — One pill thrice 
daily, in neuralgic dysmenorrhea. 



]$. Ext. Opii, gr. v. 

Ext. Cannabis, 

Ext. Hyoscyami, aa gr. x. 

Camphorae, gr. xxv. 

M. Fiant pill. no. x. Sig. — One pill two 
or three times daily. (McLane.) 



Dyspepsia. 

Pancreatin for intestinal indigestion; Liquor Pancreaticus to peptonize 
milk gruel, soups, etc., before administration; in cases of great digestive 
debility. Ingluvin, promotes digestion (B). Pineapple Juice has the power 
of digesting proteins (Marcano) ; the fresh juice is a very constant and power- 
ful digestant of albuminous matters, its ferment being decidedly active in the 
presence of either acids or alkaline carbonates, but most energetic in neutral 
solution and between 122 and 140 F. (Chittenden). Taka -diastase, gr. 
ij-v after meals, is very efficient in amylaceous dyspepsia, in which the diges- 
tion of starches is faulty (Watson) ; an effective substitute for the inefficient 
pancreatic extracts, etc., hitherto employed (Wilcox). Mineral Acids, 
Hydrochloric with Pepsin after meals in atonic dyspepsia; Hydrochloric 
after meals for pyrosis due to abnormal fermentation; Nitro-muriatic for 
dyspepsia with mental despondency, oxalates in urine, offensive gas, sallow 
complexion (R); Phosphoric, dilute, very efficient before meals (Da C). 
Alkaline Mineral Waters, before meals in atonic dyspepsia, and highly useful 
in the dyspepsia of obese subjects (B). Alkalies in acid dyspepsia, Soda being 
the best (W) ; Lime-water is often efficient. Sodium Bicarbonate is the most 
efficient drug for general use, gr. iij-v an hour before meals for atonic form, 
5ss-j two hours after meals in hyperchloridic dyspepsia (Huchard). Nux 
Vomica, gtt. v-x ter in die before meals as stomachic tonic (B) ; when flatu- 
lence, weight on head, and heartburn (R) ; often of the highest possible value 
in simple atonic form, or in the dyspepsia of drunkards (P). Chloroform, 
gtt. xv-xx in sweetened water, when rapid fermentation of food and evolution 
of gas soon after eating; is promptly efficient in giving relief (Willis); a 
highly efficient remedy in acute dyspepsia. Chloral, is a very good remedy 
in doses of 5 to 10 grains in § j of cinnamon water; acts as a gastric antiseptic 
and sedative, and is efficient in the nervous dyspepsia of neurotic subjects 
with severe gastric pain. Opium in small doses, never more than 2 minims 
of the tincture, before meals, often gives excellent results (Smith). Arsenic, 
drop doses of Fowler's solution before meals in irritative dyspepsia (B); also 
when diarrhea is excited by food (R). Ipecacuanha, TUv-x of the wine 
most valuable in atonic and chronic catarrhal dyspepsia (P); constipation, 
depression, food like a heavy weight (R). Hydrastis, gtt. v-xv of the tinc- 
ture before meals, a good stomachic tonic (B) ; in chronic dyspepsia, sluggish 
liver (P). Cinchona, with mineral acids in atonic dyspepsia (P). Taraxa- 



650 



DYSPEPSIA. 



cum, certainly does good in simple atonic dyspepsia (P) . Belladonna, gr. J to 
J of the extract, once a day when there is constipation (R). Bismuth, mixed 
with vegetable Charcoal in flatulent dyspepsia (R); gr. x with same quantity 
of Calcined Magnesia, in chronic gastric catarrh where diet cannot be regu- 
lated (Rose); the subgallate (Dermatol) is said to be an efficient remedy. 
Xanthoxylum, as stomachic tonic, 5j of the fluidextr. in atonic dyspepsia 
(B). Simple Bitters, Gentian is the best; Quassia or Gentian or infusions 
of them as vehicles for acids and alkalies (B); Calumba is easily tolerated 
when the stomach is weak (R) ; Gentian as stomachic and tonic, very useful 
in atonic dyspepsia and that of gouty subjects; the tinct. in some aromatic 
water, or in combination with alkalies and sedatives (Wa); Chirata is par- 
ticularly serviceable in the dyspepsia of gouty subjects. Cascara Sagrada, 
in all cases of dyspepsia associated with a torpid liver and constipation; 
small doses at first, gradually increased (Wa). Salophen, is used with 
decided benefit in intestinal dyspepsia with flatulence. Strontium Bromide, 
is excellent in dyspepsia, also in acetic and lactic fermentations. Aloes, 
combined with other agents, where habitual constipation accompanies 
dyspepsia (R); especially indicated in duodenal dyspepsia, gr. ij-iv with 
Ipecac gr. j-ij two or three times a week (Wa). Water, a dry diet will 
entirely relieve the ice-water dyspepsia, or that due to excessive beer- 
drinking (B); half a tumbler of cold water \ hour before breakfast acts to 
some people as a purgative and removes many dyspeptic symptoms, but 
flatulent dyspepsia is often traceable to excessive water drinking at meals, 
especially that of iced beverages (R). Hot Water, \ a pint to a pint at no°- 
150 F. an hour before each meal and \ an hour before going to bed, each 
draught sipped slowly during 15-30 minutes; as a cure for dyspepsia this is 
an old and efficient practice (Wa). Milk-cure has succeeded admirably (B) ; 
fresh Buttermilk a most excellent article for dyspeptics, as also is Kumyss. 
Diet, avoid tea and hot beverages, over-cooked food, over-feeding and iced- 
water; masticate all food well, eat slowly, small quantities and frequently. 
Active out-of-door habits should be cultivated, and all articles of food known 
to disagree should be strictly avoided. [Compare Biliousness, Flatu- 
lence, Gastralgia, Gastric Acidity, Pyrosis.] 



]$. Acidi Hydrochlorici Diluti,. 5ij- 
Fluidextracti Condurango, . §j. 
Tincturae Cardamomi 

Composite, q. s. ad § iij. 

M. Sig. — Dessertspoonful in water with 

or after each meal. {Hare.) 



]$. Sodii Bicarbonatis, 5ij- 

Tinct. Nucis Vomicae, 5iij. 

Tinct. Gentianse 

Comp., q. s. ad §iv. 

M. Sig. — Two teaspoonfuls before meals. 

fy Tinct. Capsici, ttj>xvj. 

Tinct. Nucis Vom., 5jj. 

Tinct. Gentianae Co., q. s. ad §ij. 
M. Sig. — A teasp. in water thrice daily, 
with gr. i of Aloin at bedtime, avoiding a 
starchy diet. For aggravated dyspepsia 
with constipation. {Da Costa.) 



]$. Creosoti, TT^viij. 

Bismuthi Subcarb., ' . 5ij- 

Glycerini, 

Aq. Menth. Pip., aa §j. 

M. Sig. — To be well shaken. A teasp. 
every 3, 4 or 6 hours, for pain in stomach 
and wind. (B.) 

1$. Ac. Hydrochlorici Dil., 5j. 

Tinct. Capsici, 5ss. 

Tinct. Calumbae, § jss. 

Essence Pepsini, — q. s. ad §iv. 
M. Sig. — Dessertsp. after meals. In 
atonic dyspepsia. {Pancoast.) 



DYSPHAGIA — DYSURIA. 65 1 

Dysphagia. 

Cocaine, the Hydrochloride in solution, 20 per cent., as spray or by swab, 
relieves the dysphagia of phthisical laryngitis (P). Cajuput Oil, in nervous 
dysphagia, used in India with considerable success (P). Potassium Bromide 
in hysterical dysphagia (Wa) ; benefits a curious affection sometimes seen in 
children, who from their birth can swallow solids with ease but choke at 
liquids (R). Sprays of Ammonium Bromide, Chlorine-water, or other seda- 
tive agents in warm solution, for the dysphagia depending on specific disease 
of the larynx (Muirhead). Galvanism, in the vicinity of the esophagus will 
speedily remove hysterical dysphagia (Muirhead). Tonics, as Strychnine, 
Iron and Quinine, for post-diphtheritic dysphagia. Iced Fluids, slowly 
swallowed, will often remove spasmodic dysphagia (Wa). 

Dyspnea. 

Morphine, hypodermically, the most efficient agent in relieving dyspnea 
from cardiac disease, or any other form; but if albumin in the urine it must be 
withheld (Allbutt); controls dyspnea from any cause, more energetically 
than any other agent, giving the very power to breathe (Huchard). Valerian 
has proved useful when nervous (P). Asafoetida, in combination with 
other anti-spasmodics, often very beneficial in dyspnea of chronic bronchitis 
(Wa) . Strychnine, is a stimulant of the respiratory centre, and in small doses 
is useful for the dyspnea of pulmonary affections and that with cardiac pal- 
pitation in hysterical subjects. Arsenic, is efficient in the dyspnea of weak 
heart and in that of chronic bronchitis. Chloroform, a few whiffs give great 
relief in the cough and dyspnea of phthisis and bronchitis (Wa). Ethyl 
Iodide, by inhalation, is very serviceable in many forms (See). Terpin 
Hydrate, of especial value in asthmatic dyspnea, gr. ij every \ hour until gr. 
x are taken (Boyland). Terebene, for the dyspnea of chronic emphysema 
of the lungs; efficient in combating this symptom of various pulmonary 
affections. Bleeding, in a plethoric subject of pneumonia, with firm and 
incompressible pulse, suffering from dyspnea, or much pulmonary embarrass- 
ment and lividity, may be relied on to turn the scale in the patient's favor 
(Whitla). Oxygen inhalations, relieve the dyspnea of advanced phthisis and 
also the cardiac dyspnea connected with mitral disease (P) . Dyspnea is a 
symptom, and may be due to cardiac, pulmonary, pharyngeal, laryngeal or 
tracheal disease (T). [Compare Angina Pectoris, Asthma, Bronchitis, 
Croup, emphysema, Heart Affections', Phthisis, Pneumonia.] 

Dysuria. 

Cannabis, relieves dysuria (R); when bloody urine (P); an excellent 
anodyne in painful affections of the bladder, having specific action on that 
organ. Belladonna and Hyoscyamus, have similar sedative effects in vesi- 
cal and urethral irritation (P). Opium, in suppository, gr. ij combined 
with Hyoscyamus, gr. x, an excellent palliative (P) ; an enema of Laudanum 
or Morphine hypodermically to relieve the strangury 'caused by blisters 
(B). Camphor, is said to relieve strangury (R). Squill, often produces the 
best effects, especially a combination of the Acetum with Spt. Athens 
Nitrosi equal parts, of which 5 ss in 5 ij oi Anise- water, every hour or of tener 
(Wa). Gelsemium, a useful remedy (B). Ergot, in paralytic dysuria, 



652 EAR AFFECTIONS — ECTHYMA. 

with sensation of bladder being imperfectly emptied (P). Alkalies, the 
Citrates, when dysuria from uric acid crystals in young male children (R). 
Nitrous Ether, Spt. ^Etheris Nitrosi, 3j~jss in any convenient vehicle, 
a popular and efficacious remedy (Wa) . Diluent Drinks, freely, especially 
a decoction of Uva Ursi or of Cotton-root (P). [Compare Bladder Irri- 
table, Cystitis.] 

Ear Affections. 

Boric Acid, dry by insufflation, to destroy aspergillus in the external mea- 
tus; used after weak astringent injections, leeches, fomentations, etc., in 
general inflammatory conditions of the external ear (Whitla). Sodium 
Bromide, in large doses, gr. xxx ter die, gives some slight benefit in tinnitus 
aurium (Id). Cocaine, by instillation, sometimes gives considerable relief 
in tinnitus aurium, from its influence on arterial pressure (Id). Water, 
warm, by syringe, to remove wax and foreign bodies. Olive Oil, poured 
into the canal, to drive out insects or their larvae. Iodol, renders good serv- 
ice in eczema of the ear; in moist, confluent eczema of the pinna, extending 
within the auditory canal, the surfaces should be thoroughly cleansed and 
the powder insufflated into the canal; in dry, external eczema it is best 
applied in the form of a Lanolin ointment. The inflammation disappears 
completely under this treatment in about 2 weeks, but irrigation should be 
kept up for a short time afterwards to complete cure (Chatellier). [Compare 
Boils, Deafness, Eczema, Otalgia, Otitis, Otorrhea, Vertigo.] 

Ecchymosis. 

Arnica, rapidly disperses, if administered 'shortly after injury, TT|.v-x in 
water every two or three hours (P) . Alcohol, diluted more or less, according to 
the amount of irritation present, is a good lotion (P). Hamamelis, the tinc- 
ture diluted with 5 to 8 parts of water, as lotion, when much discoloration. 
Amm onium Chloride, in solution, as lotion on lint, in ecchymosis of the eye- 
lids ( Wa) . Capsicum, the tincture or a strong infusion mixed with an equal 
bulk of mucilage or gum arabic and a few drops of glycerin added, painted 
on over the bruised surface, a second or third coating being applied as soon 
as the first is dry; there is nothing to compare with this treatment for a 
black eye. [Compare Bruises, Purpura.] 

Ecthyma. 

Frequent washing with soap and water is necessary. If thick crusts 
have formed, they must be removed by dressings soaked in Olive Oil before 
any medicaments can be applied. Bichloride of Mercury dressings, one to 
two thousand, changed every three hours are of the greatest benefit. 
Ammoniated Mercury, 20 grains to the ounce of Petrolatum, may be applied 
twice daily. Hydrogen Peroxide sprayed into the lesions if they are deeply 
infected will keep them clean. Boric Acid, a drachm to the ounce in 
petrolatum, is very soothing. 

If the lesions are very extensive and have developed into deep ulcers which 
will not heal over readily, one of the best remedies that can be used is Scarlet 



ECTROPION — ECZEMA. 653 

Red, 1 to 2 per cent, in petrolatum applied twice daily for three days with- 
drawn for a like period, and a bland ointment used. 

As this condition is frequently the result of unhygienic surroundings, it 
is necessary in order to perfect a cure, that the patient be placed in different 
environment and be treated hygienically as well as symptomatically, with 
especial care paid to building up of the entire physical condition. For very 
extensive cases, the treatment should be the same as for a Pustular Eczema. 

Ectropion. 

Bandaging the eye after carefully closing the lids may be of service in the 
spasmodic and senile varieties. In the latter cases the bandage should be 
worn at night for a long time and the patient instructed to wipe away the 
tears by applying his handkerchief from below upward. Slitting the lower 
canaliculus may be necessary to diminish the epiphora due to eversion of the 
punctum (Fuchs). In the paralytic form the facial paralysis should receive 
attention. Silver Nitrate, in i per cent, solution, applied to the lids is useful 
in cases of ectropion associated with much hypertrophy of the conjunctiva. 
Boric Acid Lotion or normal salt solution is of service for the associated con- 
junctivitis and to moisten the cornea. Operative Procedures, of which there 
are many, usually result in permanent improvement. 

Entropion. 

Collodion, painted on the external surface, may keep the lid everted for a 
few days in the spasmodic variety. Adhesive Strips passing from the lid 
margin to the cheek may also help. Epilation of the lashes encroaching on 
the cornea will also give relief. Boric Acid Lotion or other bland collyria are 
of service for the associated conjunctivitis. If these measures give no relief, 
and in the cicatricial form, operation is necessary. Many Operative Proced- 
ures have been devised, and usually produce good results. 

Eczema. 

Constitutional and General Treatment. — The diet is of vital importance 
in the treatment of this disease. It has been found that certain individuals 
possess idiosyncrasies to certain articles of food and at times it is impossible 
to ascertain the particular food product which is responsible for the eruption 
without resorting to the Cutaneous Reaction Tests of various proteins. 
Articles of diet which are known to be difficult to digest, such as sausage, 
veal, pork and fried meats and potatoes, as well as pastries and rich desserts, 
should be avoided. In addition to this, fish should be used with caution, 
as should cheese, pickles, etc., strawberries, as well as other small fruits. 
Alcohol is contraindicated in eczema as in other skin diseases. Rice is one 
of the most easily digested foods and according to Buckley, should be given 
almost exclusively in cases of acute eczema. He adds to this rice diet, 
stale bread, butter and sugar. Water should be taken freely between meals, 
six to eight glasses a day being of material benefit in many cases. Tea and 
coffee should be avoided. Systematic exercise, particularly in the open air, 
is of considerable value in certain cases. Laxatives are indicated in manv 



654 ECZEMA. 

cases of eczema, particularly in the chronic type which is so often accompa- 
nied by marked constipation. Epsom Salts, Rochelle Salts, Cascara Sagrada, 
Castor Oil, Calomel, are almost a routine treatment at the onset of this dis- 
ease. In marked constipation, the Aloin, Strychnia & Belladonna Pills 
should be used. In cases of hyperacidity of the stomach, alkaline drugs such 
as Sodium Bicarbonate, Sodium Salicylate, etc., are of value. Pepsin and 
Pancreatin, 5 to 10 grains each, are of considerable value. For intestinal 
fermentation, Charcoal, Salol and Bismuth may be used and the latter 
particularly in those rare cases where there is any tendency to diarrhoea. 
In many cases of acute eczema due to physical strain or mental worry, Rest 
is of the utmost importance either absolute or comparative. A severe case 
of acute eczema can be much more readily cured if the patient is absolutely 
confined to his bed. 

General tonics are indicated in eczema of the subacute and chronic stage, 
the best of which are Strychnine £- to B \; Quinine, 3 to 5 grains and Arsenic. 
This latter drug was formerly used in all stages of eczema for its specific 
action. It is very questionable if Arsenic has an influence other than that of 
a general tonic and it should be used with that idea alone. It has its great- 
est value in the papulo-squamous type, sluggish and indurated, which has 
existed for a considerable length of time. Cod Liver Oil is used in a certain 
number of these cases in which there is anemia or the patient is poorly 
nourished. In this same type, Iron is also indicated. 

In eczema of the face in infants, in addition to the external applications, 
most satisfactory results can be obtained by the restriction of the diet and 
High Colonic Irrigation, using a No. 28 soft French catheter, inserting it 
6 to 8 inches into the rectum and allowing to flow with no great amount of 
pressure from one to three pints (according to the age) of warm soapsuds. 
This should be repeated every other day. Vaccines are of value only if the 
condition is pustular. 

External Treatment. — It is absolutely necessary in treating eczema to 
first ascertain the degree of inflammation. In acute eczema, soothing 
remedies; chronic cases, stimulating remedies are indicated. In acute, in- 
flammatory cases, soap and water are usually contraindicated except for 
necessary cleanliness. In the chronic sluggish types, however, frequent 
washing with Tincture of Green Soap will soften the parts as well as help re- 
move the thick scales. Crusts can be removed either by washing carefully 
with soap and water or by soaking the parts in Olive Oil. The bandages 
should be kept on for r2 to 24 hours and upon their removal, the parts 
washed very carefully with soap and water. Sometimes ointments work 
better in individual cases; at other times, lotions and dusting powders. Of 
the last two, this is particularly true in the acute type. It is good prac- 
tice to order a mild lotion which can be allowed to dry and then an ointment 
applied directly on top. Almond Meal may be used in place of soap for 
washing the hands. Bran is also another good substitute for soap for a 
generalized eczema where a bath is necessary, a teacupful being placed in 
the salt bag and after soaking, squeezed several times. Boric Acid is used 
very extensively in acute cases in saturated solution in water or J to 1 
drachm to the ounce of petrolatum. Unguentum Aquae Rosae alone is of value 
in the acute stage but even more so when such drugs as Zinc Oxide and Boric 
Acid are incorporated. Bismuth Subnitrate is of considerable value 
(see prescription below). Powdered Calamine is one of our most valuable 



ECZEMA. 655 

drugs. (See following prescriptions.) The Oil of Cade and Pix Liquida, 
\ to 1 drachm to the ounce, are both good treatment in the chronic type of 
eczema but their odor makes their use almost prohibitive. Liquor Carbonis 
Detergens or the Tinctura Picis Mineralis Comp., a mineral tar preparation 
without the offensive odor of the wood tar, is of great value in this disease. 
While it can be given in the acute stage highly diluted, it is of particular value 
in the chronic cases in solution from 25 to 50 per cent, in water or 10 per 
cent, in an ointment base. Carbolic Acid is a drug above all others to be 
used to abate the itching which nearly always accompanies eczema. Calomel 
and Hydrarg. Ammoniata, 10 to 20 grains, are of value in the sub-acute 
conditions. Chrysarobin, 5 to 20 grains in chloroform or in petrolatum, is 
used in the chronic type. Diachylon Ointment, a lead preparation, may be 
tried in the sub-acute stages. Ichthyol is of considerable value highly dilu- 
ted for the acute condition and up to full strength in the chronic. Lassar's 
Paste which contains 2 drachms each of Zinc Oxide and Powdered Starch 
to the ounce of Petrolatum may be used alone for the acute or sub-acute stages 
and is very valuable in combination with 5 to 10 grains of Salicylic Acid in 
the sub-acute and chronic stages. Lead Water is one of our most valuable 
drugs in the treatment of the acute stage. Lysol, \ ounce, to the tub of water 
will give considerable temporary relief. Lotio Nigra (Calomel and Lime 
Water) is of advantage in the acute stages. Picric Acid, 1 to 2 per cent, in 
alcohol, painted over small areas may be of some value. Pyrogallic Acid 
is used in the chronic type. Resorcin in alcohol or in an ointment base is 
of value in the chronic conditions, 5 to 30 grains to the ounce. Salicylic 
Acid is a very valuable drug in the treatment of this disease, usually incor- 
porated in an ointment base, 5 to 20 grains to the ounce. Where there is 
considerable induration and stimulation is required, the dose may be quite 
large. Salicylic Acid in the form of a plaster, 18 to 33I per cent, strength, 
is of considerable value in the markedly indurated chronic conditions. 
Unna's Dressing is a great addition to our armamentarium for the chronic, 
sluggish type of eczema where no mositure is present. It consists of gela- 
tine 2 parts; zinc oxide 1 part; glycerin 3 parts; water 4 to 6 parts. This 
should be warmed over a water-bath, applied directly to the parts and then 
thoroughly bandaged. The dressing need not be removed for 1 to 5 days. 
Salicylic Acid can be incorporated in these dressings to considerable 
advantage. 

One teacupful of Laundry Starch to a basin of tepid water applied to an 
acutely inflamed surface will give temporary relief and can be renewed as 
often as desired. Zinc Oxide is of particular value in a large number of cases 
either in combination with other drugs or in the form of the Zinc Oxide 
Ointment. Silver Nitrate, 1 to 5 per cent., may be used to stimulate granu- 
lation. Sulphur at one time was considered a most valuable drug in the 
treatment of this disease and while its advantages are still recognized it is 
not used as much as formerly. However, when 20 to 60 grains are incor- 
porated in petrolatum or lanolin, it is frequently of advantage. Sulphur 
Baths when in the form of Potassium Sulphide, 1 to 4 ounces to the tub of 
water, may help and the benefit derived from the sulphur health resorts 
may be partly due to the sulphur but even more to the change of scene, diet 
and out-door exercise. The X-ray is of the greatest value in the sub-acute 
and chronic types, particularly when there is marked induration and when 
used in combination with other external applications. 



656 



EMACIATION — EMISSIONS AND ERECTIONS. 



1$. Magnesii Sulphat., giss. 

Ferri Sulphat., gr. iv. 

Ac. Sulph. Dilut., 3i. 

Aquae Menth. Pip.,..q.s. ad §iv. 
M. Sig. — A tablespoonful in a tumbler- 
ful of water about 20 minutes before 
breakfast. (Stelwagon.) 



1$. Acidi Salicylici, gr. x-xx. 

Emplastri Plumbi 5iiss. 

Emplastri Saponis, 5iiss. 

Petrolati, 5iii- 

M. Sig. — Apply daily for chronic eczema . 
(Stelwagon.) 

1$. Pulvis Calaminae, 

Zinci Oxidi, aa 3ii 

Phenolis, : ttjxx. 

Aq. Calcis, , . § i. 

Aquas, §iv. 

M. Sig. — Apply every 4 hours in acute 
cases. 



]$. Acidi Salicylici, gr. xl. 

Phenolis, n#x. 

Lassar's Paste, q. s. ad §ii. 

M. Sig. — Apply every 4 hours in sub- 
acute cases. 



1$. Sodii Salicylat., 5i-ij. 

Fluidext. Cascar. Sagrad.,. 3i-iv. 

Tinct. Nucis Vomicae, 3ii-iv. 

Tinct. Cardamon. Comp., 

or 
Tinct. Gentian. Comp. q. s. ad 5 iii. 
M. Sig. — A teaspoonful in water after 
each meal. 



1$. Acidi Borici, 3i. 

Phenolis, ttjjxx. 

Aquae, q. s . giv. 

M. Sig. — Apply every 3 hours in acute 
eczema. 



1$. Bismuth Subnitratis, 3iv. 

Liq. Plumbi Subacetatis Dil. § iss. 

Phenolis, ttjjxx. 

Aquae, q. s. §iv. 

M. Sig. — Apply every 4 hours in acute 
cases. 



n 



Pulvis Calaminae, 

Acidi Borici, aa 5ii- 

Phenolis, tij?xx. 

01. Amydg. Dulc, 

Aq. Calcis, aa gi. 

Aquae, q. s. §iv. 

M. Sig. — Apply every 4 hours. 



Emaciation. 

Calcium Phosphate, is especially useful in chronic wasting disease (R). 
Arsenic, is used by cattle-breeders to fatten oxen, etc., quickly (Tr). Iodine, 
improves the appetite and digestion, and gives strength and plumpness to the 
body ( Wa) . Cinchona, in small doses improves the appetite and the general 
tone (Wa). Iron Salts, cause marked gain in flesh and color (Wa); remark- 
ably promote the appetite and digestion (B). Cod-liver Oil, internally and 
externally with friction, often very effective in the malnutrition and maras- 
mus of children (P). Hydrochloric Acid, to promote digestion of food. 
Rest to conserve metabolism. [Compare Appetite, Atrophy, Phthisis, 
Tabes Mesenterica.] 

Emissions and Erections. 

Hyoscine, the Hydrobromide in pill, gr. t ^-q ; to -gV a t bed- time, will always 
check seminal emissions (W). Belladonna, when emissions, genitalia re- 
laxed, atonic state (B) ; in gradually increasing doses produces good results, 
even in extreme cases of emissions (Wa). Camphor, fails as often as it 
succeeds (P). Potassium Bromide, exercises special influence as a sedative 
in irritable states of the genito-urinary organs (Wa). Cimicifuga, as tonic 
to the nervous system, removes irritation and melancholy, produces sound 
and refreshing sleep (Wa). Chloral, at bed-time, repeated every night until 
the habit is broken off ( Wa) . Iron, the tincture of the Chloride in 5 doses 
at bed-time, sometimes conquers nocturnal emissions (Wa). Cocaine, a few 
drops of a 4 per cent, solution upon the glans penis, promptly controls an 



EMPHYSEMA OE THE LUNGS — ENDOCARDITIS. 



657 



erection. Veronal in dose of 5 grains, to secure sleep when disturbed by 
sexual dreams, is very effective. [Compare Chordee, Spermatorrhea, and 
the List of Anaphrodisiacs.] 



Emphysema of the Lungs. 

Morphine, gr. J, and Atropine, gr. T ^ hypodermically for the dyspneic 
attacks; no remedy so efficient; the disease being incurable treatment must 
be chiefly palliative (B). Heroin is a useful remedy. Thiocol gives satis- 
factory results (Frisier). Potassium Iodide, in full closes alone or combined 
with the Bromide, affords most relief next to Morphine (B). Strychnine 
is a valuable respiratory stimulant; useful where there is constant dyspnea 
with prolonged expiration (Wa). Stramonium, the leaves smoked for the 
dyspnea before retiring, will often give a good night's rest (Wa) . Ammonium 
Iodide, with Arsenic for the bronchitis, with Copaiba, Turpentine or 
Eucalyptol, continued for some time (B). Terebene, gives good results for 
the dyspnea. Lobelia, allays the dyspnea which accompanies capillary 
bronchitis in emphysema (R). Grindelia, for asthmatic breathing and 
bronchitis (B); of great service (Wa). Chloral, for the short breath of such 
patients brought on by catching cold; if obstructed circulation caution re- 
quired (R). 



1$. Potassii Iodidi, 5iij- 

Strychninae Sulph., gr. j. 

Liq. Potassii Arsenit., 3ijss. 

Aqua, Laurocerasi, . q. s. ad §iv. 
M. Sig. — Teasp. 4 times daily. For re- 
lief of dyspnea, toning the cardiac action, 
removing the bronchial catarrh, and pre- 
venting the progress. (Hughes.) 



J$. Potassii Chlorat., 

Tinct. Belladon., aa 3jss. 

Fluidextr. Pruni Virgin., 
Tinct. Cinchonae Comp., aa §ij. 
M. Sig. — A dessertsp. 4 times a day, 
when chronic bronchitis and anorexia. Dry 
cups also to chest night and morning. 

(Da Costa.) 



Empyema. 

Surgical, the treatment is purely surgical, and the earlier it is applied the 
better; includes aspiration (almost never curative), incision, rib-resection, 
thoracoplasty, pleurectomy, Schede's operation (Da Costa). [Compare 
Pleuritis, Pneumothorax.] 



Endocarditis. 

Aconite, should be given early in all inflammations of serous membranes 
(Wa) ; gtt. J or less, frequently (R) ; is contraindicated if the heart is at all 
feeble. Digitalis, to control the circulation, especially where irregular heart 
action (Da C). Salicylic Acid, is useful in the rheumatic form (P.) Iron, the 
tincture of the Chloride with alkalies, if pyemic symptoms are manifested 
(Da C). Vaccines, Stock vaccines may be administered, but are not likely 
to prove of value, as infections are usually caused by streptococci, pneu- 
mococci, or some similar microorganisms showing so much difference in 
individual properties as to make the use of autogenous vaccines impera- 
tive (K). The initial doses should be small — not over 50,000,000 cocci; they 
may be repeated every three to five days, and are gradually increased as 
the conditions warrant (K). Rest for some days after active signs have 
42 



658 ENDOMETRITIS — ENTERITIS. 

abated with agents to lower the blood pressure within the heart and vessels 
(Fothergill) ; rest should be absolute, and kept up for some time after con- 
valescence has set in. Ice Bag to the chest wall over the heart will lessen 
cardiac excitement. Blisters, if the cause is acute rheumatism, a number of 
small blisters applied to the praecordium will be of value in preventing peri- 
cardial complications (Hare). Stimulants, as Ammonium Carbonate, etc., 
freely, if signs of oppressed circulation appear (Id). Diet should be simple 
and nutritious. [Compare Pericarditis.] 

Endometritis. 

Phenol, undiluted, on cotton- wrapped probe; no better method of treating 
uterine catarrh (B). Iodine, the most valuable of all local remedies (E); 
Churchill's tincture is one of the most useful applications to the endometrium 
(Munde). Iodized Phenol, Iodine j, Phenol, part, iv on cotton- wound 
probes, applied to the uterine cavity, has given the best results of any agent 
used for years past (Battey). Iodoform, as suppository in rectum (B); in 
pencils to uterine canal. Iodo-tannin, locally in chronic cases (B). Ichthyol 
undiluted, applied to the uterine cavity after drying it, gives excellent results 
(Kurz) ; in 10 per cent, aqueous or glycerin solution very serviceable (Bagot) ; 
facilitates the absorption of exudates and improves the tissue nutrition in 
chronic uterine inflammation. Ichthoform, a 10 per cent, solution in glycerin, 
is odorless and equally effective as Ichthyol (Goldmann). Formalin in 30 to 
50 per cent, solution, applied by cotton- wrapped probes once a week (Menge). 
Ergotin gr. j subcutaneously, for the train of uterine disorders depending on 
passive congestion of the organ (P). [See Hysteria for formula.] Glycerin, 
as a local application, introduced by Sims, is of great value; especially as a 
vehicle for Phenol or Iodine, on cotton or oakum (E). Hot Water injections 
in large quantity about the os uteri, are of great value (E) ; as usually made 
are of no value; must be applied by special syringe, in the dorsal recumbent 
posture with elevated hips, at a temperature of ioo° to 120 F. twice daily for 
at least 20 minutes each time, and persevered in for months and years 
(Munde). [Compare Uterine Congestion and Hypertrophy.] 

Enemata. 

Enemata, for an infant, §ss-j; child of 2 to 5 years, ^ij-vj; 5 to 15 years, 
gvj-Oj; adult, Oj-quart j. A simple domestic enema consists of soapsuds 
with a little common salt, or a pint of cold water (B). Simple warm water or 
gruel sometimes; or to one or the other of these add Soap, Turpentine, or 
Castor Oil, with soap or gruel to suspend the two latter. Very cold water 
may be used without inconvenience. Starch, boiled or raw, of cream con- 
sistence, temperature ioo°, with a few drops of Tinct. Opii, in extreme cases 
of choleraic diarrhea, or that of phthisis or typhoid fever (R). Nutrient 
Enemata, recent studies have proved that the use of nutrient enemata is of 
little avail in sustaining nutrition and that the benefit derived from them is 
due to the absorption of the fluid content. The use of normal salt solution by 
low pressure (drop method) proctoclysis is of distinct benefit in a large number 
of toxic states. 

Enteritis. 

Opium, to the point of tolerance, is the remedy, the deodorized tincture 
in 10-drop doses every second or third hour, according to age (Da C) ; of great 



ENURESIS. 659 

value to control inflammation and quiet the intestines (B); proves of signal 
use (Wa). Aconite, of great utility in acute inflammation with high tempera- 
ture, sthenic condition, resisting pulse (R). Arsenic, surprisingly curative; 
small doses with Opium (B). Podophyllum, with occasional doses of Aconite, 
will often allay the vomiting and diarrhea (P). Castor Oil or Epsom's Salts 
to remove from the bowel any irritant such as poisonous food, etc. Lime- 
water, is mucous enteritis. Tannalbin, is very efficient in the acute and 
chronic enteritis of children (Goliner). Ichthoform as an intestinal anti- 
septic, is valuable in acute gastro-enteritis and chronic gastro-intestinal 
catarrh (Goldmann). Turpentine stupes, hot, over seat of disease, are of 
advantage (Wa). Skim -milk, is of the highest value as sole diet in acute 
imflammation of digestive organs (B). Poultices, Linseed, large and hot 
(Wa) ; may be used or not, as the patient feels benefit from them or otherwise 
(Da C). Water, hot fomentations, followed by a wet compress; cold and hot, 
principally cold, or ice, of unquestionable advantage (B). Ice or cold water 
freely swallowed. Perfect quiet in bed. Diet, no food until inflammation 
subsides, then beef-tea, milk, gum-water, etc., the very mildest and most 
bland diet for four or five days (Da C). [Compare Appendicitis, Cholera, 
Diarrhea, Dysentery, Peritonitis, Typhlitis.] 

Enuresis. 

Belladonna, no single remedy so uniformly successful; children require large 
doses; small doses are useless (P); a solution of Atropine best, gr. -^-q to -fa 
(B); the best remedy for children, gtt. x-xx of the tinct. three times a day; if 
unsuccessful and no worms or other irritation exist, try Strychnine, Canthar- 
ides, Turpentine, Santonin or Galvanism (R). Santonin, in over-doses pro- 
duces incontinence of urine in children, but curiously will sometimes stay the 
habit, even when not dependent on worms and in cases where Belladonna 
fails (R) ; in the enuresis from worms (P) . Cantharides, one or two drops of 
the tinct. three or four times a day in middle-aged women or the aged, even 
when due to paralysis; sometimes also in children, but for them Belladonna 
is generally better (R). Urotropin, gr. xv-xxv well diluted, during the 24 
hours will usually stop the enuresis in cases due to colon bacillus infection, but 
to clear up the bacilluria an autogenous vaccine, 5 to 10 million at first every 
fourth day, increased up to 50 million (Fleischner) . Hydrated Chloral, 
enuresis in children (R) ; three-grain doses thrice daily for infantile inconti- 
nence (Da C). Strychnine, may succeed when the above remedies fail (B); 
sometimes useful for old people with paralysis of bladder, also for children 
(R). Quinine, in full doses, does good service in cases where chorea exists 
(Potts) . Buchu, often successful in chronic enuresis (P) . Turpentine, small 
doses sometimes remove the trouble (B). Potassium Bromide, succeeds in 
some cases (Wa). Collodion, painted to form a cap over end of prepuce (R). 
Ergot, when from paralytic state of sphincter (B); said to be useful (R). 
Iron Iodide, the syrup Tfl.xv-xx, well diluted with water, ter die, in pale, deli- 
cate, strumous children (B); sometimes useful even when no worms (R). 
Thyroid Extract, gr. ss. to ijs's twice daily, cured 7 out of 25 cases (Williams). 
Habits, children to be taught to retain water as long as possible during the 
day, little salt to be eaten, abstinence from fluids not necessary, bland fluids 
diminish acridity of the urine. Removing meat from the diet has cured 
several cases permanently, after all remedies had been tried without success. 
Removal of starchy food corrects the enuresis of children (Lewis). 



660 EPIDIDYMITIS — EPILEPSY. 

Epididymitis. 

Aconite, a few drops of tinct. in a glass of water, every 2 or 3 hours, 
produces the happiest effects (Pf, St). Belladonna, the extract, 5j-ij ad 
o j of glycerin and water, on lint, applied to the inflamed testicle (Bumstead). 
Mercury and Morphine, locally, a 20 per cent, oleate by inunction, in cases 
of syphilitic origin (R). Silver Nitrate, gr. lxxx ad giv aquae destil. freely 
applied to the scrotum will sometimes abort an epididymitis ( Wa) . Guaiacol 
in 20 per cent, ointment with Lanolin as a base, applied on lint daily for 6 
days, followed by Ichthyol ointment, 25 per cent. (Christian). Lobelia, the 
tinct. with an equal amount of glycerin, locally to relieve the pain. Sodium 
Salicylate, gr. xv every 2 hours, is excellent in the acute form (Huhner). 
Gonococcic Vaccine, diminishes pain and promotes resolution (Jamieson). 
Moist Heat, locally for 2 or 3 days before beginning the guaiacol treatment, 
will give speedy relief (Christian) . Ice Bag in the early stages for severe pain. 
Strapping and suspensory bandage to support the testicle, also rest in the 
recumbent posture from the beginning, with a saline cathartic to clear the 
bowels are all measures of great importance (Bumstead). If epididymitis in 
gonorrhea arises, put the patient to bed, abandon injections, shave the hair 
from the groin, leech over the cord, elevate the testicles, and early in the case 
apply an ice bag. (Da Costa.) [Compare Orchitis.] 

Epilepsy. 

Bromides, should be first employed in all cases, there being no remedy 
equal to large doses of Bromine salts, which should be persistently continued 
for many months, and with short periods of rest may be kept up for years; 
the combination mixture of Bromides has been taken by patients for 8 to 10 
years without harm (Brown-Sequard) ; Bromides taken for long periods 
without a physician's supervision have caused profound muscular depression, 
mental alienation and death (Hammond). 

Opium, a valuable adjunct to the Bromide treatment, a prolonged treat- 
ment by opium rendering the organism extremely susceptible to the action of 
bromides; for 6 weeks ascending doses beginning with 1 grain, up to a daily 
dosage of 15 grains or more; then suddenly stopped and replaced by 30-grain 
doses of Potassium Bromide four times daily, produced remarkable effect on 
cases in which all other medication for several years had failed (Flechsig); 
this method fails in 62.8 per cent, of cases (Seige) . Apomorphine gr. j\ hypo- 
dermically, an excellent sedative in hystero-epilepsy and pure epileptic seiz- 
ures (Faucher). Belladonna, for petit mat and nocturnal epilepsy, in pale 
and anemic subjects, should be given for a year or more; extract and leaves, 
gr. I of each in pill, every day at same hour, one additional pill every month 
(Tr) ; useful, especially when from fright (P) ; when the bromides fail of effect 
(Brower) . Atropine is better than belladonna, drop doses of a 1 per cent, solu- 
tion of the sulphate in brandy (Tr). Hyoscine, was used in 17 cases of 
status epilepticus, with but 2 deaths ; is the most successful drug in this con- 
dition (Raffle). Sodium Borate, in doses of gr. xx 3 or 4 times a day, has 
produced very good results in nocturnal epilepsy; is of real value and better 
than Bromides in symptomatic epilepsy, may also be found useful in nervous 
forms after the bromides have failed (Mairet) ; if begun with small doses may 
be gradually increased to 90 grains a day; when dose exceeds 60 grains daily 
it is advisable to add glycerin to the water and syrup used as excipients 
(Dijoud); excellent results obtained from a combination of Borax with Bro- 



EPILEPSY. 66l 

mides, especially Sodium Bromide (Alexander). Digitalis is valuable in petit 
mat and in nocturnal epilepsy (Da C), a good addition to the bromides when 
there is cardiac weakness (Huchard) ; io-minim doses of the tincture with 20 
grains of Potassium Bromide thrice daily, in cases complicated with cardiac 
dilatation (Gowers): Digitalis, Belladonna or Physostigma in combination 
with the bromides give better results than the latter alone (Poulet). Phy- 
sostigma used in 12 cases, of which 6 were improved, and in the others a 
notable increase took place in the number of the paroxysms (Williams). 
Chloral, a valuable auxiliary in troublesome cases with tendency to insomnia, 
violent convulsions or maniacal excitement; should be given in the evening, 
combined with bromides and used with caution when cardiac debility (Y); 
in full doses at night the most suitable remedy for the nocturnal variety (B) . 
Chloretone is used with benefit (Sinkler) ; in doses of gr. iij very effective in a 
severe case of epilepsy in a child of 5 years, apparently due to alcoholic poi- 
soning (Ellis) ; has a very powerful action on the disease, is best given in gly- 
cerin, gr. x ter die in robust cases (Bentley). Antipyrine in combination with 
Ammonium Bromide, gr. vj with gr. xx, has proved very efficient, alleviating 
some quite hopeless cases (W) ; is a real gain in the management of epilepsy 
(Y); Potts has published a report of 43 cases treated with this combination. 
Acetanilid, of great value where bromides fail; in four such cases it produced 
definite cures in doses of 7! grains in cachets thrice daily (Dujardin-Beaumetz) ; 
of very uncertain action (Y) ; is most useful in the diurnal form and in cases of 
full habit, active circulation, red face and injected eyes (B). Trional, 
is a useful substitute for the bromides (Mackey). Veronal is highly recom- 
mended as a sedative and antispasmodic (Fischer) . Amyl Nitrite inhaled at 
the beginning of the aura will prevent an attack (B); or TTL i j— v in mucilage 
when fits are very frequent (R) . Nitroglycerin, is slower in action than 
Amyl Nitrite, but more enduring (Pf ) ; is a useful alternative to the bromides 
(Pellegrini) . Chloroform, by inhalation during paroxysm and also in inter- 
vals (Wa); is of high value especially in cases of an hysterical character 
(Brown-Sequard). Anesthetics are rarely called for (W). Quinine, when 
of malarial origin (P) ; often useful in intermittent epilepsy (Ros) . Arsenic is 
sometimes useful (R); in epileptiform vertigo from gastric disorder (B); 
Silver Nitrate, is not without efficacy, and was formerly much used, but the 
danger of staining the skin has caused its disuse, especially as better agents 
have been found (Wa). Thyroid Extract gave most satisfactory results in 
several cases (Gordon). Diet, a salt-free diet causes exaggerated elimination 
of the products of metabolism, and has proved satisfactory (Id) ; a purin-free 
and saltless diet gives excellent results (Turner) ; a salt-free diet as an aid in 
carrying out a long course of bromide treatment (Strauss) ; the use of meat 
must be prohibited entirely in many cases. Trephining the skull, has cured 
two cases of Jacksonian epilepsy (England) ; has given good results in several 
cases where a distinct impression from injury existed; in others where appar- 
ently indicated it has been of no service. [Compare Convulsions, Hysteria.] 

]$. Potassii Bromidi, § j. 

Ferri Bromidi, gr. iv 

Aquae, gij 



Syrupi Simplicis, § vj. 

M. Sig. — A tablesp. twice daily. 

1$. Strychninae Sulphatis, gr. j. 

Acidi Sulphurici Dil., tt#x. 

Aquae Destil., §iv. 

M. Sig. — A teasp. gradually increased 
to a dessertsp. after each meal. 



1$. Potassii Bromidi, 

Sodii Bromidi, 

Ammonii Bromidi, aa 3iij- 

Potassii Iodidi, 

Ammonii Iodidi, aa 3jss. 

Ammonii Carbonat., 3 j- 

Tinct. Calumbae, 5 jss. 

Aquae, q. s. ad Bviij. 

M. Sig. — A teasp. and a half before each 
meal, and three teasp. at bed-time. 

(Brown-Sequard.) 



662 EPITHELIOMA — EPISTAXIS. 

Epithelioma. 

For any except the very superficial type, the treatment for this disease is 
operative. For the superficial type, particularly when occurring on the face 
where it is necessary to consider cosmetic effect, the following drugs have 
proved of value in a very large number of cases, after the lesions have been 
thoroughly curetted. Acid Nitrate of Mercury applied full strength with a 
cotton applicator has the advantage of making its own protective dressing and 
not requiring any other covering. At the expiration of ten to fourteen days, 
the scab will drop off leaving a healthy scar underneath. I can endorse this 
treatment which is so strongly advocated by Sherwell. Arsenical Plaster 
may be used but is extremely painful and does not produce any better results 
than some of the other drugs. Carbon Dioxide Snow is advised by some but 
its use can only be condemned as it does not penetrate sufficiently deeply and 
is much more prone to cause proliferation of the cells rather than destruction. 
The same cannot be said of Liquid Air for the action here may be much 
deeper than with Carbon Dioxide Snow. Pyrogallic Acid, $$% per cent, 
in equal parts of petrolatum and simple cerate, applied twice daily for 4 or 
5 days is of value though rather painful. Radium has been used with 
varying degrees of success but recent reports of cases that have been 
compiled during the last few years do not seem to warrant the expectation 
of permanent results being obtained from this drug (Gaskill). However, it is 
of value in certain cases. The X-ray at times is of the greatest value in the 
inoperable type and is of great value in every form of skin cancer, either 
alone or in conjunction with some other treatment. Zinc Chloride, 50 per 
cent, strength, is also used. 

Epistaxis. 

Aconite, has been used with the best results (P); small frequent doses 
quickly check epistaxis in children and plethoric people (R) . Antipyrine, has 
been highly efficient; in 5 to 15 per cent, solution as a local hemostatic, it will 
arrest almost any nasal hemorrhage (Huchard). Adrenal Extract, used 
locally is very efficient. Adrenalin Chloride, the 1 to 2,000 solution sprayed 
into the anterior nares, is effective (Robinson); on cotton tampon into the 
nares proved efficient in a persistent and alarming case resisting other treat- 
ment (Booth). Cotarnine, the Hydrochloride in 10 per cent, solution locally, 
remarkably successful (Munk). Gelatin, 5 parts dissolved in 95 of normal 
.salt solution and sterilized by boiling at a temperature not above 239 F., 
is a promptly styptic application (Carnot). Belladonna, when the bleeding 
is of congestive origin (P). Ipecacuanha, has been highly praised (R); acts 
upon the vessels (B) ; gr. j-ij every quarter hour until nausea is felt, but vomit- 
ing need not be excited (Wa). Alum, injected or snuffed up in powder (R). 
Iron Spray, in obstinate cases Liq. Ferri Subsulph., 5 j to § viij aquae by spray 
or injection; Tannin, finely powdered, blown into the nostrils through a quill 
(Wa) ; a strong solution, 5ij ad §iv, by nasal syringe (B). Turpentine, may 
be given internally with advantage (Wa) ; especially in debilitated conditions 
(B) . Lead Acetate, gr. ij-iv with Opium gr. ss-j, proves signally useful (Wa) . 
Vinegar, on lint introduced into the nostrils, sometimes highly efficient (Wa). 
Tamponade, a condom makes an excellent tampon, inserted and inflated by 
means of a flexible catheter, then tied close to the exterior nares (Matthews). 
Facial Artery, compression of (R). Keep head elevated and cool, warm the 



ERUPTIONS 663 

feet and hands by plunging into hot water, apply ice over the nose, resort at 
once to the tampon if bleeding becomes alarming. Cauterize with electric 
cautery any ulcers in anterior nares. (Compare Hemorrhage.] 

Eruptions Produced by Drugs, etc. 

For treatment, see Dermatitis Venanata and Dermatitis Medicamentosa. 

Bullous, Aconite, anacardium, antipyrine, boric acid, chloral, bromine, 
copaiba, quinine compounds, copaiba and cubebs, iodine compounds, iodoform, 
mercury, opium (?), phosphoric acid, and salicylates. Carbuncular (Anthra- 
coid), Arsenic, chloral, iodine and bromine compounds, and opium. Cyanotic, 
Acetanilid, potassium chlorate. Edematous, Aspirin, usually about head; 
salipyrine and santonin. Eczematous, Boric acid, belladonna, carbolic acid, 
opium and morphine, sodium borate. Erysipelatous, Arsenate, belladonna, 
conium, digitalis, ipecac, quinine and stramonium. Erythematous, Ace- 
tanilid, antipyrine, arsenic, alcohol, antitoxin, aspirin, belladonna, benzoic 
acid, boric acid, bromine compounds, capsicum, carbolic acid, chinolin, chloral, 
chloralamide, cantharides, chloroform, castor oil, conium, copaiba and cubebs, 
cubebs, dulcamara, exalgin, iodine compounds, iodoform, guaiacum, gurjun 
oil, hydrocyanic acid, hyoscyamus, lead acetate, mercury, opium, pilocarpine, 
piper methysticum, phenacetin, phosphoric acid, potassium chlorate, quinine, 
salicylates, sodium benzoate, santonin, sodium borate, stramonium, sul- 
phonal, tannic acid, tar, oil of turpentine, tuberculin, veratrum, and veronal. 
Erythematopapular, Acetanilid, antipyrine, benzoic acid, copaiba, digitalis, 
gurjun oil, iodine compounds, iodoform, phenacetin, silver nitrate, and potas- 
sium chlorate. Epitheliomatous, Arsenic (secondarily to keratoses). Fur- 
uncular, Antipyrine, arsenic, bromine compounds, calx sulphurata, chloral, 
condurango, ergot, mercury, and opiates. Gangrenous, Arsenic, belladonna, 
ergot, iodine compounds, quinine, salicylates. Herpetic, Arsenic, belladonna, 
iodine compounds, mercury, and salicylates. Keratotic, Arsenic. Morbilli- 
form, Antipyrine, antitoxin, belladonna, copaiba and cubebs, boric acid, opium, 
sodium borate, sulphonal, tar, turpentine, tuberculin and veronal. Nodu- 
lar, Iodine and bromine compounds. Papillomatous, Iodine and bromine 
compounds. Papular, Arsenic, boric acid, bromine compounds, cantharides, 
chloral, conium, copaiba and cubebs, cubebs, digitalis, iodine compounds, 
jaborandi oil of turpentine, mercury, terebene, and opium. Papulovesicular, 
Capsicum. Pigmentary, Arsenic, silver nitrate, and antipyrine. Pruritus 
(without eruption), Opium, chloral, copaiba, strychnine. Purpuric (including 
Petechial), Antipyrine, antitoxin, arsenic, benzoic acid, calx sulphurata, chlo- 
ral, chloroform, copaiba, copaiba and cubebs ergot, hyoscyamus, iodoform, 
iodine compounds, lead acetate, mercury, phosphoric acid, potassium chlorate, 
oil of sandalwood, quinine, salicylates, stramonium, and sulphonal. Poly- 
morphous (resembling Erythema Multiforme), Antipyrine, antitoxin sodium 
benzoate, copaiba and cubebs, iodine compounds, iodoform, boric acid, 
chloral, exalgin, coal-tar derivatives, opium, potassium chlorate. Psoriasi- 
form, Sodium borate and tuberculin. Pustular, Aconite, antipyrine, arsenic, 
bromine compounds, calx sulphurata, condurango, antimony, hyoscyamus, 
iodine compounds, ergot, mercury, nitric acid, cod-liver oil, opium, tanacetum, 
oil of turpentine, salicylates, and veratrum viride. Papulopustular, Bromine 
and iodine compounds. Scarlatiniform, Antipyrine, antitoxin, belladonna, 
chloral, copaiba and cubebs, copaiba, digitalis, hyoscyamus, mercury, nux 
vomica, opiates, oil of turpentine, pilocarpine, rhubarb, quinine, strychnine, 



664 ERYSIPELAS. 

sulphonal, salicylates, stramonium, tuberculin, viburnum prunifolium, and 
veronal. Ulcerative, Arsenic (secondarily to keratoses) , bromine compounds, 
chloral, iodine compounds, and mercury. Urticarial, Alcohol, antimony, ana- 
cardium, antipyrine, antitoxin, arsenic, bromine compounds, benzoic acid, 
chloral, copaiba, copaiba and cubebs, digitalis, dulcamara, hydrocyanic acid, 
guarana, hyoscyamus, iodine compounds, opium, mercury, pilocarpine, phena- 
cetin, pimpinella, quinine, salicylates, salol, santoninum, oil of turpentine, 
sodium benzoate, tannin, tar, and valerian. Vesicopustular, Antimony, 
antipyrine. Vesicular, Aconite, anacardium, antimony, antipyrine, arsenic, 
bromine compounds, cannabis, calx sulphurata, chloral, copaiba and 
cubebs, copaiba, cod-liver oil, ergot, iodine compounds, iodoform, nux vomica, 
oil of turpentine, opium, quinine, salicylates, and sodium santonate; veronal, 
and other drug erythematous and erythematopapular eruption sometimes 
present some associated vesiculation, especially on the extremities. (After 
Stelwagon.) 

Erysipelas. 

Iron, Tincture of the Chloride, the nearest to a specific yet discovered; the 
remedy of most service, any man being decidedly to blame who neglects its 
use; requires decided doses, gtt. xl every four hours (Da C); treatment by it 
very general but questionable (B); should be given with shorter intervals 
than 4 hours (R) ; is very successful in this disease (P) ; ten-drop doses every 
hour, or Tfl,xl every 4 hours (Quain) ; is also used locally with much success, 
being painted over the surface in full strength. Quinine, may be given with 
the Iron, also alone if thoracic complications, wherein Iron might be contra- 
indicated (Da C) ; a combination of Quinine and Tincture of the Chloride of 
Iron offers special advantages (Wa) ; in the more severe cases to sustain the 
vital powers and prevent cerebral embolism; but large doses, gr. xv-xx every 
4 hours, are alone of any use (B). Ammonium Carbonate, when feeble cir- 
culation, cyanosis and delirium, also when any signs of embolism appear (B) ; 
highly useful in debilitated subjects (Wa) ; after free purgation the continued 
use of this salt is all that is needed in most cases (Watson) . Sodium Salicy- 
late has an almost specific effect (Hallopeau), used internally also externally 
as a 5 per cent, lotion on compresses (Moore) . Quinine Salicylate is an excel- 
lent adjuvant, especially in the advanced stages when a tonic is required (Id). 
Potassium Iodide, with agents to secure free action of the bowels, skin and 
kidneys, the most efficient treatment in erysipelas ambulans, in which Iron 
and Quinine are useless (Da C). Antipyrine, is particularly efficient when 
hyperpyrexia (Ernst). Tartar Emetic, in doses of gr. T V frequently repeated, 
renders incontestable service (B). Calomel and Jalap, as purgative at onset, 
followed in 4 or 5 hours by Magnesium Sulphate 5 ss (Da C). Chloral, is an 
admirable adjunct to give sleep at night (Id). Turpentine, as a stimulant in 
traumatic erysipelas, more generally serviceable than alcohol (B). Vaccine, 
In severe cases an autogenous vaccine of about 20,000,000 cocci per 
mil may be administered every 3 or 4 days, and frequently aids in re- 
ducing the severity of the inflammation and overcoming mental unrest 
and physical discomfort (K) . A vaccine may be of aid in the treatment of 
subacute and chronic types of this disease (K). Stock vaccines are of little 
or no value (K). Streptococcus Antitoxin was used in 411 cases with a mor- 
tality of 2>h P er cent. (Marmorek) ; used in several cases with Ichthyol oint- 
ment locally, all recovering (Davis). 



ERYTHEMA INTERTRIGO. 



66 5 



Local Applications. Silver Nitrate, by Higginbotham's method in 
traumatic form; gr. lxxx of the brittle stick dissolved in 5iv of water and 
painted 2 or 3 times over inflamed surface and beyond, after careful washing 
and drying (R); no agent more useful in subduing external inflammation. 
Iodine, painted over affected and neighboring surfaces, to prevent spread- 
ing (R). Ichthyol, is very efficient as a 10 to 25 per cent, collodion: Ichthyol 
and Ether, of each 5, Collodion 10 parts, with or without the addition of 
Castor Oil; has almost specific properties in this disease (Radcliffe); in 25 per 
cent, ointment with Lard as a basis, the best external treatment, being almost 
specific (Eberson); affects the micrococci and shortens the duration of the 
disease one-half (Klein); was employed in 100 cases with excellent results 
(Allen); is the local remedy most favored by the dermatological world 
(White). Phenol, one part, with 8 to 14 parts of Oleic Acid, locally by 
inunction for 3 or 4 minutes every J hour, all around the edge of the diseased 
part until it ceases to spread (Jacobi); Phenol 3, Spt. Camphorae 6, Alcohol 1, 
freely applied by a cotton swab to the infected area and an inch beyond the 
line of demarcation 2 or 3 times daily, is the most effective application (Davis) ; 
Phenol undiluted, painted over the affected area, and beyond, left until 
whitening begins, then neutralized by pure alcohol, used by me in 82 cases 
with 5 failures (Judd). Magnesium Sulphate, in saturated solution con- 
tinuously applied locally on a mask, relieves local symptoms promptly, and 
rapidly reduces the temperature to normal; in 35 uncomplicated but severe 
cases, all recovered within 2 to 7 days, without any other treatment (Tucker). 
Zinc, Benzoated, as ointment, or the Unguentum Zinci Oxidi, anything to 
exclude the air, and whichever one is most agreeable to the patient (Da C) . 
Bismuth, the Ointment of the Oleate, a very certain application to allay 
itching and burning and lessen pain (Shoemaker) . Picric Acid in saturated 
solution, relieves the pain and burning sensations (F). Guaiacol with 
Menthol, in camphorated oil, painted on every 2 hours (Desesquelle). 
Protargol, a 5 per cent, solution on compress, proved very efficient in a 
severe case (Van Hoesen). Collodion, a thick coat relieves the symptoms 
(B) ; the Iodized Collodion is a serviceable application. 

Tracheotomy, promptly if edema of glottis occurs, the operation giving 
time for inflammation to subside (DaC). Incisions, may be necessary in 
traumatic erysipelas when limb is greatly swollen and inflamed; also in the 
phlegmonous variety (Id). Diet, a milk-diet is generally suitable; should be 
light but nutritious (R) ; feed the patient well (Da C). [Compare Phlegmon.] 



1$. Quininae Sulphatis, 3j- 

Ac. Sulphurici Dil., q. s. 

Aquae, §ij. 

Tincturae Ferri Chlor., §ss. 

Spt. Chloroformi, 5vj. 

Glycerini, q. s. ad giv. 

M. Sig. — A teasp. in water every 



two 



hours. 



(Loomis.) 



1$. Pyroxylini, 5 j- 

^Etheris, 

Alcoholis, aa 5 v. 

Solve, et adde — 

Ammonii Iod., 5j- 

Ammonii Bromidi, gr. xx. 

M. Sig. — For local use with a camel's 
hair pencil. (Humphreys.) 



Erythema Intertrigo. Chafing. 

The adjacent surfaces should be kept separated by cotton or folds of 
gauze and if it occurs under the mammary glands and they are pendulous, 
they should be supported by figure of eight bandages over the shoulders. 
The parts should be kept absolutely clean and the following prescriptions are 



666 



ERYTHEMA MULTIFORME — EXHAUSTION. 



of considerable benefit. Frequently soap and water bathing is of advantage 
in the treatment of this condition, especially of the parts when there is much 
secretion. After thoroughly drying, one or more of the following prepara- 
tions may be used. Lotions are usually more beneficial than are ointments 
on account of their drying properties. Boric Acid as a dusting powder is of 
considerable advantage, as is Zinc Oxide and Talcum Powder. Magnesium 
Carbonate is of value in absorbing the perspiration. Zinc Stearate is of 
advantage, particularly when combined with desiccated Balsam of Peru. 



]$. Pulvis Calaminae, 

Pulvis Zinci Oxidi, aa 5iv. 

Glycerini, 5iv. 

Alcoholis, §j. 

Aquas, q. s. 5iv. 

M. Sig. — Apply locally. 



1$. Acidi Salicylici, gr. xx. 

Acidi Borici, 5iv 

Pulvis Talci, q. s. gj. 

M. Sig. — Apply twice daily. 



Erythema Multiforme. 

Calomel, i to 2 grains in divided doses, should be given at night, followed 
by saline purge in the morning, as it is essential that the bowels should be 
free from all fermenting products. As a certain percentage of these patients 
are neurotic, Sodium Bromide or Potassium Bromide, 10 to 15 grains t. i. d. 
should be administered when indicated. Mineral Waters which are laxative 
in character should be given before breakfast. Tincture of Nux Vomica, 10 
to 15 minims, may be used alone or in combination with other gastro- 
intestinal correctives. Quinine is of value, particularly in the bullous type, 
and should be given in full doses. Salol and Thymol, 5 grain doses, are some- 
times of considerable value. Sodium Salicylate, 10 to 15 grains t. i. d., is of 
value. In the milder cases, there is not a great amount of itching, and sooth- 
ing lotions containing Zinc Oxide and Powdered Calamine, each 20 grains, 
and Phenol, 5 minims to the ounce of water, are frequently all that is necessary. 
However, at times the itching becomes in extensive cases very troublesome 
and the treatment is practically the same as would be given for Acute Eczema. 



Esophageal Affections. 

Belladonna, the liniment with frictions to the sternum, often very useful 
as a palliative in stricture of the esophagus (Wa). Hyoscyamus, or Conium, 
in stricture of esophagus, if much irritability; with occasional leeching to re- 
lieve exacerbations of pain or spasm (D). Silver Nitrate, in stricture of the 
esophagus, a weak solution on sponge probang (D). Thiosinamin, a 10 per 
cent, solution in glycerin and water, hypodermically in the interscapular 
region every other day, to promote absorption of scar-tissue in cicatricial 
stenosis of the esophagus (Teleky) . Anesthetics, should be used only to meet 
temporary indications ( W) . Nutrient Enemata, in stricture of the esoph- 
agus, when swallowing impossible (R) ; may, in some cases, even preserve 
life (Wa). [See Enemata.] Dilatation, by bougies, in non-spasmodic 
(structural) stricture, the only appropriate treatment (H). [Compare 
Choking, Dysphagia.] 

Exhaustion. 

Acetanilid, for the "tired feeling," a pinch put into the mouth, mixed 
with saliva and swallowed, rests one up in a few minutes and makes one as 



EXOSTOSIS — FAVUS. 667 

fresh as before (Brodnax). Phosphorus, for physical or mental exhaustion; 
also in depression 'from overwork (R). Calcium Phosphate, combined with 
Calcium Carbonate and Ferric Phosphate, gr. j of each for a dose (R). 
Potassium Bromide, when insomnia, bad dreams and irritability (R) . Opium, 
gtt. j of Laudanum with 2 or 3 of the Tinctura Nucis Vomicae, 3 or 
4 times a day, for symptoms of exhaustion with headaches, flushing and 
dyspepsia (R). Ammonia, internally; its influence is but brief (R). Coffee 
or Tea, in hot or cold climates (R). Castor, is serviceable but seldom used 
(P). Musk, benefits all forms of nerve-exhaustion (P). Cimicifuga, for 
headache from overstudy or excessive fatigue (R). Alcohol, of value in all 
conditions of fatigue (P). Coca, lessens the sense of fatigue under exertion, 
relieves thirst, and obviates the effects of a too rarefied atmosphere; is 
suitable for weakly subjects easily fatigued and convalescents (P). Cocaine, 
has been used successfully in exhaustion from sunstroke, loss of blood and 
diarrhea (P). Wet Sheet, dripping, cold, as a restorative and to prevent 
aching of muscles (R). Sea Bathing, is valuable (R). Habits, change of 
occupation better than absolute rest. [Compare Adynamia, Convales- 
cence, Insomnia, Myalgia, Neurasthenia.] 

Exostosis. 

Potassium Iodide, may promote absorption when recent; also use friction 
with an ointment of Mercury or Iodine (D). Aconite, was used by Storck 
(P). Mercury, a moderate course of mercurials may be effectual, when 
exostoses are due to a blow or from syphilis (D). Excision, if required 
(MacCormac). Exostoses of the clavicles in children almost always dis- 
appear of themselves (D). 

Face. 

Amyl Nitrite, Tfl, T V to J, in 30 times its volume of spirits, for flushing 
of face, or sensation of flushing, with cold feet and hands and great prostra- 
tion, occurring in women at change of life (R). Blisters, behind the ear, 
in facial palsy, followed by warm covering to the part (H). Strychnine, has 
improved some cases of facial palsy (P). [Compare Acne, Freckles, 
Neuralgia, Odontalgia, Parotitis, Tic-douloureux.] 

False Pains. 

Tartar Emetic, with small doses of Opium and external fomentations, 
where evidence of congestion (L). Opiates, to allay uterine irritation, after 
rectifying any derangement of bowels (L) . Opium, is valuable, having spe- 
cific action on uterine muscular fibres, relaxing some, stimulating others 
(Wa). Acetanilid may be given with benefit. 

Favus. Tinea Favosa. 

As no medicines can reach the scalp or the surface of the body through the 
deep favus crusts, these should be removed by soaking in Olive Oil or if 
they are crusted over the entire body, have the patient take strong Alkali 
Baths. The hair around or near the affected areas should be extracted by the 



668 FEET. 

forceps but as this is rather painful, a depilatory drug such as Barium Sul- 
phide made into a paste with water may be applied. After the crusts have 
been removed, the parts should be scrubbed thoroughly with soap and hot 
water, the lather remaining on for sometime to further soften the crusts. 
After it has been washed thoroughly, Bichloride of Mercury, i to 2 grains 
to the ounce of water, may be used. I have found that in this condition, 
as well as ringworm, one of the best preparations consists of 2 grains of 
Biniodide of Mercury to the ounce of the Tincture of Iodin. 

Chrysarobin is very valuable in the treatment of this disease, either 20 
grains to the ounce of chloroform painted on every other day or 30 grains to 
the ounce of petrolatum. Mercuric Chloride, 1 to 5 grains to the ounce of 
water, is of value. Resorcin, J to 1 drachm to the ounce of water may also be 
tried. Sodium Hyposulphite, a drachm to the ounce of water, may be used. 
Sulphur may be used in the official ointment. Tar is used at times when its 
odor does not counterbalance its efficacy. The X-Ray is the treatment par 
excellence for this condition. As there is always an associated loss of hair 
in this disease, a little additional alopecia produced by deeper applications 
of the X-ray treatment is of no importance. 

Feet. 

Arsenic, swelled feet of old or weak persons (R) ; edema of feet and ankles 
in the old, from feebleness of the heart (B). Lead, as ointment, equal parts 
of Emplastrum Plumbi and Linseed Oil spread on linen and wrapped round 
sweating feet, to be renewed every third day for nine days (R) . Potassium 
Permanganate, solution gr. j to the § as a wash will remove fetor of feet 
(B) ; temporarily discolors the skin. Tannoform, with equal parts of Boric 
Acid and Talcum, an excellent dusting powder for bromidrosis. Zinc Stearate 
with Salicylic Acid, for sweating feet, an excellent application. Picric 
Acid, a saturated solution locally for intertrigo affecting the interdigital 
spaces of the toes, gives good results (Milward). Boric Acid, in strong solu- 
tion, a good application for bromidrosis. Chloral, 1 in 50 of water as bath, 
efficient against fetor. Sodium Bicarbonate, a solution freely applied will 
remove fetor CB). Belladonna, will check fetid secretions (R). Salicylic 
Acid, in solution with Borax, the most agreeable and efficient deodorant for 
fetid perspirations (B); 3jss-iij and §iij of dried Alum in powder, applied 
freely to feet after washing and drying; Acid Salicylic 3, Magnesium Silicate 
87, is the composition of the powder used in the German army for sweating 
of the feet. Iron, the Chloride, mixed with i its weight of glycerin, as paint 
to the soles and interdigital spaces, in severe cases of sweating feet, should be 
exposed to the air while drying; repeat after 48 hours at first, subsequently at 
longer intervals during which the feet should be washed in vinegar and 
water night and morning and powdered with salicylated talc or starch and 
tannin (Vignol) . Alum, powdered, locally, the most satisfactory application 
for bromidrosis (Baylor). Sodium Chloride, 3 tablespoonfuls to i a pint 
of water, as antiseptic lotion for tender feet, answers perfectly in most cases. 
Ice, to the spine, or heat and cold alternately, to equalize the circulation, has 
been strongly advocated ( Wa) . Stockings, should be changed every day, and 
dipped in a strong solution of Boric Acid and dried, to effectually check 
fetid perspirations. Cold Footbath, and drying with friction, for cold feet 
(R). [Compare Chilblains, Dhobie Itch, Dropsy.] 






FEVER. 669 



1$. Ac. Salicylici, gr. xv. 

Amyli, gr. cl. 

Talci, 5iij. 

M. et trit. Sig. — Locally. (Kohnhorn.) 



1$. Ac. Borici (pulv.), 5jss. 

Petrolati, 5j. 

M. Sig. — Ointment for bromidrosis. 
(C hampionniere.) 



Fever. 

[See also the titles of the Fevers, in their alphabetical order.] 

Guaiacol, applied to the surface, as antipyretic. Aconite, has the highest 
value in the eruptive fevers, also in all hyperpyrexia (B); indicated in early 
stage of simple inflammatory fevers, pneumonia, and in most acute conges- 
tions (P); has marvellous power over sthenic fevers; the thermometer should 
go hand in hand with Aconite (R). Belladonna, in the eruptive fevers, 
especially scarlatina (B), in typhus, with delirium, insomnia, painful sen- 
sitiveness to light and sound, and in all hyperemic states of brain and spinal 
cord (P) ; is prophylactic often against scarlet fever (Pf) ; in delirium of fevers, 
also excellent in typhus (R). Quinine, in the malarial fevers. Antipyrine 
one of the best of the synthetical antipyretics; moderates the intensity of the 
febrile movement, and is especially indicated in self-limited diseases with 
persistent hyperpyrexia, especially tonsillitis, erysipelas, etc. Acetphenetidin, 
the favorite antipyretic among the new synthetical compounds; efficient and 
safe, but strongly diaphoretic. Salicylic Acid, or Sodium Salicylate of greatest 
importance in fever of acute articular rheumatism, usually combined with the 
alkalies. Digitalis, very useful in scarlet fever, rheumatic fever and pneumonia 
(B); especially in typhoid (R). Cimicifuga, as substitute for Digitalis, but 
less effective; good in hectic fever (B). Camphor, subdues reflex excitability; 
is praised as stimulant in adynamic fevers (P) ; in adynamic fevers and where 
there is delirium (R). Mercury, small doses of Calomel at commencement 
followed by a saline purgative. Opium, much less used than formerly, useful 
in delirium and with Quinine in remittents and intermittents (B); fevers 
characterized by prostration, insomnia and delirium, noisy or muttering, 
with picking of bed-clothes and twitching of the muscles, — in such cases 
Opium, judiciously given, may save an almost hopeless case (R) : Morphine, 
hypodermically, the best form in febrile diseases, being less disturbing to 
the stomach and digestive power (B). Turpentine, in typhoid, puerperal, 
and yellow, Tfl.x-xxx, as a stimulant to vaso-motor nervous system (B) 
as enema, 5ss-j in starch mucilage, with TUx of Tinct. Opii if pain; invaluable 
when in typhoid, hemorrhage occurs with tympanites (R). Tartar Emetic, 
minute doses, gr. T V, frequently repeated and with Opium, are of great 
value in many acute febrile diseases (B); as a diaphoretic; in ague; large 
doses to abort specific fevers (B). Hydrochloric Acid, useful in all forms, 
especially in typhoid and the exanthemata ; relieving dryness of the mouth 
and fauces, increases digestion and restrains the diarrhea (B). Acid Drinks, 
such as raspberry vinegar, citric acid, etc., very grateful and useful (R, B); 
two sliced [limes or lemons, with 5 ij of sugar in Oj of boiling water, cooled 
and strained, makes an agreeable refrigerant beverage (Wa). Eucalyptus, 
has given varied results in malarial fevers, some observers praising it highly 
(P). Valerian, has done much good in- fevers of a nervous character (P). 
Ammonium Acetate, as a diaphoretic and in simple forms, as catarrhal; the 
Carbonate in scarlet fever and measles (R). Purgation, by Castor Oil, 
Magnesium Sulphate, etc., before exhaustion (R). Mustard Bath, on 



670 



FEVER, SIMPLE — FISTULA IN ANO. 



recession of rash in eruptive fevers (R). Aliment, milk and beef-tea alter- 
nately, every 3 hours; milk in fevers and in inflammations of the digestive 
tract (B) ; Kumyss is a valuable food in convalescence from fevers (Brush) ; 
Alcohol in low conditions is useful when it causes improvement in symptoms, 
some of which may however become worse under it (R); Coffee is a better 
stimulant than alcohol (P). Water, especially carbonated water as a drink, 
is a valuable adjunct to remedies in the treatment of fevers; warm baths, 
the wet pack, hot and cold compresses, fomentations, moist inhalations, etc., 
have great value (see the various fever titles): a most important agent; 
cold baths or cold wet pack to reduce temperature (B) ; cold affusion, baths, 
packing, ice and ice-bag, hot affusion and sponging, all of great value in 
every form (R). Fever is a normal reaction to toxic invasion, and is a 
symptom as proper to certain diseases as normal temperature is to health 
(Powell). 



]$. Tinct. Aconiti, 5ss-j. 

Spt. Athens Nitrosi, 5ij. 

Glycerini, q. s. ad §ij. 

Sig. — A teasp. hourly to an adult. 



fy. Acetphenetidini, 5ss-j. 

Aquae Cinnamomi, § iv. 

M. Sig. — A teasp. every 2 hours for 
children, to control pyrexia. 



Fever, Simple. 

Aconite, in small repeated doses, the best remedy for febricula (B); in 
ordinary febrile conditions, if given early, will abate fever and induce free res- 
piration; may be administered in conjunction with any other remedy 
indicated (R). Veratrum Viride, in small doses, as antipyretic (P). 
Hyoscyamus or Belladonna, very useful in febricula, especially for head 
symptoms and constipation (P). Gelsemium, when remittent or bilious 
symptoms (P). Arsenic, if malarial symptoms (B). Acetphenetidin, 
in hourly doses of gr. ij or less, in the simple continued fever of children, as 
antipyretic. Hydrochloric Acid, in the continued fever of childhood, has a 
beneficial influence (West). Valerian, when nervous excitability (P). Lem- 
on-juice, as lemonade or with Potassium Bicarbonate, as a mild diaphoretic 
and diuretic (P). Pomegranate -juice is very grateful if mixed with sugar 
or honey (P). Bromides, gr. ss-j every quarter-hour are excellent for the 
febrile disturbances of children (Smith). Baths, warm, in simple fevers of 
children (R). Aliment, milk and beef -tea alternately every 3 hours, the 
most useful (B). 



]$. Ac. Hvdrochlor. Dil., 5ss. 

Spt. yEtheris Co., 3jss. 

Syr. Rosae, §ss. 

Aquae Camph., q. s. ad §iv. 

M. Sig. — Teasp. to tablesp., according 
to age, every 6 hours. 

{Modified from West.) 



]$. Potassii Acetatis, 5ij- 

Spt. vEtheris ^Eitrosi, 5iv. 

Syr. Simplicis, _ §j. 

Liq. Ammonii Acetatis §ij. 

Aquas Camphorae,.. .q. s. ad gviij. 
M. Sig. — Teasp. to tablesp. doses, ac- 
cording to age. 



Fistula in Ano. 

Iodine, by injection, sometimes curative, but generally fails (Wa). 
Sanguinaria, as injection, has cured (P). Capsicum, the weak infusion, 
as useful stimulant in fistulous ulcerations (P). Bismuth Subiodide, after 
operation, dusted over the surface of the wound after washing, to stimulate 
granulations when the healing process is indolent, is remarkably efficient. 



FLATULENCE — FOREIGN BODIES. 



671 



Surgical, division if sphincter in anal fistula by knife or ligature, the best 
treatment (D); in fistula lachrymalis dilatation of passage by probing the 
canaliculus or slitting the canaliculus up (D); in vesico-vaginal or recto- 
vaginal, surgical methods best. Diet, should be nourishing and digestible; 
fresh air and good general hygienic conditions are necessary (R). 



Flatulence. 

Nux Vomica, will remove flatulence and intestinal indigestion (B) ; when 
constipation, heartburn, weight on head (R) . Charcoal, gr. v or x, soon after 
or just before meals (R); mixed with Bismuth (R). Chloroform, pure, in 
drop doses, benefits (R) ; by far the best agent in flatulent dyspepsia to pre- 
vent flatulence, always given well diluted (Huchard). Phenol when no 
acidity present (R). Turpentine, gtt. iij-v on sugar, will quickly relieve (B). 
Strontium Bromide, is excellent in flatulence from decomposition. Asaf etida 
or Valerian, quickly relieves the flatulence of hypochondriasis (P). 
Asaf. 5j of tinct. to OJ water, dose 5j; useful for children (R). Sodium 
Phenolsulphonate, gr. xxx after eating, will be found very serviceable (R). 
Phosphoric Acid, dilute, is often promptly alleviative. Anise, the Oil, also 
Ether, or any other member of the carminative group, will promote the ex- 
pulsion of gas from the stomach and intestines. Mercury, in flatulence with 
clayey stools (R). Calumba, an effective remedy for flatulent disposition is 
an infusion of 5ss of Calumba and Ginger, 5 j of Senna, hot water Oj, a wine- 
glassful ter die (P). Potassium Permanganate, in flatulence attendant on 
obesity (B). Physostigma, flatulence of women at climacteric (B). Sul- 
phurous Acid, in 5 to 10 minim doses, when flatulence due to fermentation (R). 
Diet, abstain from sugar, starchy food and tea — especially sugar; eat little, 
slowly and regularly; as a general rule abstain from alcoholic drinks and 
from vegetables, especially cabbage. Pepsin or Ingluvin after meals, to 
promote digestion (R). [Compare Colic, Dyspepsia.] 



]$. Tinct. Illicii Anisati, 

Tinct. Gentianae, 

Tinct. Nucis Vomicae, aa5j. 

Chloroformi, njjxv-xxx. 

M. Sig. — 8 to 10 drops in a winegl. of 
water, before meals. 



1$. Bismuthi Salicylatis, 

Magnes. Calcinat., aa 5iv. 

Carb. Ligni (pulv.), 3vj. 

Olei Anisi, §ij- 

Ft. pulv. Sig. — A teaspoonful before 
each meal. {Huchard.) 



Flushing-heats. 

Nux Vomica, TTUj of the tinct., with lUj of Laudanum in hysterical 
flushings of the middle-aged, with flatulence, weight on head and perspira- 
tions (R). Amyl Nitrite, TTtyV to \ in thirty times its volume of rectified spir- 
its, is effective for flushing of face, or sensation of flushing, followed by cold- 
ness, with cold feet and hands and great prostration occurring at climacteric 
chiefly (R). Potassium Bromide, at climacteric, with mental depression 
(R) . Zinc Valerate, or Valerian, flushings at the climacteric (R) . Eucalyp- 
tol, for the flushings, palpitations and flatulence incident to the change of 
life (R). [Compare Climacteric Disorders.] 



Foreign Bodies. 

In the Eye, remove by bathing, or wiping towards the lower inner corner 
with a soft, moistened handkerchief or a bent bristle, the two ends being 



672 FRACTURES AND DISLOCATIONS — GALL-STONES. 

held in the fingers ; use tepid solution of Vinegar, 3 ss to the 5 , for removing 
lime, tepid water for powder; then apply a weak Zinc or Alum collyrium, or 
instil a solution of Atropine, gr. ij to the § , or of Cocaine 4 per cent. In 
the Ear, examine carefully with speculum before removal; first syringe with 
warm water, or instil a drop of sweet oil to drive out insects, before using the 
forceps; apply equal parts of Laudanum and Olive Oil, a few drops on cotton, 
if much pain. In the Nose, a current of tepid salt water, forced up one nos- 
tril may force down the body through the other, if the mouth be held open. 
In the Larynx or Pharynx, if water can be swallowed the obstruction is in the 
trachea. Never push a body down; remove by curved forceps or blunt 
hook. If passed into the stomach use solid diet to embed the article. If 
the case be urgent, resort to quick laryngotomy or tracheotomy. In 
skilled hands the tracheo-bronchoscope is of value. In the Flesh, remove at 
once by forceps, or sponge and water. [Compare Asphyxia.] 

Fractures and Dislocations. 

Aconite, quickly and repeatedly, if feverish symptoms ensue (P). Iodine, 
internally and by friction, occasionally useful in ununited fractures (Wa). 
Calcium Phosphate, promotes formation of callus (Wa) . Opium, for nervous- 
ness or muscular spasms after dressing, gr. J of Morphine hypodermically as 
anodyne (Ag). Benzoin, the tincture on lint as a dressing for compound 
fractures and other severe injuries, leads to rapid and satisfactory healing 
(Bryant). Lead- water and Laudanum, on lint, to the part, after reduction 
of the injury, with morphine hypodermically and perfect quiescence. Mas- 
sage by stroking, from the first, and passive movements as soon as possible, 
tend to a rapid and perfect cure (Jordan) . Diet, should be very simple for a 
week or ten days. [Compare Wounds.] 

Freckles (See Lentigo). 
Gall-stones. 

Ammonium Chloride is of value, thins the bile, allays catarrh, and 
modifies the amount of mucous secretion (Musser) . Aspirin and other salicy- 
lates increase the secretion of bile and gradually sterilize it (Musser). Sod- 
ium Salicylate, increases the secretion of bile and renders it more watery; 
it is therefore indicated in cases where there is a tendency to the formation 
of gall-stones (Br). Chloroform, as an inhalation may be used to relieve the 
pain of the paroxysm (Br). Morphine, gr. J with Atropine, gr. y^- hypo- 
dermically, the best anodyne for the pain and vomiting during the 
paroxysm (Br). Chloral sometimes relieves the pain (R). Counterirri- 
tants, as mustard poultices to relieve the pain during the paroxysm (Br). 
Surgical Measures will be required sooner or later for their removal, there 
being no solvent for gall-stones, and no medicinal means for removing them 
(Musser) ; drugs should be indicated by a study of the gastro-intestinal 
tract, the circulation and the blood (Id). Early operations are easy and 
comparatively safe; later operations are difficult and dangerous, and by early 
operation dangerous complications (infections, adhesions, obstructive 
jaundice) are avoided (Da Costa). Diet, is important; withhold all 
starches, sugars and fats, also malt liquors and spirits; moderate exercise 






GANGRENE — GASTRALGIA, GASTRODYNIA. 673 

out of doors, lean meats, eggs, fish, fruits and succulent vegetables to be 
used freely. Mineral Waters, the alkaline are useful, especially Vichy, 
which is deemed of great benefit. [Compare Jaundice.] 

Gangrene. 

Salicylic Acid, pure, in powder locally, to destroy fetor and change the 
character of the morbid action (B). Sodium Sulphate, in solution, i to 5 or 
10 of water, as lotion or applied on compresses, to destroy odor, soothe pain 
and restore healthy action (Wa) . Ammonium Chloride, in* solution as baths 
and fomentations, very successful in one case of senile gangrene (Wa). Tur- 
pentine, locally, after removal of gangrenous part, a most efficient applica- 
tion (B); by stomach and inhalation from hot water in gangrene of lungs; 
the oil locally in dry and chronic gangrene (P). Nitric Acid, strong, applied 
carefully, until the ulcer is converted into a firm, dry mass (Wa) ; is probably 
the best escharotic, next to Bromine, for destruction of gangrenous tissue 
(B). Bromine, is the best escharotic for hospital gangrene (B). Chromic 
Trioxide, an efficient caustic, penetrating deeply with but little pain (B). 
Opium, to soothe the pain, and diminish restlessness and irritability (Wa). 

Rules when to Amputate for Gangrene (Da Costa) . In dry gangrene, 
due to obstruction of a non-diseased artery, wait for a line of demarcation. 
In senile gangrene, if it affect only one or two toes, let the dead parts be cast 
off spontaneously. If a greater area is involved or the process spreads, 
amputate above the knee without waiting for the line. In ordinary moist 
gangrene, if there are not severe symptoms of sepsis, and if the gangrene is 
not rapidly progressive, wait for a line of demarcation. In the severer cases 
amputate at once high up. In traumatic spreading gangrene amputate at 
once high up. In many cases of diabetic gangrene amputate at once high up. 
In ergot gangrene, in carbolic acid gangrene, in postfebrile gangrene, in Ray- 
naud's gangrene, and in frost gangrene wait for a line of demarcation. [Com- 
pare Lungs, Gangrene of.] 

Gastralgia, Gastrodynia. 

Resorcinol, internally, acts exceedingly well. Opium, in some form nec- 
essary to relieve the pain in severe cases (Da C). Morphine, is of great value 
(P) ; subcutaneously in epigastrium very efficient, or in small doses with Bis- 
muth and milk before meals (R) . Belladonna, is useful in painful affections 
of the stomach (R). Atropine often relieves promptly, and is excellent in 
neuralgic pain of the abdominal viscera (P). Nux Vomica, an excellent 
stomachic, gtt. v-x of tincture before meals (B) ; gtt. j-ij every 2 hours in 
many forms of gastric derangement (R). Strychnine, hypodermically for 
gastralgia and gastrodynia (R); in very small doses, gr. tto~3V two or three 
times daily, a very successful remedy (P) . Arsenic, sometimes dissipates the 
pain surprisingly (B) ; a drop of Liq. Pot. Arsenitis before food in irritative 
dyspepsia and gastralgia with heartburn (R). Bismuth Subnitrate, when 
gastralgia due to irritation of mucous membrane, acts well alone, but is most 
efficient when given with aromatic powder and a little Morphine (R) ; or a 
combination of Bismuth and Arsenic in more chronic cases (B); the Sub- 
carbonate is especially adapted to gastralgia with laborious digestion and 
putrid or acid eructations (Wa). Silver Nitrate, in solution to check the 
43 



1 



674 



GASTRIC ACIDITY. 



pain of many stomachal disorders (R) ; a pill of gr. ss, with Extr. Hyoscyami 
gr. ij-iv (Wa). Hydrocyanic Acid, often cures rapidly when gastralgia from 
nervous derangement (B); may check vomiting as well as relieve pain (R); 
Nitro-hydrochloric Acid, gtt. ij-iij of the dilute acid, is serviceable (Da C). 
Ether, a few drops or the compound spirit, Tfl.x-xx often relieves quickly (B). 
Chloroform, TUij-v on sugar, often relieves (B). Chloral, sometimes relieves 
pain in gastralgia (R). Creosote, checks pain after food (R). Cocaine, in 
doses of Tfl.v of a 4 per cent, solution every hour, given by the mouth for its 
local action, is an efficient gastric sedative and anodyne. Alum, often affords 
relief (B). Ergot, of value in visceral neuralgiae (P). Quinine, in cases 
showing periodicity and those of neuralgic type (P) . Sodium Salicylate, for 
gastralgia with fermentation (R) . Nitroglycerin allays the pain speedily (B) . 
Condurango relieves gastric pain and hyperesthesia. Carbonic Acid Water, 
in painful and irritable conditions; may be mixed with milk (R). Milk-cure, 
very efficacious in obstinate cases (B) . Galvanism of the pneumogastric, and 
locally to the organ itself (B) . Diet is of the greatest importance ; food should 
be digestible, varied and plainly cooked; persons of sedentary life should re- 
frain from much animal food; meals regular and frequent, eating little at a 
time and that very slowly. Alcoholic beverages do harm as a rule, but may 
benefit particular cases. Eating should be done in as agreeable a frame of 
mind as possible and the patient should rest for a time after a meal. [Com- 
pare Gastric Acidity, Dyspepsia, Gastric Ulcer, Neuralgia.] 



. Morphinae Sulph., gr. j. 

Phenolis, 3ss. 

Aq. Menth. Pip.,. . . .q. s. ad 5iv. 
M. Sig. — Teasp. thrice daily. 

(Da Costa.) 



1$. Bismuthi Subnit., 5ij- 

Ac. Hydrocy. Dil., 3ss 

Mucil. Acaciae, 

Aq. Menth. Pip., aa §ij. 

M. Sig. — Tablesp. thrice daily. 



Gastric Acidity. 

Acids, Hydrochloric or Phosphoric before meals; acid wine, a genuine 
Rhine wine best; Sulphurous Acid TUv-xxx well diluted, for acid fermenta- 
tion of starchy foods (R) ; acids after meals for alkaline pyrosis (R). Tannic 
Acid, useful in pill, gr. iv withTTLj of Glycerin (B). Phenol, will often arrest 
eructations (B). Alkalies, after meals, for immediate relief, effects only 
temporary, Bicarbonates best (R) ; frequent use of alkalies enhances the mis- 
chief (B). Ichthyol 5ss-j in an equal amount of glycerin and §iv-viij of 
water, by irrigation with the stomach-tube once or twice daily before meals, 
for gastric hypersecretion with hyperchlorhydria (Stewart). Nux Vomica, 
Tfl.ij-ij of tincture before meals, is excellent in small doses (B); especially in 
acidity of pregnancy (R). Kino, a favorite remedy (B). Ipecacuanha, in 
acidity of pregnancy (R) . Mercury, gr. ss of gray powder thrice daily, when 
acidity with clayey stools (R) . Atropine, the sulphate, thrice daily by mouth, 
gave excellent results in a case of gastric hypersecretion of acid; after the 
third day pain had stopped and vomiting ceased. Bismuth, gives excellent 
results, combined with Opium or Morphine, sometimes with Magnesia (R). 
Diet, the proteins should be reduced to the physiological minimum, and 
should be selected and cooked for easy digestion; starches altered as much as 
possible, and the quantity of food should not exceed the physiological re- 
quirements (Russell); avoid new bread, pastry, and vegetables. [Compare 
Gastritis.] 



GASTRIC DILATATION GASTRIC ULCER. 675 



fy Bismuthi Subnitrat, 3iij- 

Phenolis, gtt. ij-v. 

Mucil. Acaciae, §j. 

Aquae Menth. Pip., 5iij- 

M. Sig. — A tablespoonful 3 or 4 times 

daily for adults. 



1$. Sodii Bicarbonatis, 3ij- 

Spt. Ammoniae Aromat.,.. . . 3ij- 

Tinct. Zingiberis, 5 j- 

Infus. Gentianae Co. (1870), 

q. s. ad Sviij. 
M. Sig. — A tablespoonful or two. 



Gastric Dilatation. 

Phenol, given internally to allay fermentation, with an occasional wash- 
ing by the stomach-pump (Da C). Strychnine, hypodermically or by the 
mouth, or Nux Vomica, the best remedy, conjointly with washing of the 
stomach and strict diet (Da C). Bismuth Subnitrate, with Magnesia or 
Soda, or Lime-water frequently, for the acidity, which is one of the most 
distressing symptoms (Fen wick). Bismuth Salicylate, as an internal anti- 
septic, is highly praised. Salophen, relieves the fermentative disturbances. 
Lavage, does good in any case, but especially when there is retention of 
mucus; stimulates peristalsis, acts beneficially on the gastric mucous mem- 
brane and the muscular coat (Kussmaul). Diet, should be free from all 
starch and sugar and from vegetables of any kind (Fenwick) ; milk not ad- 
visable as much fluid will further dilate the organ; solids better, as small 
quantities of dry, stale bread or gluten bread and underdone meat (Da C). 

Gastric Ulcer. 

Arsenic, Fowler's solution in drop doses lessens the pain and relieves the 
vomiting remarkably (B) ; has given relief when commonly used remedies 
failed (B); gives good results when used in very small doses (Da C). Bis- 
muth Subnitrate, relieves pain and vomiting and contributes to the cure (B). 
Condurango relieves the symptoms by its sedative action on the stomach. 
Chloroform i, with Bismuth Subnitrate 3. and Water 150, of which '5j~ij 
hourly, or without the bismuth, which is not necessary, gives marked im- 
provement in recent ulcer as well as in long-standing cases (Stepp). Silver 
Nitrate, in solution, to check pain and relieve the vomiting (R) ; is next in 
value to Bismuth, promoting cicatrization and easing the pain (B). Atro- 
pine, often happily relieves the pain and vomiting even when given in very 
small quantity (B). Morphine, for the pain and vomiting (R); in full doses 
if perforation occurs, to localize peritonitis until adhesions take place (Da C). 
Gallic Acid, in 5-grain pill every hour for hemorrhage. Lead Acetate, is 
sedative and hemostatic; gr. ss-ij in pill with Opium, very useful to check 
hemorrhage and allay pain (R). Resorcinol, acts very well; its analgesic 
property herein is so marked that the stomach is enabled to tolerate food 
(Pope). Charcoal is said to ease the pain by preventing formation of acid 
products (R). Cotarnine, the Hydrochloride as a powerful hemostatic for 
the hemorrhage. Orthoform, as a differential test, gr. xv in \ glass of water 
relieving the pain within 20 minutes by contact with the ulcer, but does not 
so act in simple gastralgia (Memmi). Olive Oil internally, a valuable ad- 
junct (Cohnheim). Ice-bag, to the epigastrium, for pain and vomiting (R). 
Saline Enemata, to rest the stomach while supplying fluid to body; (see 
under Enemata), Brandy may be added, also Laudanum gtt. x-xx, if 
the rectum is irritable (B). Milk-cure, has succeeded admirably (B); a 
strictly skimmed milk diet with Lime-water, 2 parts of milk to 1 of Aqua 



676 GASTRITIS. 

Calcis (Da C). Diet, should be of non-irritating character, with cold or hot 
compresses to the epigastrium, leaves little room for medicine: in bad cases 
nourish per rectum so as to give the stomach complete rest; in any case use 
such food as is chiefly digested in the small intestine, farinaceous vegetables, 
rice, arrowroot, etc. A nice change from milk diet is a warmed pancreas, 
chopped up with rare meat, being nutritious and well relished (Da C). Rest, 
in bed for several months is imperative (Da C). Surgical. The exact cura- 
tive value of operation is not settled and we would not advise surgical treat- 
ment in acute ulcer unless complicated by hemorrhage, perforation, or 
obstruction; or in chronic ulcer, until careful medical treatment has failed 
(Da Costa). In chronic ulcer if patient grows worse in spite of careful 
dietetic and medical treatment, if hemorrhage has been profuse or if there 
have been frequent distinct hemorrhages, if the pain is violent, or if tender- 
ness is marked, open the abdomen and inspect the stomach (Id). [Compare 
Hematemesis.] 

1$. Bismuthi Subcarb., 5iij- 

Morphinae Sulph., gr. j-ij. 

Pulv. Aromat., 5 j- 

Ft. pulv. no. xij. Sig. — One powder in milk before each meal. 

Gastritis, Acute. 

Mercury, Calomel in broken doses with ice, frequently swallowed, for the 
idiopathic form, which is occasionally seen and cannot be distinguished from 
that due to irritant poisons (Da C). Bismuth, the Subnitrate or Subcar- 
bonate in full doses after the acute symptoms have abated (Da C) . Morphine, 
hypodermically for pain (B). Ice, internally and externally gives great 
relief (R). Icnthoform has been used in many cases of acute gastro-enteritis 
with success (Goldman). Aliment, fluids should be administered per rectum; 
no food, except milk and Lime-water, being admitted to the stomach for 
some time (Da C). Antidotes, in cases of irritant poisoning, as Alkalies to 
neutralize acids, Dialyzed Iron or the Ferric Hydroxide for arsenic, etc. 
(see Poisoning) : then Oil, Albumin or milk, to protect the mucous membrane ; 
stimulants; Opium; Ammonia, etc., to antagonize depression of the vital 
powers. 

Gastritis, Chronic. 

Arsenic, sometimes surprisingly curative; for the vomiting gtt. j-ij of 
Fowler's solution before meals (B). Hydrastis, gtt. v-xv of tincture or 
fluidextract, daily before meals, especially for gastric catarrh of acute alco- 
holism (B). Nux Vomica, gtt. j of tincture every 5 to 10 minutes for 8 or 10 
doses, in acute gastric catarrh, with headache or sick-headache; also drop or 
2-drop doses every 2 hours or oftener, when chronic gastric catarrh occurs in 
the course of chronic disease (R). Cinchona, to promote healthy state of 
mucous membrane, the infusion with mineral acids, or Quinine; the Red Bark 
in gastric catarrh of drunkards (B). Alkalies, either shortly before meals to 
stimulate production of gastric juice, or some hours after to neutralize the 
acids of decomposition (Da C). Podophyllum, in small doses at night, to act 
on upper bowel; purgation as a method of treatment stands at the head 
(Da C). Ipecac, in small doses may prove useful, TTlv-x of the wine (P) ; for 
the nausea and vomiting (R). Ichthoform used successfully in many cases 



GLANDERS AND FARCY — GLANDULAR AFFECTIONS. 



677 



(Goldman) . Bismuth Subnitrate, is very useful in chronic gastritis, especially 
that of drunkards, and the chronic gastric catarrh of children with vomit- 
ing (R); invaluable for its sedative, alterative and astringent action; 10-15 
grain doses several hours after meals (Da C) ; the Subgallate is also used as a 
remedy for chronic gastritis. Bismuth Salicylate, as an internal antiseptic, is 
praised in chronic gastric affections. Calcium Permanganate in \ grain 
doses with plenty of water, gave prompt relief in many subacute and chronic 
cases in which Bismuth had failed (Stephens). Resorcinol, acts exceedingly 
well. Silver Nitrate, in J- or J-grain doses with Opium if pain, or preferably 
Belladonna, is extremely useful (Da C); to check pain and vomiting (R). 
Opium, or Morphine, to quell pain in chronic gastritis from alcoholic excess 
(R) . Caffeine, when gastritis is complicated with migraine (B) . Ammonium 
Chloride has much repute among German physicians (B). Calumba 
and other bitters are sometimes useful (B). Condurango relieves, by its 
astringent and sedative actions. Alum when vomiting of glairy mucus (B). 
Lead Acetate with Morphine, in chronic gastritis with gastralgia and pyrosis 
(B). Aliment, such as will be digested in the small intestine; requires careful 
attention; the milk-cure has been very effective in bad cases; malt liquors are 
harmful (B) ; mineral waters of purgative type, to keep portal system drained: 
exercise is not beneficial, better live quietly and occasionally spend a day or 
two in bed (Da C) : Kumyss agreeable and tolerant to stomach; the milk-cure 
and buttermilk have been efficient; the farinaceous vegetables, rice, tapioca, 
arrow-root. [Compare Dyspepsia, Gastralgia.] 



1$. Sodii Bicarbonat., 5jss. 

Tinct. Aurantii Cort., §ss. 

Infusi Calumbae, q. s. ad Sviij. 

M. Sig. — Two tablesp. before each meal. 
In chronic gastric catarrh. 



T^. Magnesii Sulphatis, 5j~ij- 

Sodii et Potassii Tart., 5ss-j. 

Ac. Tartarici, gr. xx. 

Sig. — Dissolve in a glass of water and 

drink, an hour before breakfast. 



Glanders and Farcy. 

Ammonium Carbonate, in water hourly, as concentrated as can be 
swallowed, followed by an opiate and preceded by an emetic of Ipecac, and an 
incision into each of Wharton's ducts; proved successful in a case of acute 
glanders ( Wa) . Potassium Chlorate , as a mouth wash. Hydrogen Peroxide , 
as a spray to nostrils. Creosote, or Phenol in Glycerin, locally (Wa) ; or dilute 
Chlorinated Soda and Lime-water. Escharotics, to destroy the affected spot, 
if inoculation occurs. Iodine, internally, also Arsenic and Strychnine, have 
been recommended. Quinine, in large doses and Ferric Chloride, may be 
useful. Potassium Iodide, 5 ijss daily, with baths in Hot Springs of Arkan- 
sas, conquered the disease in me, probably the only man who ever survived it 
(Paquin) . Diet should be nutritious and stimulating. Treatment, no drug 
yet tried has any marked specific effect on the disease (Durham). Surgical, 
in treating this disease the point of infection is at. once to be incised and 
cauterized, dusted with iodoform, and dressed antiseptically (Da C). 
Ichthyol, the skin over enlarged glands and swollen lymphatics is to be painted 
with iodin and smeared with ichthyol (Id). Mallein, for diagnostic 
purposes. 

Glandular Affections. 

Iodine and Iodides, no remedy more efficient, when simple hypertrophy; 
useless (with all other medicines) when caseation or suppuration has set in: 



678 GLAUCOMA — GLEET. 

Iodine injected into cystic and glandular growths of neck; Syrup of Ferrous 
Iodide occupies an important place (B) ; Potassium Iodide for mammae and 
testicles. Iodoform is equal, if not superior to Iodine, in enlarged scrofulous 
glands and other glandular swellings (Wa). Ung. Hydrarg. Iodidi Rubri, 
produces very striking effects in goitre, enlarged spleen (B). Calcium Sul- 
phide, for hard, swollen glands behind the angle of the jaw, with deep-seated 
suppuration (R) . Calcium Chloride, highly useful in strumous inflammation 
and suppuration (B). Mercury, useful in acute inflammatory states, ton- 
sillitis, parotitis; Hydr. Chlor. Corr. gr. T V or Hydr. cum Creta, gr. -A-, every 
two hours (B) ; the Oleate of Mercury and Morphine in obstinate and painful 
tonsillitis and inflammation of lymphatic glands (R). Belladonna, especially 
in tonsillitis (P). Valerian, with Guaiacum, in strumous enlargement (P). 
Hydrastis, frequently controls (P). Phenol, in a 2 per cent, solution injected 
into substance of gland (B). [Compare Bubo, Goitre, Lymphadenoma, 
Parotitis, Scrofulosis, Tabes Mesenterica, Tonsillitis, Tuberculosis, 
Wen.] 

Glaucoma. 

Eserine Sulphate or Salicylate (gr. j to 5 j aqua) one drop in the affected 
eye two or three times a day, or oftener, to cause contraction of the pupil and 
relieve tension and pain in the prodromal stages and in the acute inflammatory 
variety. The salicylate is said to be less irritating to the lids and can be used 
over a greater period of time than the sulphate. Pilocarpine, in 1 per cent, 
solution, may also be used to produce miosis, but is not as powerful as eserine, 
although less irritating. Dionin (3 to 5 per cent.) one drop in the eye thrice 
daily, is also of service. Hot Compresses applied to the affected eye for 20 
minutes three or four times daily, is of value. Morphine Sulphate, J grain 
hypodermatically may be necessary to control the pain in the acute inflam- 
matory form. In the simple non-inflammatory form eserine (gr. |-i to § j 
aqua) may be used thrice daily to relieve tension. Strychnine, gr. -fa thrice 
daily, may be of service, or Nux Vomica in the form of the tincture, Tfl.x 
thrice daily. General Treatment is indicated, rest, proper food, relief from 
worry and care, sleep and general hygienic measures should be instituted. 
Operative Treatment consists of iridectomy in the acute inflammatory form 
and iridectomy or corneo-scleral trephining in the simple variety. It is 
usually successful in acute glaucoma, but of doubtful benefit in the simple 
non-inflammatory type. 

Gleet. 

Cantharis, in drop doses, when frequent desire and pain in region of 
prostate (R); of benefit in subjects of relaxed fibre and feeble circulation 
(B). Blisters, to the perineum, of undoubted benefit (R). Bismuth 1, 
glycerin 1, water 6 parts, as an injection, often useful in gleet (R). Eucalyp- 
tol, is used with benefit in chronic catarrh of the genito-urinary tract (R). 
Iron, the tincture of the Chloride, 5ss in Oss of water with 3 j of Laudanum, 
makes a good injection for gleet (R); internally for anemic subjects (St). 
Mercury, \ grain of Corrosive Sublimate in 5 vj of water, is a good injection in 
gleet, used every 2, 3 or 4 hours (R); Donovan's solution in doses of 10 
minims thrice daily, so uniformly successful in controlling chronic urethral 
discharge as to be almost a specific for gleet. Zinc Salts, the Sulphate or 
Chloride, gr. ij of the latter to a pint of water, as injection every hour (R). 



GLOSSITIS — GOITRE. 



679 



Bougies, of gelatin, medicated with astringents, are extremely efficient. 
Turpentine, in moderate doses, when due to relaxed condition (R). Copper 
Sulphate, a solution as injection (R) ; astringent injections may be used with 
benefit ( Wa) . Copaiba, smeared on a bougie and introduced into the urethra, 
will sometimes cause gleet to yield (Wa). Sandalwood Oil, TUxv ter die (R). 
Glycerite of Tannin, with equal quantity of Olive Oil or mucilage, as injection, 
5ij enough; persevere 8 or 10 days after discharge ceases and do not use at 
bedtime (R). Balsams of Peru and Tolu, Buchu, Canada Balsam, Copaiba, 
Mastic, and Tannin, are used with advantage (P, R). Gleet is often kept up 
by over- treatment, will some time or other come to an end (St). Diet and 
Habits important; stimulants, both solid and liquid, should be rigidly avoided, 
also coffee; frequent ablutions, fresh air, good nourishment, are most desir- 
able. [Compare Gonorrhea.] 



]$. Ac. Tannici, gr. x. 

Bismuthi Subnit 3ij. 

Aq. Rosae, p V J- . 

M. Sig. — Shake and use as an injection 
thrice daily. {Maury.) 



1$. Cantharidis, gr. iij. 

01. Terebinth., 5j. 

M. Ft. pil. no. xij. Sig. — One thrice 
daily in obstinate gleet. If strangury occur, 
stop for a day or two. 



Glossitis. 

Bismuth, gr. xx of Subnitrate with § j of glycerin and B vij of water, as 
lotion for erythematous inflammation of the tongue (A). Purgatives, with 
gargles, leeches, antiphlogistic regimen generally (D). Quinine and Iron, 
should be given internally with dilute acid washes, and free purgation (CI). 
Alum, dry, powdered, may be dusted on tongue (CI). Leeches, applied 
beneath the jaw, if symptoms are urgent (CI). Abscess, should be opened, 
if any form. Incisions, along superior surface, followed by vapor of hot water, 
may instantly relieve congestion (A). Tracheotomy or Laryngotomy, if 
suffocation is apparently imminent (A). 



Goitre. 

Iodine, is of value in simple hypertrophy (ordinary goitre) used both 
internally and externally. Mercuric Iodide, as oint. assisted by the sun's 
rays; a piece the size of a large pea rubbed in daily, very successfully used 
in India for simple hypertrophy (R); the Unguentum Hydrargyri Iodidi 
Rubri, 1 in 10, daily (B); is too strong (Gross); gr. xv to the § strong enough 
for the worst cases (Wa). Potassium Iodide, internally, also externally as 
ointment, in simple hypertrophy of the gland (R). Thyroid Gland, cured 4 
children completely, and cured or relieved 9 out of 12 cases so treated (Bruns) ; 
Thyroid Extract is used successfully (Edmunds). It may do much good in 
parenchymatous goitre but is useless in the other forms and should be associ- 
ated with the use of tincture of Iodine or ointment of Red Iodide of Mercury 
locally (Da C). Electrolysis, has sometimes cured in cases of simple 
hypertrophy and cystic gland (B). The Roentgen Ray has benefited some 
cases. Operation should be performed in every non-malignant- goitre which 
is growing in size steadily or rapidly (Da C). Remember, however, that 
a goitre which begins at puberty may pass away (Id). Radium applied for 
24 hours in the centre of the tumor, gave excellent results in a well-defined 
case (Shober). [Compare Exophthalmos.] 



6So GONORRHEA. 

1$. Unguenti Hydrargyri Iodidi Rubri, 5j- 

Petrolati, 3vij. 

M. Sig. — Use as directed. 

Gonorrhea. 

Aconite, a drop of tinct. each hour in the acute stage (R) ; when inflamma- 
tion (Pf, St). Gelsemium, serviceable, acute stage (Pf). Methylene Blue, 
in doses of gr. ij thrice daily, given in the earlier stages, will shorten the course 
of the disease (Horwitz). Alkalies, Citrates or Bicarbonates to render the 
urine alkaline (R) ; Lithium Carbonate in five-grain doses thrice daily, for the 
same purpose: Alkalies are the chief factor in Otis treatment; Vichy Water 
(Celestin) freely (Otis) ; Potassium Bromide internally, with purgatives, low 
diet, and the zinc chloride injection (Hutchinson). Cubeb unlike Copaiba 
is given with good effect in the acute stage; is not irritant to the stomach 
(Wa). Oil of Santal in subacute cases (P); the best internal remedy (St); a 
good quality difficult to obtain (Pf). Copaiba in the second stage; if given 
too early in the disease it will aggravate the symptoms (P) ; should not be used 
until pain in urinating is nearly gone, chordee ceased and the discharge 
diminishing and of yellow color (Wa); does no good but is injurious, and 
prolongs the disease (Otis) ; the La Fayette mixture should not be given before 
the third week of the disease (Huhner) . Colchicum, the wine of the seed has 
frequently cured gonorrhea, and was used in thirty-minim doses nightly for 
the relief of chordee by Brodie (B). Ferric Chloride, when acute stage has 
passed and the discharge is degenerating into gleet, few remedies are more use- 
ful than this tincture in doses of ITlxv-xx thrice daily (Wa). Turpentine, in 
chronic stage when parts are relaxed, moderate doses are of great benefit (B). 
Cantharis, drop-doses may be used (R); in the chronic stage (B). Salol in 
emulsion is serviceable, is the best drug to use after instrumentation of the 
urethra, gr. v in capsule every 2 hours for 4 or 5 doses to prevent urethral 
chill or epididymitis (Huhner). Sodium Salicylate is one of the most 
effective drugs in the early stages, in combination with potassium bicarbonate 
(Dixon). Vaccine, " There is a considerable difference of opinion as regards 
the efficacy of vaccines in the treatment of acute and chronic urethritis of 
gonorrheal origin. A polyvalent stock vaccine of gonococci of proved im- 
munizing powers may be even more efficient than an autogenous one, es- 
pecially if the latter must be prepared from a strain that has been repeat- 
edly subcultured in order to obtain the vaccine in a pure state, or from one 
that has lost its virulence from long residence in the infected urethra. Owing, 
therefore, to the difficulty of isolating and cultivating gonococci, stock vac- 
cines have been generally employed. In subacute urethritis the initial dose 
may be 25,000,000; if complications threaten, less than this, and if no local 
reaction has followed more than this is given, the object being to secure a 
slight increase of the secretion, which should become more purulent, and a 
little constitutional disturbance, followed by lessening of local pain and 
tenderness" (Kolmer). 

Injections, of Tannin, Copper Sulphate, Iron, Cadmium, Port-wine, 
Brandy-and- water and 1000 other agents (R); injections are very bad, es- 
pecially in the acute stage; should never be used until the 5th week and then 
only if the case is not progressing (Otis) ; true gonorrhea is never cured in less 
than four weeks (Van Buren and Keyes); urethritis is a different disease 
entirely (Otis). Silver Nitrate, a weak solution, gr. j-v to the § , as injection; 






GONORRHEA. 68 1 

in vaginal gonorrhea a strong solution, 3 j to the 5 , through speculum to 
every part of the canal (B) ; as abortive injection is useless and dangerous (St) : 
Silver is the only drug which has stood the test of time (Yale). Argyrol, 
Silver Vitellin, is the most satisfactory gonococcide ever used (Otis); the 
best and safest of the silver preparations (Kevin) ; i to 5 per cent, solution held 
in the urethra 5 minutes 4 times daily. Protargol, Silver Protein, a few drops 
of a 20 per cent, solution in glycerin instilled into the fossa navicularis after a 
suspected coitus, will secure almost perfect immunity from infection (Kopp) ; 
in gonorrhea a 1 per cent, solution injected every 30 minutes during the day 
(Neisser); causes but little irritation and a rather speedy checking of the 
gonorrheal discharge; on the whole it presents no decided advantage over sil- 
ver nitrate (Kopp). Organic Silver Preparations are discussed in the pre- 
ceding section of this book. Zinc Salts, a weak injection of the Chloride, gr. 
j to §vj or viij of Rose-water; or of the Sulphate, gr. j to the §, frequently 
repeated, is probably the best treatment (B); the best injections are those of 
the Sulphate or Acetate, gr. vj-xij to § iv aquae, after the acute inflammation 
subsides (St) ; the Sulphate gr. jss to the 5 of water, as injection after each 
urination, preferred to any other local treatment (Molina); the Chloride has 
been used for 50 years, gr. j-iij to the § of water, as gonococcide and astrin- 
gent injection, used in the acute stage prevents complications (Hutchinson). 
Potassium Permanganate, a solution of 1 to 1000, one or two quarts at each 
sitting, washing out the bladder as well as the urethra several times daily, is 
highly efficient; a solution of 1 or 2 per cent, as injection in chronic gonorrhea 
(Keyes); a hot solution of 1 in 2000, gradually increased to 1 in 1000, 
injected into the bladder, in chronic gonorrhea, especially posterior urethritis 
(Ultzmann); has proved disappointing, both as an abortive agent and for 
acute gonorrhea (Kopp). Mercury, excellent results from Corrosive Sub- 
limate (Pf) ; gr. J— § to § viij aquae destill. in subacute and chronic stages, as 
injection thrice daily; may have gr. ss-j of Zinc Chloride added with benefit; 
is often effectual (Wa); the Oxycyanide, in solutions of 1 to 3000 or 1 to 
1000, is well tolerated by the urethral mucous membrane; resembles Protargol 
in action and has no specific power in gonorrhea (Kopp). Bismuth, the 
oleate, smeared on a sound, and inserted for 5 minutes (Shoemaker); with 
mucilage as an injection, excellent in chronic gonorrhea (Hill). Lead 
Acetate, the dilute solution of the Subacetate, as injection, may be employed 
at any stage (B). Chloral, a weak solution, gr. j-iv to the § , a very good in- 
jection (Hill). Resorcinol, a 1 per cent, solution makes a useful injection 
(Wa). Boric Acid 3 jss, Tinct. Iodine, 3ij> Glycerin gij, Distilled Water 
q. s. ad 3iv, as injection morning and night, has given excellent results in 
both acute and chronic cases when other treatment proved inefficient (James) . 
Ichthyol is superior to all other agents (Neisser); especially valuable in fe- 
males, a solution of 1 to 5 per cent, as urethral injection, and a 5 to 10 per cent, 
solution applied to the cervical canal (Clarke). Formaldehyde in 1 to 1000 
solution as wash for vulva, 2 to 3 per cent, for vagina, 1 in 500 for cervical 
canal of the uterus, in gonorrhea of women (De Smet). Hydrastis, TTtx-xx 
of the fluidextract to the § ,♦ suspended in mucilage, often of service in the 
second stage (W) ; an infusion of the root, 1 to 8, as an injection (Pf). Alum- 
nol in solution, 1 to 3 per cent., is reported an efficient injection. Irrigation 
of the deep urethra is injurious in acute cases, leading to complications 
(Horwitz). Abortive Treatment, if case is seen soon after infection, Silver 
Nitrate in aqueous solution, gr. xv to the § , applied along the urethral mu- 



682 



GOUT. 



cous membrane through an endoscope, in anterior urethritis, is painful 
(Hirsch); is futile, the disease is not curable in less than 4 weeks (Horwitz). 
Rest, in bed is an absolute desideratum, especially during the inflammatory 
stage. Hot water, ioo° F., to the penis during urination, extreme cleanliness, 
milk diet; water freely as a beverage, flavored with a few drops of Oil of 
Gaultheria; or Flaxseed tea, or Infusion of Triticum with Potassium Bicar- 
bonate. Sexual thoughts to be entirely avoided (Otis) . Alcohol, or any other 
stimulant, must be avoided entirely (R). [Compare Chordee, Cystitis, 
Gleet, Orchitis, Rheumatism Gonorrheal, Urethritis, Urethral 
Stricture, Vaginitis.] 



E. 



For Internal Use. 

01. Santali §i. 

Ft. capsules No. xlviii. 
M. Sig. — One capsule four times daily. 

(Otis.) 



R. 



, Oleoresinae Cubebas, 5iv. 

Potassii Bromidi, §j. 

Olei Sassafras, ffgx. 

Syr. Acaciae, § ij. 

Aquae, q. s. ad 5 vj. 

M. Sig. — Dessertsp. 3 or 4 times daily. 
(/. Wm. White.) 



fy Phenylis Salicylatis, 
Sodii Bromidi, 

Potassii Bicarb., 

Misce, et div. in chartas no. xxiv. 
Sig. — One powder every 2 hours in the 
early inflammatory stage. (Christian.) 



aa gss. 



I*. 



M 



For Local Use. 

Resorcinolis, 5 j. 

Ac. Borici, . .^ gr. xx. 

Zinci Acetatis, gr. |-£. 

Aquae Destil., §iv. 

Sig. — Dessertsp. as injection. 



B/. Zinci Sulphatis, gr. vj. 

Plumbi Acetatis, gr/viij. 

Ammonii Chloridi, gr. iv. 

Aluminis, gr. v. 

Aquae Rosae,. §j. 

M. Sig.; — Injection to be used j after 
acute symptoms subside. 



B). Zinci Sulph., gr. xx. 

Bismuthi Subcarb., 3iv. 

Glyceriti Hydrastis, 5 j. 

Aquae DestUl., q. s. ad §iv. 

Misce. Sig. — Inject 5ij 3 or 4 times 
daily. (Christian.) 



Gout. 



Colchicum has long been recognized as a specific, to abort a paroxysm or 
to lessen severity of the symptoms when the attack has developed (W) ; 3 j 
of the wine often removes the severest pain in an hour or two, and soon the 
swelling and heat subside (R) ; it is especially useful in acute and rheumatic 
gout (B) ; is not specific, nor a lasting or final remedy for gout, but acts very 
directly on the pain and inflammation of acute attacks (P) ; is useful in the 
bronchitis, asthma, dyspepsia, urticaria, etc., of gouty subjects (R). Col- 
chicine Salicylate, is highly efficient in chronic gout. Alkalies are among 
the efficacious remedies (Croftan); alkaline waters have long had a reputa- 
tion (B) ; alkalies are decidedly useful in chronic conditions (Haig). Sodium 
Salicylate in sufficient quantity will quickly relieve a typical attack of acute 
gout (Luff); 10 grains every 2 hours internally, also 3ij in §vij of warm 
water as lotion on lint covered with oiled silk, in acute gout is very efficient 
treatment. Salicylates do not cure gout, they simply aid in keeping down 
the diathesis (W). Salicylates eliminate uric acid, and with proper diet will 
cure all gouty affections not amenable to iodides, chlorides, bromides and 
mercury (Haig) ; Aspirin is one of the best salicylates, in daily doses of not 
less than 3 j for acute gouty arthritis with fever (Id) ; is an excellent remedy 
(Merkel). Piperazin, gr. xv daily in carbonated water, as a solvent and 
eliminant of uric acid; has been largely used but has failed to sustain its first 
reputation (W). Morphine, hypodermically, as close to the affected joint 



GOUT. 683 

as possible outside of the red areola, is miraculous in giving immediate relief. 
Antipyrine, remarkably efficient for relieving the pain as well as prophylactic 
against future attacks (Marshall). Aconite, may certainly relieve pain (P). 
Belladonna, the best remedy effectually and speedily to soothe the pain, also 
in gout of the stomach; 5-IU doses efficacious (P). Potassium Iodide, espe- 
cially when pain is worse at night (R) ; Iodides, chlorides and bromides, with 
mercury and diet, will cure most of the diseases due to excess of uric acid in 
the blood (Haig) ; a useful remedy for the chronic inflammatory thickening 
of the fibrous tissue, causing enlargement and tenderness of gouty joints 
(Luff). Potassium Bicarbonate, 5ss in a tumbler of water at bedtime, to 
stem the nightly tide of uric acid, as prescribed by Sir Wm. Roberts, is one 
of the most useful recommendations (Goodhart). Arsenic, to prevent dis- 
integration of blood corpuscles (Crof tan) ; has been highly extolled in rheu- 
matic gout (W); is a standard remedy in chronic gout. Ichthyol in 25 to 50 
per cent, ointment externally, abates the violent pains (Nussbaum) ; a 50 per 
cent, ointment by rubbing produces an immediate and remarkable effect in 
all forms of subacute or chronic gout (Lorenz). Rhubarb with an alkali, 
regularly during intervals, very serviceable (Halford). Veratrine, as oint- 
ment to painful joints (R). Cod-liver Oil, in chronic gout (R). Sulphides, 
as baths in chronic gout, or fumigation with Sulphurous Acid, and bed-clothes 
exposed to its strong fumes (R); Sulphur waters certainly benefit (B). 
Iodine, painted around joints in chronic gout (R). Strychnine, hypodermic- 
ally for later stage of gout paralysis (R). Carbonated Water taken freely, 
has a very beneficial influence. Diet, Futcher states that "the regulation 
of the food is undoubtedly the most important factor in the treatment. 
Meat is the article supposed to possess the most baneful influence, and over 
which there has been the most discussion. The red meats have for a long 
time been considered much more injurious than the white meats and fish. 
Kaufmann and Mohr have shown that there is very little difference between 
the two so far as the purin content is concerned. The protein foods considered 
particularly injurious, are those rich in cell nuclei and, consequently, contain- 
ing an abundance of purin bodies. These comprise the thymus, pancreas, 
liver, kidney, and brain. The meat extracts are to be avoided, owing to 
their richness in nitrogenous extractives and salt. Fresh fish may be per- 
mitted in moderation. Salt fish should be avoided. Fish roe and caviar 
should be forbidden, owing to their richness in nuclein, although in the latter 
it is in the form of paranuclein. Eggs constitute the most valuable protein 
food for gout patients, in that they are free from purin bodies. Milk, for 
the same reason, is also most useful. Starchy foods may be freely allowed. 
An exclusive starch and vegetable diet has its advocates still, but their num- 
ber is gradually diminishing. Bread, rice, potatoes and other garden vege- 
tables, may form a liberal portion of the dietary. Cucumbers and tomatoes 
had better be avoided. Until recent years the prevailing belief has been that 
fruits were harmful. The best opinion at the present day favors the free 
use of fruits. The experience in any individual case is the best teacher in 
this regard, for certain fruits, such as bananas and strawberries, particularly 
the latter, may excite joint pains, and cause pharyngeal symptoms. Fats, 
in the form of butter particularly, may be allowed with freedom; and butter 
in large quantities was advocated by Ebstein. All highly seasoned foods 
should be forbidden. Pepper, paprika, and mustard should not be permitted 
in dressings. Their only injurious effect is through impairment of the diges- 



68 4 



GUMS. 



tive functions. The majority of gout patients are better off without any 
alcoholic beverages. The general advice is that tea and coffee should be 
eliminated from the diet owing to the methylxanthins they contain. The 
gout patient should be induced to drink freely of water, particularly on an 
empty stomach early in the morning and before the various meals." Local 
Measures relieve the pain but do not cure. Baths, are useful, especially 
hot, steam and Turkish baths, but they do not cure the disease (W). Exer- 
cise, if there be any cure for gout it is exercise (W). [Compare Arthritis, 
Lithemia.] 



R. 



Scudamore's Mixture (Modified). 
Villi Colchici Radicis, 

Magnesii Sulphatis, aagj. 

Magnesii Oxidi, 5ij- 

Aquae Menth. Pip., §x. 

M. Sig. — Tablesp. every hour until it 
operates on the bowels. 



1$. Colchicine, gr. j. 

Ext. Colocynthidis Co., 3ss. 

Quininse Sulphat 5iij- 

Ft. pil. no. lx. Sig. — One pill every 4 
hours. (B.) 



j Py. Vini Colchici Seminis, §ss. 

Tinct. Digitalis, §ij. 

Liq. Potassii Citratis, §ijss. 

M. Sig. — A teasp. in water every 6 
hours. 

Lallemand's Specific. 
Py. Ext. Cochici Acet. (B. P.). 

Ext. Opii Aquosi, aa gr. xv. 

Potass. Iodidi, 5iv. 

Potass. Acetalis, 5ij- 

Aquae Destill., Siijss. 

Vini Albi, §ss. 

M. Sig. — 20 drops thrice daily. 



Gums. 

Myrrh, the tincture for spongy and ulcerated gums (P) ; 5 ij-iv in 5 iv of 
water or Infusion of Cinchona, is highly serviceable as a gargle or mouth- 
wash (Wa). Alum, for spongy and ill-conditioned gums, tending to recede 
from the teeth, whether of mercurial or scorbutic origin (Wa). Catechu, 
a piece dissolved slowly in the mouth is often of service in similar con- 
ditions (Wa). Rhatany, the powder as a dentifrice, keeps gums in good 
order (B). Potassium Chlorate, gr. ij every 4 hours for a child of one 
year, for inflammation of gums in teething (Wa). Phenol, gr. iij ad §3 
aquae, as lotion in diseases of the gums (Hilditch). Pomegranate, the bark 
an excellent basis for gargles in relaxed gums (P). Potassium Iodide, gr. x 
thrice daily, for periostitis of alveolar processes, marked by looseness of teeth, 
pain and swelling of gums (Graves). Sodium Salicylate, in doses of gr. xv 
every 4 hours, is highly efficient for the same condition, especially in combina- 
tion with Blxv of tincture of Belladonna (Coley). Ichthyol undiluted to 
swab out alveolar cavities and as paint to the gums, is very efficient in alveo- 
lar pyorrhea and receded gums (Floris) . Argyrol is an effective application 
in pyorrhea alveolaris, gingivitis, and other inflammatory and suppurative 
affections of the oral tissue (Fletcher). Iodine, gr. j ad 5 j aquae, applied by 
a brush after each meal to the margin of the gums, for retraction thereof 
with loosening of the teeth (S); the tincture is a good application in many 
morbid conditions of the gums; applied in concentrated alcoholic solution 
will arrest and cure pyorrhea alveolaris (Roop) . Zinc Chloride, a saturated 
solution applied by cotton to the margins, an excellent astringent tonic. 
Tannin, the glycerite, for spongy and bleeding gums (B). Iodized Phenol 
when fetor exists (B). Benzoin, the tincture a good application (B). Tri- 
chloracetic Acid locally for pyorrhea alveolaris, as an antiseptic, astringent 
and stimulant application. Hydrogen Dioxide diluted, as a cleansing injec- 
tion to pockets. Vaccine, an autogenous vaccine has given good results in 



HAIR HAY-FEVER . 



68 5 



arresting pyorrhea alveolaris (Goadby). Emetine, locally and internally, 
will destroy the ameba present in the pyorrheal pockets. [Compare 
Odontalgia, Scurvy, Teeth. 1 



1$. Aluminis, 5ss. 

Tinct. Myrrhse, 5 j. 

Tinct. Cinchonas, 5iv. 

Mel. Rosae, gj. 

Vini Albi, 5 viij. 

M. Sig. — Mouth-wash. 



. Tinct. Orris, 

Spt. Rosas, 

Alcoholis, aa giv. 

01. Amygd. Amar., gtt. ij. 

M. Sig. — Violet Mouth-wash. 

(Piesse.) 



Hair (See Alopecia) 
Hay-Fever 

Arsenic, especially valuable when disease is more of catarrhal than of 
asthmatic type, 3-minim doses of Liquor Arsenicalis (Mackenzie) ; as cigar- 
ettes, 2 or 3 daily. Iodides are very serviceable locally and internally; large 
doses until some iodism observed; may be combined with Arsenic (B). 
Opium, especially as Morphine, of great value in any stage, but great danger 
of the opium-habit (B) ; the tincture in doses of TTlij-iij every 2 hours for 
three doses, then Tftj every 2 hours until the discharge abates (Wa). Heroin 
for the cough and dyspnea. Belladonna, when nasal secretion is very pro- 
fuse (B). Quinine, very useful after the more acute symptoms have sub- 
sided (R) ; injected into the nares checks catarrhal discharge and spasmodic 
symptoms (P); a solution of the Hydrochloride, gr. iv-viij ad § j aquae, ap- 
plied locally to nasal mucous membrane by a spray-producer or a brush, will 
arrest the disease if confined to the nares and fauces (B). Ipecacuanha, in 
hay-asthma (R); is of great value, though the smallest doses cause similar 
effects (P). Aconite is better than Arsenic in true hay-fever (R); has been 
used with the best results (P). Lobelia, has been found an efficient remedy 
(Wa). Adrenal Extract is almost specific for the symptoms and restores the 
normal condition of the nasal erectile tissue (Douglas) ; used both locally and 
internally gr. v every 2 hours. Epinephrine, the 1 in 2000 solution locally 
gives immediate relief to all the symptoms (Sawyer), has given good results 
(McFarlane). Camphor and Cubeb as spray has given me better satisfac- 
tion than any other local application (Robinson). Cocaine, a 5 per cent, 
solution locally is a most efficient palliative (R) ; a 4 per cent, solution sprayed 
into the nares gives immediate relief (Da C) ; great danger of inducing the 
drug-habit. Zinc Stearate with Cocaine, an excellent insufflation. Black 
Coffee is highly recommended (P). Pollantin, Dunbar's serum, in the dry 
form has been widely used with reported satisfaction. Tobacco, smoking 
helps some and aggravates the symptoms in other instances; internally ad 
nauseam it helps, but there are better and safer remedies (Wa). Removal 
to the sea-coast or a barren, mountainous district, gives the only relief to 
some subjects; though many of the worst cases, hitherto unaffected by 
medicine, are now relieved by the local application of Cocaine. [Compare 
Asthma, Catarrh, Conjunctivitis, Influenza.] 



1$. Ext. Hyoscyami, gr. xij. 

Potassii Iodidi,. 3 j- 

Potassii Bicarb., 3ij- 

Ext. Glycyrrhizae, 3iv. 

Aquae Anisi,.. givss. 

M. Sig.— Dessertsp. every 4 hours until 

relieved. (Weber.) 



tf. Mentholis, 3j- 

Phenolis, 3ss. 

Zinci Oxidi, 5 j- 

01. Amygd. Dulcis, Sjss. 

Cerati Simplicis, §ij. 

M. Sig. — Apply thoroughly to the nos- 
trils every few hours. 



686 HEADACHE, BILIOUS-SICK — HEADACHE, CONGESTD7E. 

Headache, Bilious-sick. 

Antipyrine, the most valuable single remedy for headaches; an 8-grain 
dose for dyspeptic headache, in a little water, at commencement of attack, 
the patient lying down in a dark room; a second dose one hour after is gen- 
erally enough, but a third or fourth may be required; sleep generally follows, 
and there are no unpleasant after-effects. Acetanilid, in 4-grain dose, equally 
effective. Acetphenetidin, safer than acetanilid, and equally efficient. 
Nux Vomica, gtt. j of tinct. frequently, when acute gastric catarrh, with head- 
ache and nausea (R) ; gtt. j every 10 minutes, soon after meals, often gives 
marked relief in sick-headache not of neurotic origin (Smith); drop doses 
every 10 minutes for an hour cure sick-headache, especially when accompa- 
nied by biliousness (M). Strychnine, with Aloin and Belladonna, in minute 
granules, for bilious headache from obstinate constipation, effective if given 
several times a day for a week or 10 days (Roy). Belladonna, the extract in 
doses of gr. ■£$ to T V, in similar form. Salol, is one of the most efficient reme- 
dies. Podophyllum, in sick headache, with dark bilious diarrhea, or when 
constipation with dark evacuations (R). Mercury, as Blue Mass, to prevent 
or mitigate sick-headache ; most effective when followed in 6 to 10 hours by 
Epsom salts. Sodium Phosphate, a useful laxative in so-called bilious sick- 
headache (B). Sodium Salicylate is probably the most powerful of the 
hepatic stimulants, and is of great value in the so-called bilious headache 
(Dixon). Potassium Bromide, a large dose in ordinary or sick headaches 
(R). Water, as cold or hot affusion, or ice-bag to head; hot sometimes best; 
the purgative waters, as Friedrichshall, before breakfast in a cup of hot 
water (R) ; a brisk saline purgative, or small doses of Epsom salts thrice daily, 
very effectual for frontal headache with constipation (Br.) Nitrohydro- 
chloric Acid, 10 drops of the dilute acid in a wineglass of water before each 
meal, often an effectual remedy (Br). Charcoal, two teaspoonfuls stirred in 
half-glass of water, as a draught, is an efficient remedy for sick-headache with 
sour stomach and flatulence. [Compare Hemicrania.] 

Py. Podophylli Resinae, gr. ij. 

Tinct. Zingiberis, 3ij- 

Alcoholis, q. s. ad §j. 

M. Sig. — Teasp. in a wineglass of water 
every night at bedtime, or every second, 
third or fourth night as required. 

(Dobell.) 

Headache, Congestive. 

Antipyrine or Acetanilid (see preceding article). Aconite, to reduce the 
circulation (R). Veratrum Viride, at menstrual periods (R). Belladonna, 
relieves cerebral congestion, and distress from light and sound (P) ; pain over 
brows and in eyeballs, often due to stomach or uterine derangements, espe- 
cially in young women; TTLiij of tinct. every 3 hours (R). Potassium Bro- 
mide, gr. xv-xx, in ordinary or sick-headaches (R) ; Bromides are useful when 
nervous system has been irritated, but when exhausted they do harm (Ham- 
mond). Calomel, gr. -fa, every hour for ten or twelve doses, will relieve the 
headache of syphilis occurring at night (Tr) . Cannabis is given with uni- 
formly good results in the headache of the climacteric. Potassium Iodide, 






HEADACHE, NERVOUS. 



687 



throbbing, intolerance of light, pain passing from back of neck over vertex to 
brow, nocturnal, tender scalp, almost unbearable; ten-grain doses ter die will 
cure (R). Amyl Nitrite, for headaches with severe flushing heats at men- 
struation or climacteric, TU^ a sufficient dose (R). Mustard, in hot foot- 
bath, or as poultice to nape of neck in various forms of headache (R) . Water, 
cold water poured gently over forehead, sometimes warm water better (R) ; 
a very hot foot-bath often effectually relieves (Wa). Purgatives are often 
beneficial, especially in persons of phlegmatic habit; Aloes best (Wa) ; or Colo- 
cynth, as derivative, when cerebral hyperemia (Da C). 



1$. Ext. Colocynthidis Co., gr. xij. 

Capsici, gr. iv. 

Ext. Gentianse, gr. xxiv. 

Ft. pil. no. xij. Sig. — One pill thrice 
daily; also a 25-grain dose of Sodium Bro- 
mide nightly, at bedtime. {Da Costa.) 



]$. Spt. Ammoniae, % j. 

Spt. Camphorse, §ss. 

M. Sig. — From a quart of water, in which 
a handful of common salt has been dissolved. 
Cork tightly and use locally on lint as an 
evaporating lotion. 



Headache, Nervous. 

Antipyrine, is an efficient remedy for headaches generally (W). Acetani- 
lid, is very efficient in headache from fatigue (Brodnax) ; as routine remedies 
for the relief of headache these agents are much more valuable than bromides 
and caffeine (Whitla). Acetphenetidin, used with success (M). Cannabis, 
ten-minim doses of the tincture thrice daily in the intervals, often curative in 
bad cases of neuralgic headache; or \ to -J-grain doses of the extract (P). 
Caffeine Citrate, one to two-grain doses in capsule every half hour, a very 
effectual remedy for nervous and sick headache, but causes insomnia if used in 
the evening. Sodium Salicylate, in small doses, gr. ij-iij every quarter-hour, 
is very efficient in neuralgic headache (Br) ; also for gouty headache. Lithium 
Benzoate is efficient in headache of lithemic origin (Coston). Belladonna, 
the tincture in doses of 3 minims every 3 hours, when pain over brows and in 
eyeballs, especially when at menstrual periods; also when from over-study or 
fatigue (R). Nux Vomica, if with gastric symptoms (R); is better than 
Strychnine, and should be given in quarter-grain doses of the extract after 
meals, combined with Iron and Quinine if patient is chlorotic (Hammond). 
Bromides, are useful when the nervous system has been irritated, but harm- 
ful when it is exhausted (Hammond). Ammonia, the Aromatic Spirit, 3ss- 
5ij, or the Carbonate, gr. v-x, in nervous headache (B); especially in hard- 
worked and delicate young women (Wa). Amyl Nitrate, inhaled, when ex- 
treme pallor of face (B). Valerian is of great value in excitable persons (P). 
Camphor, a saturated solution in Eau-de-Cologne rubbed on head, when head- 
ache of uterine origin (R) ; in hysterical females, internally, with Magnesium 
Carbonate (P). Podophyllum, purgative doses often give relief when near 
menstrual periods, with constipation and dark stools (R) . Ether Spray, for 
frontal headache, after acute illness or fatigue (R). Chloroform, TUxv-xxx 
of the spirit internally, often effective (Wa). Phosphorus, as dilute Phos- 
phoric Acid, in doses of TTlxxx well diluted, thrice daily; or Zinc Phosphide, gr. 
i\ in pill, ter die, very useful in most forms of nervous headache (Hammond). 
Cajuput Oil, well rubbed in twice daily (P). Menthol, locally to forehead in 
frontal headache ( Wa) . Guaiacol, a few drops rubbed in gently, gives imme- 
diate relief (Brodnax). Diet in headache of gouty subjects should be that of 
gout, and should be free from tea and coffee, which are, however, useful in 



688 



HEART, DILATED- -HEART, FIBROID. 



headache from nervousness or exhaustion (R). Galvanism, sometimes valu- 
able; the constant current always, avoiding too great intensity lest amaurosis 
ensue (Hammond). [Compare Hemicrania, Neuralgia.] 



R. Zinci Phosphidi, gr. iij. 

Ext. Nucis Vom., gr. x. 

Confect. Rosae, q. s. 

M. et div. in pil. no. xxx. 
Sig. — One pill after each meal. 

{Fordyce Barker.) 



1$. Extracti Nucis Vom., gr. iij. 

Ferri Reducti, gr. xij. 

Quininae Sulphatis, gr. vj. 

Ft. pil. no. xij. Sig. — One after each 
meal. {Hammond.) 



Heart, Dilated. 

"The treatment is, first of all, Rest in bed, or in any easy chair if bed is 
impossible because of orthopnea. The second object to be gained is the 
removal of the cause of the dilatation, if that be possible, as the reduction of 
high arterial tension by the use of Nitroglycerine. Third, the employment of 
Digitalis and Strychnine for effect, recalling the fact that once digitalis has 
produced its action smaller doses will maintain its influence, and also bearing 
in mind the additional fact that when it is in full effect sudden changes of 
posture are dangerous. Digitalis may also cause so much ventricular stimu- 
lation as to overdistend the auricle, which is poorly protected by the relaxed 
mitral ring." (Hare) (see article on Heart Valvular Disease). 



Heart, Fibroid (Chronic Myocarditis) . 

Hygiene. — The avoidance of mental and physical strain, simple nutritious 
diet and regular action of the bowels are essential. Potassium or Sodium 
Iodide are useful, especially in those cases associated with atheroma and cap- 
illary fibrosis. The Nitrites, especially Sodium Nitrite, are of value in con- 
junction with the iodides, particularly in those cases associated with unduly 
elevated arterial pressure. Digitalis often fails, and as a rule is contrain- 
dicated. Donovan's Solution, as a general tonic with a small quantity of 
Nux Vomica, is advocated by Hare after the course of iodides. Nauheim 
Baths and Resistance Exercises. — "In many instances when the heart is 
feeble as the result of fibroid changes in its muscle, or when the patient is 
convalescing from some disease like influenza, which seriously impairs the 
functional activity of this organ, excellent results are sometimes obtained by 
the institution of what is known as the Nauheim baths which were originally 
brought before the profession by Schott, of Nauheim in [Germany. These 
baths are composed of water which is charged by nature with large quantities 
of carbonic acid gas. The water is also naturally warm. The patient is im- 
mersed in a bath-tub and immediately there is attached to the surface of his 
skin myriads of tiny bubbles of carbonic acid gas, which as they break pro- 
duce a slight tingling sensation and exercise a stimulant influence upon the 
perpheral capillaries, as the result of which these capillaries are dilated and 
dermal hyperemia is induced. In this manner the circulation is equalized, 
internal congestions are overcome, and the heart finds it easier to pump blood 
through the dilated superficial capillaries than under ordinary conditions. 
Not infrequently when the patient first enters the bath a primary contraction 
of the peripheral capillaries ensues, and this results in a momentary increase 
in the work of the heart, so that the patient for a time feels somewhat op- 



HEART, HYPERTROPHIED — HEART, DISORDERS OF RATE AND MECHANISM. 689 

pressed. Usually he remains in the tub for 10 or 15 minutes, but this period 
is governed by the physician' who superintends the use of the baths. On his 
removal from the bath the patient is carefully dried by an attendant and has 
absolute rest for 1 or 2 hours. After the baths have been used for some time 
additional salt is added to the bath, and water containing large quantities 
of gas is employed. In addition to these baths the patients are subjected to 
gentle resistance movements and massage so as to improve the circulation of 
blood and lymph in the muscles. Great care must be taken that these 
movements are not sufficient to tire the heart. When valvular disease is 
very marked, these baths are con train dicated." (Hare). 

"The Nauheim baths are also contraindicated in cases of advanced 
arteriosclerosis, and in chronic Bright 's disease if it is well developed, al- 
though if the renal difficulty is largely due to congestion this plan of treat- 
ment is advantageous. Aneurysm also contraindicates them, and bronchial 
asthma and chronic bronchitis contraindicate them, or at least require 
great caution in their use. Cases of pulmonary tuberculosis with cardiac 
disease also should not be subjected to this method, nor should patients who 
are suffering from far-advanced degeneration of the heart muscle receive it. 
These baths should never be taken except under the care of a local physician" 
(Hare). 

"It is important to note that the resistance exercises, which are carried 
out in connection with this plan of treatment, are probably equally bene- 
ficial, if not more benefical, than the baths themselves. They consist in 
having the patient extend and flex his joints against the resistance offered 
by the attendant" (Hare). 

Heart, Hypertrophied. 

The hypertrophy which compensates for a valvular lesion requires no 
treatment unless it is associated with evidence of failing compensation. 
(See Valvular Disease.) Aconite in the form of the tincture, is occasionally 
indicated when throbfcing and oppression are present, suggesting excessive 
cardiac action. Nitroglycerin will sometimes relieve untoward symptoms 
in compensatory hypertrophy with undue arterial tension. Hygienic 
Measures, a life carefully guarded against undue strain, mental and physical, 
with an abundance of rest, simple diet, with regular habits, to prevent fail- 
ure of compensation. 

Heart, Disorders of Rate and Mechanism. 

The first essential in the treatment of disorders of the rate and mechanism 
of the heart is the diagnosis of the variety of the disturbance. For a terse 
presentation of the subject the reader is referred to the book entitled " Clin- 
ical Disorders of the Heart Beat" by Thomas Lewis, or to the article by the 
same author entitled "The Rate of Mechanism of the Heart Beat" in Osier 
and McCrae's Modern Medicine. (1) Simple Tachycardia. — The atten- 
tion should be directed to the correction of the extra cardiac factors, hyper- 
thyroidism, focal infections, acute and chronic intoxications, tuberculosis, 
etc., etc. (2) Simple Paroxysmal Tachycardia. — No remedy will unfailingly 
abort the attacks (Lewis). Pressure over the right and left parotid 
vessels alternately has been known to terminate a paroxysm. Digitalis or 
Strophanthus are uncertain remedies, but have been known to terminate the 
44 



690 HEART, DISORDERS OF RATE AND MECHANISM. 

attacks. Rest in bed is essential and an ice-bag to the region of the heart af- 
fords relief. A Mustard Plaster, Leeches or Cupping applied over the 
heart or liver, according to the seat of pain, often brings relief (Lewis). 
Venesection should be practised in the presence of cyanosis and dilatation 
of the right heart. In treating the malady as a whole, a searching inquiry 
may reveal exciting causes of the paroxysms, which may be removed; sudden 
emotion or exertion may be the chief provocative factor, and it may become 
necessary to interdict active employment (Id). The relief of oral and pharyn- 
geal sepsis, the remedying of dyspeptic troubles, and detailed attention 
to the general habits of the patient, the moderation or banning of tobacco, al- 
cohol and sexual excitement, are important considerations (Id). Eventually 
and in long-continued paroxysms, a full course of digitalis may be advisable 
(Id). (3) Auricular Flutter. — Digitalis in the form of the tincture or infusion 
is given in stiff doses, 10 to 15 minims of the tincture and 1 to 2 drachms of the 
infusion until ventricular slowing is obtained. When relief is obtained, and 
for the attacks which are of temporary duration, the treatment is that of 
simple paroxysmal tachycardia. Digitalis does good by changing the 
nutter to fibrillation which seems to submerge the original fast rhythm 
(Bastedo) allowing the ventricles to return to normal rate, or the latter may 
result from some impairment of conduction. (4) Auricular Fibrillation 
is essentially a persistent condition, and treatment is directed to controlling 
the rate of the ventricles. It occurs in 60 per cent, of the patients who 
enter the hospitals with signs of cardiac failure. Digitalis and the allied 
drugs produce their most beneficial influence in this group of cases. (See 
article on Digitalis). Strophanthin often produces remarkable effects when 
administered intramuscularly or intravenously in acute cardiac failure. 
Belladonna and similar drugs are contraindicated, as they raise the ventri- 
cular rate (Lewis). (5) Simple Bradycardia as a rule requires no treatment 
unless the retardation produces anemia of the brain or threatens to do so 
(Lewis). Belladonna may be used under these conditions with benefit. 
The general condition of the patient should be investigated and any faults 
corrected. (6) Partial Heart-block is usually one of the signs of myocardial 
disease (Vide) . Rest in Bed should be insisted upon when of recent origin. 
Digitalis may be used if signs of cardiac failure occur, the administration of 
this drug is not contraindicated, even though it increases the block (Lewis). 
(7) Complete Heart Block. — Strychnine, Strophanthin, Atropine, Epine- 
phrine have been advised to increase the rate of the ventricle, but are of doubt- 
ful value. Mercury and Potassium Iodide are indicated when a syphilitic 
origin is suspected. Rest in Bed, a light nutritious diet and a light massage 
are measures which aid. (8) Premature Contractions. — Exercise should be 
allowed and the patient reassured that the condition is not serious. Sodium 
Bromide may be given where the condition causes undue nervousness. The 
correction of indigestion, constipation, lack of sleep, errors in diet and excess- 
ive smoking, etc., is necessary. No drugs seem directly to influence the prev- 
alence of premature beats (Lewis). (9) Alternation. — The presence of alterna- 
tion, whatever its associations, is a sign of overtaxation of the muscle (Lewis). 
If the heart is normal or thereabout, the sign calls for drastic curtailment of 
work, and of all bodily or mental exertion (Id). In sedentary people it is 
an indication that the hours of rest should be still further prolonged (Id). 
It is one of the few signs of heart disease which forbids the administration of 
a general anesthetic, unless this is imperatively demanded to save life (Id). 



HEART, VALVULAR DISEASE — HEMATEMESIS. 69 1 

Heart, Valvular Disease. 

The presence of a valvular lesion does not indicate treatment unless there 
is failure of compensation. Rest is most important when compensation has 
been lost. Digitalis, when properly used, is our most valuable drug. (See 
article on Digitalis.) In acute cardiac weakness the more rapidly acting 
stimulants Ether and Alcohol, Strychnine, Ammonia and Caffein — may be 
used until digitalis takes hold. Nitroglycerin is useful in those cases 
in which the blood pressure is elevated. Strophanthus, preferably adminis- 
tered as strophanthin intravenously, is of great value in acute cardiac 
failure. Strophanthus by mouth is uncertain in action and prone to produce 
diarrhea. Atropine is useful in threatened pulmonary edema. Dry Cupping 
over the bases of the lungs posteriorly is useful for congestion and threatened 
edema. Dropsy is combated by digitalis which acts as a diuretic and by 
the use of Magnesium Sulphate. Apocynum Cannabium in the form of the 
tincture, Tfl,v-xx thrice daily acts as an efficient diuretic. Blue Mass 
is valuable to unload the liver prior to the administration of digitalis and 
other cardiac drugs, and for use at intervals of 2 weeks or 10 days there- 
after. Opium, preferably in the form of morphine hypodermically is in- 
valuable in the prolonged sleeplessness and in the distressing dyspnea of some 
cases of cardiac decomposition. Cold, in the form of an ice bag over the pre- 
cardia will oftentimes quiet an overexcited heart. Venesection with removal 
of from one-half to one or two pints of blood, according to the size of the in- 
dividual, will often save life in acute dilatation of the right heart with 
cyanosis and dyspnea. Sodium Iodide and Potassium Iodide are useful in 
those cases of chronic valvular disease dependent upon syphilis or gout. 
Diet should be simple and nutritious. (See article on Dropsy.) 

Hematemesis. 

Iron, the Subsulphate (Monsel's solution) one of the best remedies; gtt. j-ij 
frequently, diluted with ice-water (B) ; the Chloride, in a mixture with glycerin 
and pounded ice, a teasp. every hour, gave excellent results in two cases of 
very severe hematemesis (St. George Reid). Lead Acetate, especially 
when gastric ulcer, gr. ss-v (B). Tannic Acid, gr. x-xx, when hematemesis 
from gastric ulcer or obstructive disease of the liver (B). Gallic Acid, an 
extremely useful agent; is best used in combination with dilute Sulphuric Acid 
(Wa.) Ipecacuanha, is decidedly effective in small doses, also when hemate- 
mesis is supplementary to menstruation (P, Wa). Alum, serviceable in 
passive hemorrhage; Iron better (B). Turpentine, especially in passive 
hemorrhage with debility (R) ; and in hemorrhagic transudations on the free 
mucous surfaces, hematemesis, etc. (B). Epinephrine Chloride, the 1 to 1000 
solution, of which lUxxv internally, very effective in two cases (Mills). Ice, 
in small pieces swallowed, a most useful agent, with perfect rest for stomach; 
iced champagne sometimes to arrest faintness, if persistent; when moderate 
the bleeding need not give cause for alarm. Surgical, "If life is threatened 
by bleeding from an ulcer, open the belly and excise the ulcer and suture the 
wound. If severe hemorrhage follows injury, perform an exploratory lapar- 
otomy. Always remember that furious and even fatal gastro-intestinal 
hemorrhage may be due to cirrhosis of the liver, and a slight injury may be 



692 



HEMATOCELE, PELVIC HEMICRANIA 



the exciting cause of such a hemorrhage. In this condition, of course, opera- 
tion is useless 1 ' (Da Costa). [Compare Hemoptysis.] 

Hematocele, Pelvic. 

This condition is amenable only to Surgical Treatment. See Text- 
books on Surgery and Gynecology. 



Hematuria. 

Turpentine, when with constitutional debility (B) ; in very small doses (R) ; 
is often very efficacious (P); in absolutely passive hematuria (W). Gallic 
Acid, the most uniformly successful remedy (B) ; gr. x-xx every hour or two 
(Da C). Acetic Acid, in a case of alarming hemorrhage from the bladder, 
which occurred after an operation for vesico-vaginal fistula, and resisted 
all other means, an injection of apple-vinegar and ice-water, equal parts, 
succeeded in arresting it (Ghent). Quinine, large doses necessary; cures 
when intermittent or from malarial infection (B) ; useful in some cases of 
intermittent hematuria (R). Iron, the tincture of the Chloride, Tfl,x-xx 
several times daily; in this affection the best of Iron for internal use (Wa). 
Ipecacuanha, exercises a powerful influence (Wa). Cotarnine is a powerful 
hemostatic. Ergot, by stomach or subcutaneously; may be combined with 
Ipecac, Krameria, or other astringents (B). Ergot, hypodermically, is far 
superior for efficacy and rapidity of operation (Wa). Ammonium Benzoate, 
in 5-gr. doses every 2 hours for the albuminuria and hematuria of scarlatina 
(Hillier). Cannabis, is especially indicated in dysuria and strangury when 
there is bloody urine (R) . Camphor, in 2 to 5 grain doses is said to promptly 
remove the renal hyperemia with bloody, coagulable urine, caused by Can- 
tharis, Turpentine, Oil of Mustard, Copaiba, etc. (R). Gelatin 2 per cent, 
in normal salt solution, of which 5vj subcutaneously injected below the 
clavicle, conquered the hemorrhage in a case of hematuria with recurrent 
nephritis, in which all other measures had failed (Schwabe). Ice in rectum 
or perineum, for vesical hemorrhage (Thompson). Endemic hematuria, 
due to the bilharzia parasite, can 'only be palliated; as yet we know of no 
means of which the bilharzia can be destroyed (Mn). Surgical procedures 
frequently necessary, as when due to stone, tuberculosis, tumor, etc., etc. 



1$. Acidi Gallici, 5ss. 

Acidi Sulphurici Dil., 

Tinct. Opii Deodor., aa 3j- 

Infusi Digitalis, Siv. 

M. Sig. — Tablesp. every 4 hours or 
oftener. In hematuria, menorrhagia, pur- 
pura hemorrhagica, and the hemorrhagic 
diathesis. (D.) 



1$. Fluidextr. Ergotae, 

Tinct. Kramerise, aa §j. 

M. Sig. — A teasp. every hour or two. 

1$. Ext. Ergotae (Squibb), 5j- 

Aquas, §j. 

M. Sig. — For hypodermic use; tt#x con- 
tain gr. j. 



Hemicrania. 

Antipyrine, the most valuable single remedy for headache, especially in 
migraine and those cases for which Ergot and Amyl Nitrite are indicated; 5 
grains at beginning of the attack often sufficient (Birdsall); of great value in 
true migraine, employed in twenty cases with unfailing benefit; less useful in 



HEMICRANIA. 693 

the malarial or dyspeptic forms, and useless in uremic (Thompson). Acet- 
anilid and Antipyrine, the striking powers of these two agents are best dem- 
onstrated in severe migraine (Whitla). Acetphenetidin, is given with great 
benefit, in doses of 2 grains with \ grain of Caffeine Citrate, for migraine. 
Belladonna, when due to vaso-motor spasm, the face being pallid (B); the 
tincture in small and repeated doses if the disease be of reflex character (H). 
Cannabis, one of the most valuable remedies for megrim or sick headache 
apparently acting on the nervous centre whence the disorder springs; is most 
useful in the intervals to prevent the attacks, and especially when the parox- 
ysms are becoming more frequent; in the congestive form, the tincture in re- 
peated doses until some physiological action is induced (H) ; gr. \ of the extract 
before each meal, increased gradually to \ or § grain, in the intervals, kept up 
for 3 months (Seguin). Camphor, gr. iij-v, with a 20- or 30-grain dose of 
Magnesium Carbonate, is very useful, especially in hysterical females (P). 
Croton-chloral, in milder forms without severe vomiting, headache being 
predominant; the Bromides are useful after it (R); rarely of any use, but if 
given it should be in 20-grain doses twice daily (H); Guarana, is useful (B), 
a very effective palliative; gr. xx every \ hour for three hours (P) ; its efficacy 
diminishes by degrees, attacks usually becoming longer (Tr); 5ij of fluid- 
extract in course of an hour or two, to anticipate the attack when expected 
(Seguin). Caffeine, in typical migraine; gr. j hypodermically (P) ; is especially 
adapted when chronic gastric catarrh, gr. j every half-hour (B); the Citrate 
in grain doses every hour for some time before a paroxysm (Wa) ; gr. j every 
half -hour often gives marked relief (Smith). Valerian, of especial value 
when hemicrania in excitable temperaments, and after profuse or painful men- 
struation (P). Ammonium Chloride, is exceptionally serviceable; seldom 
failing to cut short an attack (Austin); 10- to 15-gr. doses (R); as a diffusible 
stimulant is very efficient, gr. xx up to 5 j every hour during the attack (H) . 
Sodium Chloride, in small doses, proved very efficient in six positive cases 
attended by gastric distress (Rabon). Podophyllin or Mercury, when of 
bilious origin (R). Bromides, for true migraine; Raspail's Eau Sedative 
locally, gives great relief (B); when due to uterine disorder (R). Potassium 
Bromide, very serviceable in the paroxysm, also in the continuous form (R). 
Potassium Iodide, gr. v-x thrice daily, caused immediate improvement and 
absolutely eradicated it after 2 or 3 weeks in many cases, this drug being 
given by reason of the increased arterial tension and the similarity between 
migraine and the headache of cerebral syphilis (Clemens) . Eucalyptus when 
migraine is due to cerebral anemia (B) . Phosphorus, is strongly recommended 
(R). Amyl Nitrite, by inhalation, in migraine with pallor of face (R). 
Sanguinaria, a few doses very successful when migraine is due to gastric de- 
rangement (P). Nux Vomica, when of gastric origin (R). Cimicifuga, is 
strongly recommended (P). Arsenic, for cerebral congestion and hemicrania 
(B); for throbbing pain in one brow (R); often has the best effect: Watson 
believed that gtt. iv-vj of Liq. Arsenicalis, 3 or 4 times a day, with due atten- 
tion to the bowels, would cure 9 out of every 10 cases (Wa). Aconitine or 
Veratrine, ointment over brow (R) ; Aconitine internally is of great service 
(Seguin). Digitalin, gr. -fa bis die in granules for congestive hemicrania (B). 
Ergot, if due to miliary aneurisms of intercranial arterioles; also in congestive 
migraine and in nearly all kinds (B). Menthol, locally in frontal headache 
due to migraine, is said to be very efficient (Wa). Thyroid Extract is of 
great value in some cases of migraine which are thyroid in nature (Gordon). 



1 



694 



HEMIPLEGIA — HEMOGLOBINURIC FEVER. 



Diet in lithemic subjects must be free from meat, tea, coffee, etc., the diet 
for gout (Haig). Rubber Bandage, applied tightly from eyes up, protecting 
the temporal arteries by pads, or a dry muslin bandage wetted after being 
put on (Weir Mitchell). Acupuncture, the needle run down to the cranium 
will give relief in clavus hystericus, when nothing else will do so (Pancoast). 
[Compare Headache, Bilious Sick and Nervous.] 

1^. Ammonii Chloridi, 5vj. 

Ammonii Bromidi, 5iv. 

Spt. iEtheris Nitrosi, §j. 

Syr. Pruni Virgin., giij. 

Aquae, q. s. ad gvj. 

M. Sig. — Dessertsp. 3 or 4 times daily, 
conjoined with the use of RaspaiVs Eau 
Sedative locally. 



]$. Quininae Sulphatis, 5ss. 

Belladonnae Fol. (pulv.),.. . . gr. x. 

Ext. Digitalis, gr. xv. 

Ext. Valerianae, 5ss. 

Mellis, q. s. 

Ft. pil. no. xl. Sig. — 2 to 10 puis daily, 
gradually increased, during three or four 
days before the expected attack. 



Hemiplegia. 

Aconite as a cardiac sedative, is often advantageous in cases with high 
arterial tension, as a prophylactic against future attacks (Taylor). Nitro- 
glycerin to lower arterial pressure in the same class of cases (Id). Strych- 
nine, is most useful when the muscles are relaxed; hypodermically, when 
paralysis incomplete and the muscles flaccid but not wasted (B). Potassium 
Iodide, gr. x-xviij daily, occasionally proves effectual (Wa) ; it is improbable 
that this, or any other remedy, hastens in the slightest degree nature's deal- 
ing with the blood-clot (O). Galvanism, constant current to the brain or 
cord, faradic to the muscles opposite those contracted (Hammond). 
Massage, in hemiplegia and other forms of paralysis due to intracranial 
lesions, when cold and blue skin, wasting and contracted muscles, ulcera- 
tions (B). Stimulants to the circulation and avoidance of purgation, to 
promote the collateral circulation in cases due to thrombosis (Id). Ice-bag 
to the head and hot bottles to the feet (O). Treatment, very little can be 
done for hemiplegia, the damage being too often irreparable and permanent 
(O). [Compare Paralysis Facial.] 



Hemoglobinuric Fever. 

Prophylaxis. — "The view now generally entertained is that where malarial 
prophylaxis is properly carried out there will not be any blackwater fever. 
In persons who have had a previous attack of blackwater fever quinine pro- 
phylaxis should be with quinine tannate or quinine base, avoiding the acid 
salts of quinine. In particular any exposure to chilling influences or condi- 
tions which lower resistance should be avoided. As blackwater fever is more 
prevalent among those who have been for 2 or 3 years in highly malarious, 
tropical regions than among recent arrivals, the former should exercise the 
greater care as to errors in diet, alcoholic excesses, exposure to wet and irreg- 
ularity in quinine prophylaxis" (Stitt). 

Antipyrine, Acetphenetidin, and similar antipyretics, are dangerous agents 
in this condition (Mn). Quinine, is less efficient in this than in any other 
form of malaria (Mn) ; as it conduces to hemoglobinuria its use is deprecated 
(Plehn) ; should be given in this affection if the malarial parasites are found 
in the blood, but not if they are absent (Bastianelli) ; the sulphate is peculiarly 
prone to cause hemoglobinuria, and should be replaced by the hydrochlo- 



HEMOPTYSIS. 695 

ride (McCay) ; the latter should always be used in preference to the sulphate 
(Lukis). Saloquinine in daily dosage of gr. xl-3j did excellent service after 
quinine had failed (Fitch). Methylthionine is destructive to the malarial 
parasite, but not irritant to the kidney, and is the best substitute for Quinine 
(W). Calomel in doses of 20 to 30 grains, is the favorite remedy in Africa 
(Mn); Calomel and Jalap, separately or combined, to keep the bowels well 
open (Copeman). Mercury, the solution of the perchloride in doses of TTlxxx 
with sodium Bicarbonate gr x to a tablesp. of water hourly for 24 hours then 
every 2 hours until the urine clears, with prohibition of acid drinks, quinine 
and beef extracts, the patient wrapped in blankets with hot water bottles, 
reduced the mortality promptly, and a series of 21 cases was reported with- 
out a death (Hearsey) . Chloroform, in small doses internally, the effect to be 
kept up by enema ta of Chloral; of 22 cases so treated none died (Quennec). 
Chloral, with perhaps small doses of Pilocarpus, if uremic convulsion or coma 
supervene (Copeman) . Tannic Acid, gr. xv well diluted, every 2 hours for 4 or 
5 times, repeated on the third and sixth days to the extent of two doses each 
day (Mn). Transfusion of blood has been successfully practised in high de- 
grees of anemia in some of these cases (Id). Hot Water, in bottles in the bed, 
if the temperature should fall below normal (Copeman). Diuretics must 
not be given if urine suppressed, but hot fomentations to the loins, diapho- 
retics and plenty of bland diluents internally (Mn). Milk Diet exclusively 
until all albumin has disappeared from the urine (Id). Care necessary at all 
times to avoid getting wet or chilled or overf atigued, f or those who have 
suffered once from this affection (Id). [Compare Malaria.] 

Hemoptysis. 

Rest is by far the most important therapeutic procedure. The patient 
should be placed in bed, preferably on his back, and not be allowed to move 
around. If the hemorrhage has been large and the patient tends to syncope 
it may be necessary to raise the foot of the bed a few inches; usually, however, 
the absence of a pillow is all that is necessary. In mild cases a low pillow may 
be allowed. The surroundings of the patient should be kept quiet, visitors 
excluded, and only a minimum of visits from relatives allowed. The patient 
should make no effort whatever; he should not talk unless absolutely neces- 
sary, and then in a low whisper; he should use a bedpan and urinal; he should 
not raise his head to cough and expectorate, but rather turn his head to the 
side and expectorate in gauze or some material which can be burned. The 
importance of rest, while in direct proportion to the severity of the hemor- 
rhage, cannot be underrated even in the most trivial cases of blood-spitting, 
particularly when it is recalled that small hemorrhages frequently tend to recur 
and sometimes precede large ones. The patient should be kept in bed until 
blood has ceased to appear in the sputum, from three days to a week longer, 
depending upon the severity of the attack and the influence upon the activity 
of the tuberculous process. It is well to keep in mind the tendency toward 
bronchopneumonia, the incidence of which is reduced by rest in bed. When 
the time comes for the patient to get up, it should be gradual and consist, 
first, of propping up in bed, then sitting up in a chair for a few hours, etc., 
until the patient is back to his normal activity. Drugs play a minor though, 
if judiciously used, an important part in the therapy of hemoptysis. To 
quiet the patient and to check the excessive cough are the indications for 



696 HEMOPTYSIS. 

Opium or one of the derivatives, preferably codein. Opium is our best drug 
and, although it should not be used routinely, it is extremely valuable for the 
mental excitement which at times approaches a panicky alarm, for the agita- 
tion which militates against all the good which comes from Rest, for the cough 
in excess of that which is required to remove gross quantities of blood and 
secretions from the air passages, and which tends to continue the bleeding 
and prevent the formation of the thrombus, and for those with fluctuation of 
the pulse rate and blood pressure (probably as a result of the increased nervous 
irritability). It is to be given cautiously, however, and in small doses fre- 
quently repeated, rather than in large doses, particularly when it is thought 
that there exists any inundation of the bronchial tubes. Hemostatics, the 
use of drugs to directly favor coagulation of the blood and to influence the 
caliber of the vessels of the lungs, has not met with much success. The 
drugs so used are legion, and the experimental and clinical data collected 
enormous and confusing. The tendency of pulmonary hemorrhage to stop 
spontaneously has led to many erroneous conclusions, and almost every drug 
known to even remotely influence the circulation has been lauded as a specific 
at some time or other. Calcium, preferably in the form of the lactate, in 
doses of 15 to 20 grains three to four times a day, has been used largely by 
the followers of Wright with the view of increasing the coagulability of the 
blood. An important point, which recent observations seem to point out, is 
that after a comparatively short usage the drug tends to delay the coagulation 
time. When given, therefore, it should be stopped after 2 or 3 days' 
administration. Injections of Normal Horse Serum have been used for the 
same purpose. Recently Emetine, the active principle of ipecac, has found 
favor in the hands of a number of clinicians. Chauffard states that hemop- 
tysis is rapidly and effectively arrested by the injection of 0.04 or 0.06 mils of 
Emetine Hydrochloride. It is administered in one-quarter and half -grain 
doses hypodermically, and in our experience, several or more injections may be 
necessary. It is of distinct value in the type of hemoptysis in which there is 
a tendency to repeated small hemorrhages suggesting an involvement of the 
smaller vessels; or when the continued appearance of streaked sputum sug- 
gests capillary bleeding. Ergot, Epinephrine, Pituitary Extract, Aconite, 
Veratrum, etc., etc., have their staunch supporters among phthisio therapists. 
Forchheimer believes that Adrenalin is our most valuable remedy. Pituitary 
preparations are used by many, although Minor, after an extended clinical 
use, has discarded them entirely. Pottenger believes that reliance should be 
placed upon tincture of Veratrum Viride given until slowness of the pulse is 
produced. Sodium Nitrite, Nitroglycerin, Amyl Nitrite and Erythrol 
Tetranitrate are the most useful of this group of drugs. In addition to lower- 
ing the general blood pressure a rather paradoxical action has been noted 
experimentally, namely, constriction of the pulmonary vessels (Macht). 
This action of the nitrites, pulmonary vasoconstriction and peripheral and 
splanchnic vasodilatation, would seem to be ideal in the treatment of pul- 
monary hemorrhage and probably explains the good results which have been 
noted in their use. Measures Other than Drugs.' — The Ice Bag should not be 
used. The variable position of the point on chest wall nearest the bleeding 
point, the size of the vessel, the thickness of the tissues between it and the 
surface, the difficulty in keeping an ice bag from shifting its position, the 
weight and discomfort to the patient, the chilling in certain cases where 
warmth is desired, etc., all militate against the so-called value of the ice bag. 






HEMORRHAGE, HEMORRHAGIC DIATHESIS. 697 

Its use in hemoptysis is limited to a few cases in which extreme cardiac ra- 
pidity is present, in which when applied to the precordia it seems to lessen the 
frequency of the rate. In cases where blood gushes from the mouth and it 
is evident that a large vessel is opened, it is advisable to place Ligatures 
Around the Extremities; great care being exercised, however, to exert just 
sufficient pressure to retard the venous return and not obstruct the arterial 
inflow. When the bandage is removed it should be done gradually to prevent 
sudden increase in blood pressure with the danger of recurrence of bleeding. 
In this same type of case it may be necessary to Raise the Foot of Bed, apply 
Warm Water Bottles to the body. Stimulate with camphorated oil, pituitrin, 
atropine and apply those measures which are generally used in shock. Thera- 
peutic Pneumothorax. — Considerable interest has been aroused within recent 
years in the therapeutic use of artificial pneumothorax. Persistent bleeding 
which fails to respond to the usual methods calls for a consideration of this 
form of treatment. The object sought is mechanical compression of the 
bleeding point by collapsing the lung. The results are often startling, the 
bleeding ceasing with remarkable promptness. In other instances because of 
pleural adhesions, extensive consolidation, or dense fibrosis of the cavity wall, 
collapse is not obtainable, or only partially so, and the treatment fails. The 
technic of the operation is simple, but should never be undertaken except by 
those skilled in its performance. Cases of sudden death have occurred even 
in experienced hands. Lyon noted among sixty-two patients treated by 
artificial pneumothorax one case in which treatment had to be abandoned 
because of severe hemoptysis from the uncollapsed side. Diet depends 
largely upon the severity of the hemoptytic attack. In frank hemorrhage 
efforts at swallowing increase the bleeding. In slight hemorrhage character- 
ized by blood-streaked sputum efforts at swallowing have little or no in- 
fluence. In the former all food and liquids should be withheld for the time 
being, excepting small quantitites of cracked ice sparingly allowed. In the 
latter, an easily digestible diet with a reduction in the amount of liquid in- 
take, should be allowed, the liquids limited with the hope that increased con- 
centration of the blood may favor lowering of the blood pressure and increased 
tendency to coagulation. 

Hemorrhage, Hemorrhagic Diathesis. 

Iron, when hemorrhagic diathesis due to anemia; the tincture of the 
Chloride preferred (B). Ergot, in uterine hemorrhage of any kind, and many 
forms of hemorrhage, Ergot or Ergotin of great value (P) ; not to be relied on 
alone (B); is harmful in arterial hemorrhage as it increases blood pressure 
(Fenn). Hydrastinine is a powerful vaso-constrictor, and especially efficient 
in arresting uterine hemorrhage (W). Hydrastine, a salt of this alkaloid in 
doses of gr. |-J hypodermically when a speedy action is required (W). 
Opium freely, to allay excitement and reduce blood pressure. Cotarnine is a 
powerful hemostatic, also anodyne and sedative, and is efficient in many forms 
of hemorrhage. Epinephrine is powerfully angiostenotic and efficient in 
hemorrhages when it can be applied locally. Antipyrine, is a most efficient 
hemostatic; a 4 per cent, solution checks general oozing from a bleeding sur- 
face; as a styptic it constricts the small vessels without causing an external 
clot to break down (Park). Gelatin, as a styptic and hemostatic is efficient; 
used by subcutaneous injection of a 2 to 5 per cent, solution, also by rectal 



698 HEMORRHAGE. 

injection; and by the mouth in hemophilia, 5 vj daily of a 10 per cent, solution 
(Hesse). Ipecacuanha in toxic doses causes hemorrhage, but has great 
energy in arresting it (P) ; exercises a powerful influence on internal hemor- 
rhage generally, and in exhaustion therefrom; gr. j-ij every J hour (Wa). 
Turpentine, few agents more useful in the passive forms (B) ; small doses in 
hematuria (R); for serious hemoptysis, and hemorrhage of typhoid (P). 
Belladonna, hemorrhage from rectal ulcers (P). Digitalis, in uterine, and 
many other forms, of great value (P); especially when due to passive con- 
gestion as a result of failing heart. Aconite to reduce the circulation in epis- 
taxis, hemoptysis, etc. (P) ; to quiet the circulation and lower blood pressure, 
in profuse hemorrhage from the lungs (Fenn) . Calcium Chloride in doses of 
gr. vij every 2 hours, increases the coagulability of the blood and is efficiently 
hemostatic in uterine hemorrhages and hemophilia (Gross). Gallic and 
Tannic Acids in all passive hemorrhages, especially in that of the bladder (P) ; 
Tannic Acid for local use, Gallic for systemic effects upon remote parts: when 
hemorrhage occurs in relaxed and debilitated constitutions, Gallic Acid may 
be combined with Ergot and Digitalis (B). Copper Sulphate, in stick, 
solution or ointment, to arrest hemorrhage from small vessels (R). Hema- 
toxylon, is devoid of irritant qualities and is therefore well adapted to check 
the diarrheas and hemorrhages of young children. Dilute Vinegar to leech- 
bites, piles, cuts, etc. (R). Alum, is sanctioned by high authority (B) ; dusted 
on in slight cases (R) ; in uterine and traumatic hemorrhage, when small ves- 
sels open (Tr). Normal Blood-serum, numerous reports have shown that 
injections of normal human, horse, or rabbit serum are of considerable value in 
the treatment of melena neonatorum, hemophilia, purpura hemorrhagica, 
hemorrhagic retinitis, intestinal bleeding in typhoid fever and in connection 
with cirrhosis of the liver, pulmonary tuberculosis, in some cases of uterine 
hemorrhage, and in surgical operations upon icteric persons (K). The doses 
advised have been from 10 to 20 mils for infants and children and from 20 to 50 
mils for adults. The technic is very simple and is tersely described by Kolmer 
as follows: Sterile normal horse serum ready for injection may be purchased 
in the open market. Human serum may be secured by withdrawing blood 
into large centrifuge tubes and allowing the serum to separate, or the clot 
may be broken up after an hour and the serum secured by rapid centrifugali- 
zation. For intravenous medication the serum should be free from particles 
of fibrin. Indeed, the whole operation may be conducted at the bedside by 
withdrawing blood from the donor into a flask containing sterile glass beads, 
and after a few minutes of vigorous shaking the defibrinated blood is injected 
subcutaneously or intramuscularly. Whenever human serum or blood is 
used and time permits, a Wassermann reaction should be performed before- 
hand, and it should be determined, by hemolytic and agglutination tests, that 
the donor's serum does not hemolyze or agglutinate the recipient's erythro- 
cytes. All procedures should be conducted in an aseptic manner. Styptics, 
are either needless or inefficient, hence practically useless in general surgery; 
hemorrhage should be controlled by either pressure or ligation (Roberts). 
Hot Water, sponged over a bleeding surface, is the best agent to stop hemor- 
rhage (Gross). Hypodermoclysis to replace fluid lost in severe hemorrhage 
(Kemp). Transfusion of blood is resorted to in severe cases where a suitable 
donor can be secured. Infusion of normal saline solution is used to replace 
fluid lost in excessive hemorrhage and to raise the blood pressure. Ice, inter- 
nally in wounds or hemorrhage of lungs, or from stomach; small pieces fre- 



HEMORRHAGE — HEMORRHOIDS. 699 

quently (R). Rest, perfect rest is often indispensable. [Compare Dysen- 
tery, Ecchymosis, Epistaxis, Hematemesis, Hemoptysis, Hemorrhoids, 
Hematuria, Hemorrhage Postpartum and Intestinal, Menorrhagia, 
Metrorrhagia, Purpura, Wounds.] 

Hemorrhage, Intestinal. 

Gallic Acid, gr. xv with gtt. iij-iv of Laudanum, in a wineglass of iced 
water in the hemorrhage of typhoid (Jenner). Opium, a valuable adjunct to 
astringents, allaying the nervous excitement (Wa); most useful (Da C). 
Tannin, one of the most serviceable remedies for the intestinal hemorrhage of 
typhoid fever (B). Turpentine, the oil in capsule containing 1Uij-iij (Tirard) ; 
should be used (B); especially in the hemorrhage of typhoid (P). Lead 
Acetate is often of great service, especially in enema (Jenner). Belladonna, 
for irritable and bleeding rectal ulcers (P). Iodine, in passive form, gtt. 
j-ij of tinct. frequently repeated, of great service (B). Sulphuric Acid, is 
serviceable (B); is much less efficacious than other remedies (W). Copper 
Sulphate, gr. J-j as a pill (Tirard). Ice over the abdomen is recommended; 
contraindicated in typhoid by the amount of depression (Id) . Diet, withhold 
food if severe hemorrhage; saline fluid by hypodermoclysis or intravenously. 
[Compare Dysentery, Hemorrhoids, Typhoid Fever.] 

Hemorrhage, Post-partum. 

Ergot requires 15 to 20 minutes for action when given by the mouth, so is 
best used hypodermically when flooding has set in (W); a full dose of the 
fluidextract as soon as birth is completed, as a prophylactic (Playfair) ; hypo- 
dermically in urgent cases, gr. ij of Bon jean's Ergotin deeply into the tissues 
of the arm (Wa) ; 5 ss doses of the fluidextract every 2 to 4 hours in secondary 
hemorrhage. Caffeine Sodio-benzoate in doses of gr. v-x, is superior to ergot 
(Misrachi). Atropine hypodermically in profuse flooding after abortion, is 
very efficient (Squibb). Ipecacuanha has been given with advantage (W); 
in flooding after delivery (R) . Hydrastinine is a powerful uterine vasocon- 
strictor, and efficient in uterine hemorrhage (W). Cotarnine is a powerful 
uterine hemostatic (Sartig). Digitalis, the infusion best; a tablesp. bis die, 
or in urgent cases every half hour for 4 doses (B). Nux Vomica, the tinct. 
gtt. xx ; Fluidextr. Ergotae gtt. xxx; each hour for 2 or 3 doses (B). Opium, 
with Brandy, in profuse flooding (R). Vinegar, a handkerchief soaked in 
vinegar and carried into the uterus, will often check a severe hemorrhage 
(Landis) ; is antiseptic, astringent and sufficiently irritating to produce con- 
traction, yet not so irritating as to cause subsequent mischief, and always acts 
promptly (Penrose). Tamponade, by aseptic gauze packed firmly in the 
uterus will control in the obstinate cases. Auxiliary Measures of importance 
are firm pressure on the uterus, compression of the abdominal aorta, and if 
necessary hot intra-uterine injections followed by gauze tamponade (Wa). 
Hot Water, no° to 122 F., injected into uterus, extremely successful in 
checking post-partum hemorrhage (Atthill); the most prompt and certain 
method, and the least unpleasant to the patient (Parrish). [Compare Abor- 
tion, Metrorrhagia.] 

Hemorrhoids. 

Galls, as ointment, very useful; the Unguentum Gallae, or Galls combined 
with Lead and Opium (R). Tannic Acid, as ointment locally (W). Ferric 



7oo 



HEMORRHOIDS. 



Subsulphate, (Monsel's Salt), in solution as wash to bleeding piles, which 
should then be well oiled (B) ; as ointment gr. xv or xx to the § , locally night 
and morning, gives 'excellent results, if applied by a pile-pipe. The pre- 
scription should contain a warning against substitution of the Sulphate, which 
is irritant. Hamamelis, as lotion or injection in bleeding piles (R); is 
employed with satisfaction; TTtij-x of tincture several times a day; also as 
enema or suppository (Pf). Sulphur, gr. v-x, with 3j Confec. Sennae, as 
laxative (R) ; exercises a most soothing influence (Wa) . Aloes, causes conges- 
tion of pelvic viscera, yet Fordyce Barker shows it to be curative in piles, 
especially in recent ones, as after delivery (B) ; to greatly relieve bowels (R) ; 
cures by removing constipation (P). Podophyllum as a cathartic for hemor- 
rhoids of recent formation, bleeding from stasis in the portal circulation (B). 
Cocaine locally for inflamed hemorrhoids, is invaluable as a palliative (W) ; 
gr. xij with 5j of iodoform, 3ss of ext. opii and 5 j of vaseline, as ointment 
when the piles prolapse and inflame (Mathews) . Hydrastis, as lotion or oint- 
ment to external piles, of great value. Senna, to produce soft and easy evacu- 
ations use the Confectio Sennae at bedtime, gr. cxx in a bolus (B). Iodo- 
form, the ointment, and in suppository (B) ; gr. v-x in suppository for painful 
hemorrhoids (W) . Ichthyol, TTL v-xv internally after each meal, seldom fails to 
relieve the congested capillaries of the lower rectum and anus if not too 
aggravated (Bulkley). Epinephrine, the i to iooo solution on tampon 
locally, very effective for irreducible hemorrhoids threatening strangulation 
(Mosse). Nitric Acid, as caustic, followed by free use of Olive Oil (B), § ss- 
5 j ad Oss aquae as lotion for bleeding piles (R). Hyoscyamus or Stramon- 
ium, ointment, locally for pain (P). Alum, to painful bleeding piles, a crystal 
trimmed and passed into rectum, or as an ointment (B). Ice, to painful, 
bleeding piles, or cold water injected daily (B); locally for pain after opera- 
tion (R). Leeches, directly to swollen, irreducible, and painful piles (B). 
Saline Purgatives, especially Epsom salts, with Sulphuric Acid, will often 
stop the bleeding (B). Diet, etc., avoid stimulants, indigestible food and 
over-eating; during an attack use little animal food. Petroleum soap when 
piles protrude, with cold or tepid water ablutions. Injections, Oj of cold or 
tepid water, are very useful. Stool should be at night. Surgical Methods, 
the ligature for internal hemorrhoids, excision for external ones. Ligation, 
is the proper treatment for internal piles, all other methods of operating 
radically being now discarded as unsurgical and dangerous to life (Gross); 
the ligature is much superior to excision or cauterization (Ehrich). Clamp 
and Cautery operation has many advantages, and is efficient in the worst 
cases (Brick) . Prevention, hard feces, constipation, straining at stool, uterine 
displacements, etc., etc., favor the production of piles. 



1$. Iodoformi, 5 j- 

Balsam. Peruv., 5ij- 

Magnesii Oxidi, 3 j- 

Cetacei, 3ss. 

01. Theobromae, q. s. 

M. et fiant suppositoria xij. Sig. — One 

twice daily. {Potter.) 



J$. Gallae (pulv.), gr. xx. 

Opii Pulveris, gr. x. 

Ung. Plumbi Subacet., gr. xl. 

Ung. Simplicis, oj- 

M. et ft. unguentum. Sig. — Ointment 
for piles. (CEsterlen.) 



1$. Ext. Colocynth Co., gr. xxx. 

Ext. Nucis'Vom., gr. vj. 

Hydr. Chlor. Mitis, 

Ext. Hyoscyami, .... aa gr. xij. 

M. et div. in pil. no. xij. 
Sig. — One pill as required for sluggish 
bowels. (Barker.) 



]$. Mentholis, '. gr. xx. 

Cocainae, gr. x. 

Camphorae, gr ; x. 

Ung. Aqua Rosas, § j. 

M. et Sig. — Apply locally for itching 
piles. 



HEPATIC CIRRHOSIS — HEPATIC DISEASES. 701 

Hepatic Cirrhosis. 

Iodides, are the best remedies for the first stage (B) ; Potassium Iodide is 
highly recommended by some authorities (Da C); the great measures in the 
treatment of this affection are Potassium Iodide, hydrotherapy, and a milk 
diet (Lancereaux). Alkaline Mineral Waters, are important in the first 
stage (B); Alkalies early, especially Carlsbad water, with total abstinence 
from alcoholic beverages (Legg). Mercury, Corrosive Sublimate in small 
doses, gr. -fa thrice daily, for long time, does benefit the condition and has 
possibly cured a few cases (Da C). Nitro-hydrochloric Acid in the early 
stages while the liver is still enlarged, has apparently benefited some cases 
(W). Mercury and Potassium Iodide, in cases having a syphilitic history 
(Tirard). Arsenic, small doses perseveringly, give good results in improving 
the nutrition of the organ (B). Sodium Phosphate is said to produce good 
results (Da C) ; when cirrhosis has been fairly established no drugs can con- 
trol the new growth of fibrous tissue or lead to the formation of fresh glandu- 
lar tissue (Tirard). Tapping becomes necessary for the dropsy, though pur- 
gation and diuresis may help to lessen it (Da C). Diet, should be of easy 
digestibility, especially milk, avoiding starches and fats and quitting alcohol 
(Id). [Compare Ascites, Dropsy.] 

Hepatic Congestion. 

Sulphates, in natural purgative waters, small doses often repeated (R); 
in the shape of some bitter water or of Carlsbad salts, generally give prompt 
relief (Mn); a good substitute for Carlsbad salts is Sodium Sulphate 2, Sodium 
Bicarbonate 1, Sodium Chloride 1 (Id); Potassium Sulphate is occasionally 
poisonous (R). Iodine, tincture internally, and ointment locally for hepatic 
engorgement after malarial attack; also Ammonium Iodide in moderate fre- 
quent doses, for functional derangement from malarial disease (B). Sodium 
Phosphate, 3j - ij> 3 or 4 times daily, in plenty of water, as a purgative (B); 
seems to have specific action on the liver and is used with great advantage 
in chronic hepatic torpor (W). Ammonium Chloride is an effective remedy 
in chronic torpor and chronic hepatitis (W) ; in passive congestion, and chronic 
torpidity, is well worthy of attention; gr. xx every 4 hours (Wa); an excellent 
[remedy (Da C). Turpentine, hot stupes to hepatic area, often found very 
beneficial. Quinine, gr. xv-xx with Morphine, gr. J-J, in the acute conges- 
tion due to malarial causes, no remedy so efficient (B). Mercury, valuable 
only as a purgative; a full Calomel purgative is of utility in cases of conges- 
tion (Wa). Podophyllum, the resin in congestion of the portal circulation, is 
especially useful (B); gr. |-| every six hours will speedily relieve symptoms 
(P). Aliment, no starches or fats; give milk, eggs, oysters, beef -broth, white- 
fish, etc. (B); in chronic hepatic congestion (tropical liver), alcohol must be 
forbidden in every shape, animal food used very sparingly, especially beef 
and mutton, fruit and farinaceous substances may be more freely taken, but 
over-eating in every form must be avoided (Mn). Exercise should be taken 
twice daily, and should provoke perspiration (Id). Cold water Belt around 
the abdomen, covered with oiled silk, gives comfort in chronic cases (Da C). 
Compare Biliousness, Jaundice, Hepatitis.] 

Hepatic Diseases. 

Ammonium Chloride is serviceable in all cases of liver disease, whether 
due to organic changes or to functional derangement; especially indicated 



702 HEPATITIS AND HEPATIC ABSCESS. 

after the more acute symptoms have abated (Wa). Nitro-hydrochloric Acid, 
formerly held high rank, but is superseded by Ammonium Chloride (Wa) ; 
even the acid baths, so long considered of great importance, are but little, if 
ever, used in India (Fayrer). Nitric Acid acts in some way beneficially on 
long-standing liver-diseases, as in chronic congestion and cirrhosis (R) ; with 
vegetable bitters, long continued, useful in waxy liver (Wa). Podophyllum 
has a high reputation in a variety of liver diseases (P). Mercury, mercurial 
purgatives are frequently used; harmful in many acute forms of hepatic dis- 
ease, and generally are of doubtful propriety in liver affections (B) ; in hepatic 
congestion a full Calomel purge is of great benefit (Wa). Red Mercuric 
Iodide, as ointment, gr. j to 3 v , gives best results in malarial enlargement of 
the liver (W). Ipecacuanha may be used in small doses with great advantage 
in functional derangement of the organ (Wa). Euonymin is of great value 
in torpid liver and its accompanying headache (W). Sodium Phosphate is 
extremely useful in liver affections, especially the jaundice of children (Thudi- 
cum) . Potassium Salts, as depuratives, are of decided value, especially the 
Citrate, in hepatic torpor and other affections (W). Sulphur, the sulphurous 
mineral waters, prolonged, give excellent results in liver disorders (B). Alka- 
line waters are very serviceable (B); especially the sulphur waters; Glauber's 
salt in their place (Da C). Iron preparations, long continued, in amyloid 
degeneration (Da C). Gentian, and other bitter tonics, in functional dis- 
order; also Nux Vomica occasionally, but use Mercurials and Podophyllum 
sparingly (Da C). Iodine and Iodides in waxy enlargement, simple hyper- 
trophy and chronic congestion, of great value (Wa); Potassium Iodide 
alternately with Ferrous Iodide in waxy liver (Frerichs). Malt Liquors are 
harmful in all chronic affections, especially in fatty liver (B). [Compare 
Biliousness, Calculi, Cancer, Hepatic Congestion, Hepatic Cirrhosis, 
Hepatitis, Jaundice.] 

Hepatitis and Hepatic Abscess. 

Ipecacuanha, in full doses, repeated once or twice daily for 2 or 3 days, if 
dysentery be present (Id) ; in full doses during the pre-suppurative stage will 
certainly prevent abscess (Rogers); of great value in cases which follow on 
dysentery, preventing abscess S thoroughly used in the early stage (Murray). 
See article on Ipecacuanha and on Amebic Dysentery. Quinine in large 
doses for the acute parenchymatous inflammation (Da C); in medium doses 
persistently for a long time has done excellent service in chronic hepatitis 
without abscess, but with frequent exacerbations. Tartar Emetic, gr. f-J, 
every two or three hours, with Opium or Calomel as indicated by symptoms; 
of especial value early in the acute attack (Wa). Alkalies and Colchicum, 
when the affection is of a gouty nature (Wa). Sinapisms and Linseed poul- 
tices over the hepatic region in acute hepatitis (Wa). Saline Purgatives, as 
the Sulphate of Sodium or Magnesium, to increase the watery exudation 
from the mucous membrane of the intestines, in acute hepatitis (Wa); free 
purging by the Sulphates, massive hot poultices, low diet and rest in bed, the 
treatment for hepatitis which has not proceeded to abscess formation (Mn). 
Nitro-hydrochloric Acid, used with great success in the hepatitis of hot cli- 
mates, especially in the chronic form which normally ends in enlargement and 
induration (W). Incision and evacuation are demanded early in tropical 
abscess to avoid the dangers of spontaneous discharge, which leads to pro- 



HERNIA — HERPES ZOSTER. 703 

longed and exhausting suppuration (Tirard). Aspiration when pus has 
formed, has induced many recoveries; early operation the rule of practice 
(Da C). [Compare Jaundice.] 

Hernia. 

The Operative Treatment of hernia is indicated in ordinary cases of re- 
ducible hernia where the individual is in good health and in strangulated 
hernia and in irreducible hernia. The radical operation is almost without 
danger in properly selected cases and is one of the most successful of surgical 
procedures (Da Costa). We are justified in doing the operation upon an 
individual under fifty years of age and free from complications, purely to 
relieve him or her from the annoyance of wearing a truss (Id). Organic dis- 
eases of the heart, kidney or lungs are contraindications (Id). The Palliative 
Treatment consists in avoiding sudden strains, violent exercise, and constipa- 
tion. The patient should wear a truss. 

Herpes Simplex ; Facialis ; Labialis ; Progenitalis. 

The treatment for the above conditions is very largely the same, being 
modified to suit the situation. For Herpes Labialis and Progenitalis, clean- 
liness is of the utmost importance. After thorough washing, dusting powders 
are indicated, giving better results than ointments. Alum in 10 per cent, 
solution will sometimes assist in drying this eruption. Unguentum Aquae 
Rosae to which Menthol or Camphor has been added is very soothing. Com- 
pound Tincture of Benzoin may be applied to the affected areas with good 
results, particularly in Herpes Facialis, and is of considerable value when in- 
corporated in Unguentum Aquae Rosae, i drachm to the ounce. Boric Acid, 
alone or with equal parts of Zinc Oxide is one of the best remedies and often 
good results can be obtained with the addition of 5 to 10 grains of Salicylic 
Acid or 20 to 30 grains of Calamine. In severe and recurrent cases, the 
Galvanic Current has been used with success. Menthol, 5 to 10 grains to 
the ounce of water, will relieve the burning sensation, as will Spirits of 
Camphor. Liquor Plumbi Subacetatis Dil., 25 to 50 per cent, heated in a 
water-bath, is of great value in Herpes of the genitalia. Zinc Sulphate, 1 to 5 
grains to the ounce of water, is of particular value in Herpes Progenitalis. 

Herpes Zoster. 

As a rule, the only internal treatment which is required for this disease 
is something to allay the neuralgic pains and for which Aspirin in five grain 
doses, gives very satisfactory results. But when the pain is very severe, it 
may be necessary to resort to Morphine or some other hypnotic. Acetanilid 
and Phenacetine may also be used to allay the pain and these drugs, it has 
been alleged, not only accomplish that, but may favorably influence the 
disease (Stel wagon). Bichlorid of Mercury, 1 to 1000, on cloths changed 
every three hours, is indicated if an infection is superimposed. If a drying 
lotion is required, one containing Boric Acid and Powdered Calamine each 
a drachm, Phenol 5 minims to the ounce of water, is very valuable. In mild 
cases, no external applications are required though it may be necessary in 
the more severe cases to protect the parts with dusting powders of Boric 
Acid or Zinc Oxide. Cocaine, one part to fifty parts each of lanolin and vase- 



704 HICCOUGH — HIRSUTE S; HYPERTRICHOSIS; SUPERFLUOUS HAIR 

lin, is claimed to shorten the duration of the disease and relieve the pain 
(Bleuler). Collodion, so often recommended, is to my mind contraindicated 
increasing the likehood of infection, or if present aggravating it to a consider- 
able extent. For the afterpains which occasionally follow this disease, the 
Galvanic or High Frequency Currents will usually relieve them. A solution 
of Lead Water and Laudanum applied freely will aid in relieving the pain. 
Quinine in large doses is usually well borne. A good dusting powder fre- 
quently used is Zinc Stearate and Balsam of Peru. It can be applied freely 
and the parts bandaged. Zinc Phosphate, -J- grain every four hours, is 
of value. 

Hiccough. 

Morphine, hypodermically, often arrests hiccough (R); an injection of 
Morphine and Atropine together has stopped a most violent hiccough in 
which morphine alone and other agents had proved unavailing. Apomor- 
phine gr. -^ hypodermically, stopped a severe case in a man of 76 years, last- 
ing 6 days (Shannon). Atropine is serviceable (W). Duboisine employed 
in many cases with uniformly good results (Rowell). Chloral is the standard 
remedy (W). Turpentine iflx of the Oil with lUxxx of spt. etheris nitrosi in 
an aromatic water has a striking effect (Smith). Rhubarb and Magnesia, in 
aperient dose is rapidly successful in obstinate cases, no other remedy to be 
compared with it (Id). Musk has been considered a specific (W). Sulpho- 
nal has been used with good results (W). Pilocarpine has cured bad cases 
resisting all other means (Ortille). Zinc Valerate, gr. J, with a small por- 
tion of Ext. Belladonnae, cured a severe case of 15 days' duration (Danet). 
Ether, as spray to the epigastrium for 10 minutes, then to the site of the 
phrenic in the neck (Regoni); or the spirit, Tfl,xx-xxx in some aromatic water, 
given internally, will often arrest the spasm immediately (Wa). Nux Vomica, 
in 5 or 10 minim doses of the tincture, with Tfl.xv of dilute Nitric Acid; a short 
course frequently curative (P). Chloroform, combined with Opium (R). 
Pepper, gr. ij-x, to stop hiccough (P). Laurel-water, a useful remedy, Tflv 
(P). Camphor, has been recommended (R). Mustard, 5j infused in giv of 
hot water has cured most obstinate cases (R). Nitroglycerin sometimes 
arrests it (R). Inspiration deep, holding the breath as long as possible, in 
mild cases; or a firm belt around the epigastrium (T). Tongue-traction 
maintained for several minutes, removed hiccough of 4 days' duration 
(Lepine). 

Hirsute s ; Hypertrichiasis ; Superfluous Hair. 

A method devised by Schwenter-Trachsler has been highly recommended 
by him but as yet has not been very favorably received. The patient shaves 
the parts affected and rubs the surface thoroughly twice daily with pumice 
stone. This is claimed to prevent the hair growing and finally the lanugo 
hairs take the place of the stiff er ones. 

Depilatory drugs and the use of the razor on the face are to be con- 
demned as they undoubtedly stimulate the growth of the hair and cause it to 
come in coarse and dark. Electricity is the only permanent means of re- 
moval of this condition. The Electric Needle is usually very satisfactory and 
if carefully applied, will leave little or no scarring. It does stimulate to some 
extent the growth of the finer hairs but to no great degree. An Iridoplati- 
num Needle should be attached to the negative pole and inserted directly 



HYDROCELE HYDROPHOBIA. 705 

under the hair shaft. The patient holds the wet positive electrode in the 
hands and the current may be made and broken with an attachment in 
the fingers of the operator or by the patient's gripping or loosening the elec- 
trode. The current is allowed to pass from J to 2 minutes, the strength 
varying from one-half to two milliamperes, depending entirely upon the 
coarseness of the hair. If the hairs are light in color and fine, it is of advan- 
tage to rub lamp black over the part that is operated upon. When this is 
wiped off, a certain amount will adhere to the mouth of the follicles, making 
them more prominent. The treatment is not very painful and from 30 to 40 
hairs can be removed in an hour. After the first treatment, patients very 
rarely complain of any pain. The X-ray in the hands of experts, those well 
trained in this line of work, has given brilliant success as after several years 
the hair has not recurred. Barium Sulphide is perhaps the best depilatory 
(if any is used), and is mixed with water into a paste, allowed to remain on a 
few minutes until the burning sensation is marked and when wiped off, the 
hairs come off also. Calcium Sulphate is used as a depilatory, as is Arsenic 
Sulphate. 

Hydrocele. 

Tapping of the sac with a trocar is only palliative. The Injection of 
Irritants which was formerly widely practised, has been abandoned because 
of the danger of inflammation and infection. Operative Removal is the only 
satisfactory method. Congenital Hydrocele is treated by the application 
of a truss to obliterate the funicular process. Infantile Hydrocele is treated 
by puncture and scarification of the sac. 

Hydrocephalus, Chronic. 

Treatment is of little use. Aspiration with the finest needle, in the coronal 
suture, a few ounces of fluid only to be taken at a time; also firm but gentle 
compression of the cranium with strips of adhesive plaster during the escape 
of the fluid and afterwards. [Compare Dropsy, Meningitis, Tuberculous.] 

Hydrophobia. 

Belladonna, is one of the very best remedies (P). Stramonium, is used in 
India with apparent success. Nitroglycerin, may be of benefit (Wa). Amyl 
Nitrite, should be fairly tried (B). Morphine, chiefly palliative; for deep in- 
jection into the muscles (B). Cauterization, with hot iron or Caustic Potash 
after cleansing wound, which should be kept open by Unguentum Basilicon 
for 5 to 6 weeks (Ros) ; with Silver Nitrate sharpened to a point and applied 
freely to every sinuosity of the wound as preventive (Wa). Excision, the 
safer practice (Wa). Baths, warm and hot, produce calm (Ros). Rabies 
Toxin, the Pasteur inoculation with a modified virus, protects the bitten 
person from the disease. "The abdominal region of the patient is bared, a spot 
touched with tincture of iodine, wiped with alcohol, and the injection given 
subcutaneously. Kierle does not vary the dose according to the age, both 
the old and the young receiving the same dose. At times the injection is fol- 
lowed by redness and induration in the subcutaneous tissues, but abscesses 
are never formed. Cases of severe injury, such as deep bites about the face 
45 



706 



HYDROTHORAX — HYPERIDROSIS. 



and fingers, should be rapidly immunized (intensive treatment) ; in other cases 
the treatment may be mild (mild treatment). The uniform dose of cord 
emulsion, is 2.5 mils. The schedule of inoculations given in the Research 
Laboratory of New York in treating human cases after an average bite are as 
follows: 



Day. 



Mild treatment. 



Intensive treatment. 



First I 14 

Second 12 

Third 10 

Fourth 8 

Fifth 6 

Sixth 5 

Seventh 4 

Eighth 3 

Ninth 2 

Tenth 4 

Eleventh 3 

Twelfth 2 

Thirteenth 4 

Fourteenth 5 

Fifteenth 2 

Sixteenth 4 

Seventeenth 3 

Eighteenth 2 

Nineteenth 1 4 

Twentieth 3 

Twenty-first 2 



and 13 day cord 
and n day cord 
and 9 day cord 
and 7 day cord 
day cord 
day cord 
day cord 
day cord 
day cord 
day cord 
day cord 
day cord 
day cord 
day cord 
day cord 
day cord 
day cord 
day cord 
day cord 
day cord 
day cord 



1 2 and 1 1 day cord. Repeated in P. M. 
10 and 9 day cord; 8 and 7 day cord P. M. 

6 day cord 

5 day cord 

4 day cord 

3 day cord 

2 day cord 

4 day cord 
4 day cord 

1 day cord 
4 day cord 

3 day cord 

2 day cord 

4 day cord 

1 day cord 
4 day cord 

3 day cord 

2 day cord 

4 day cord 

3 day cord 
2 day cord 



According to reliable statistics, the mortality of rabies without the Pasteur 
treatment is about 16 per cent.; with the treatment the average mortality 
is about 0.46 per cent." (Kolmer). 

Hydrothorax. 

Digitalis, in the purely dropsical form, also in passive pleuritic effusions; 
used as a diuretic, of great value (R). Elaterium, unquestionably of value 
as a derivative, though many fear it (P). Pilocarpus, produces good results 
(B). Blisters, when effusion has taken place, certainly seem to stimulate 
the absorbents to action (Wa). Dry Cupping, over the chest, gives relief 
(Da C). Thoracentesis, if much distress. [Compare Dropsy.] 



Hyperidrosis. Excessive Sweating. 

This is an extremely difficult condition to relieve, particularly if it is ac- 
companied by bromidrosis (sweating with offensive odor). If it is not, 
confined to certain regions but is general, then it is necessary to pay par- 
ticular attention to the building up of the entire system. Tonics such as 
Iron, Quinine and Strychnine are indicated. If it is accompanied by bromo- 
drosis, it is particularly advisable that patients should bathe frequently and 
thoroughly with soap and water, dry the parts and apply dusting powders. 
One which has worked fairly well in a number of my cases contains Salicylic 



HYPOCHONDRIASIS — HYSTERIA. 707 

Acid, gr. x, Boric Acid and Talc each \ ounce. Alcohol may be used in any 
of the following liquid preparations to replace the water or be used in equal 
parts. Alum from 5 to 10 per cent, in water may act as an astringent, as may 
also Tannic Acid and Zinc Sulphate in the same proportion. Belladonna and 
Atropine, while in other diseases preventing secretions, seem to exert very 
little influence over this disease. Boric Acid, either alone or in combination 
with Talc or other drugs is used very considerably. Diachylon Ointment as 
advocated by Hebra may be of value. Ergot has been of value. Formalde- 
hyde, 1 to 100, has been used but the odor is a great objection. Lycopodium 
as a dusting powder may be used freely. Extract of Pinus Canadensis, 10 
to 15 per cent, solution at night in a foot bath, and the use of Boric Acid 
with Lycopodium and Zinc Oxide applied inside the shoes and stockings have 
been of value (Morrow). Tartaric Acid in small quantities has been recom- 
mended by Fredericq. The X-ray has in several instances had a very drying 
influence on the affected areas. 

Hypochondriasis. 

Arsenic, in the aged, gives great comfort, especially when combined with 
Opium (B). Valerian, quickly relieves the flatulence of hypochondriacs (B). 
Asafoetida, especially indicated in cases marked by flatulence and gloom (B). 
Potassium Bromide, especially among female town-dwellers, but also in male 
(R); effects are variable; relieves some, not others (Wa). Hyoscyamus, 
when syphiliphobia (P). Caffeine, the Citrate, gr. v-j, has been used 
as a cerebral stimulant with advantage (B). The Rest Treatment of Weir 
Mitchell. Fresh Air with an abundance of Good Food with milk and eggs 
is of greater value than drugs. Turkish Baths, are useful for town-dwellers, 
with soft, flabby tissues and mental depression (R) . [Compare Melancholia.] 

Hysteria. 

Antipyrine, for the painful affections of hysteria. Arsenic, improves 
nutrition (B). Apomorphine gr. -^ hypodermically, is particularly effective 
in hysteria and hystero-epilepsy (Fancher) ; is to be recommended in the latter 
form of hysteria (Gowers). Chloroform as an anesthetic, is of high value in 
hystero-epilepsy (Brown-Sequard). Valerian, has great value, gss doses of 
fluidextract (B); useful in most cases, especially those of hysterical dyspepsia 
(P). Zinc Valerate, especially at the climacteric age, for hysterical symptoms 
which can be traced to no particular cause (R). Ergot, with Iron and tonics 
in cases depending on sub-involution of the uterus, with indigestion and 
anemia (B). Nux Vomica, of great use in middle-aged subjects, when 
flatulence, weight on head, flushing and perspirations (R). Atropine, for 
hysterical aphonia, gr. iri-o to-gV morning and evening (B). Ether, for the 
flatulence, and for the hysterical paroxysm in sudden seizures (B). Cam- 
phor, in hysterical excitement (P). Asafoetida, in hysterical convulsive 
affections, with flatulence and cough (P); arrests paroxysm, valuable for 
flatulence (B) ; removes headache, peculiar sensations in head, and flatulence 
(R). Ammonia, the aromatic spirit for the acidity and eructations (B);. 
Potassium Bromide, gives control and prevents paroxysms ; when verging on 
nymphomania large doses required (R). Iron, a course often useful, espe- 
cially when anemia (R). Accessory Measures, occupation of mind and 



708 ICHTHYOSIS — IMPETIGO CONTAGIOSA. 

body; removal from influence of over-solicitous friends; complete abandon- 
ment of the use of alcohol; the shower-bath, or cold-bath to invigorate 
the body; excitement to be avoided. The word Hysteria should never be 
applied to the case in the patient's hearing. Disorders of vision are often 
found at the bottom of hysteria; look for hypermetropia and astigmatism. 

fy Tinct. Asafcetidae, 

Tinct. Valerianae Ammon., aa 5ij- 

Aquae Camph., § vij. 

M. Sig. — A tablespoonful or two every hour. 

Ichthyosis. 

The treatment of this condition is extremely unsatisfactory, as it is a 
congenital disease and very little can be done to prevent the formation 
of the scales; however, the skin can be softened to a considerable degree. 
Alkaline Baths are strongly indicated, Sodium Bicarbonate, 4 ounces to 
the half tub of hot water, with the free use of soaps at the same time. 
The patient should remain in the tub for at least a half hour and then apply 
ointments, oils or greases. One of the best methods is to rub in thoroughly 
Olive Oil after each bath and it may also be taken internally, 2 drachms after 
each meal. Petrolatum rubbed into the skin twice daily would have about 
the same effect as the olive oil. Pilocarpine or Jaborandi in doses suffi- 
ciently large to produce sweating may prevent the formation of the scales. 
Resorcin, 5 to 10 per cent, strength will be of advantage if incorporated 
in petrolatum or lanolin or lard. Salicylic Acid, 10 to 20 grains in petrolatum 
may add to the efficacy. Thyroid Extract has been used in a certain number 
of cases with a certain amount of benefit. Vapor and Hot Baths producing 
excessive sweating are sometimes of value in the treatment of this disease 
but must be taken frequently to be of permanent advantage. 

Impetigo Contagiosa. 

If the lesions occur on the bearded region, it should be thoroughly washed 
with soap and hot water, Bichloride of Mercury, 1 to 1000 applied, and then 
sopped dry with paper toweling, care being taken to dry the affected parts 
last. Particular care should be taken that all shaving utensils be boiled 
after using. As contamination can take place by means of a strop and as 
this cannot be sterilized, a razor that requires no stropping should be used. 
Saturated solution of Boric Acid may be used as a mild antiseptic if the 
eruption occurs anywhere near the eye. Hydrarg. Ammoniata, 10 to 20 grains, 
to the ounce of petrolatum, is perhaps the most valuable drug we have in 
the treatment of this disease if it is situated on any other part than the 
bearded region. Here, the repeated shaving will implant the offending or- 
ganisms on other parts of the face and the treatment is not so simple. Some- 
times the condition occurring on the bearded region, a drying lotion such 
as the following prescription is of more value than ointments. Lassar's 
Paste is sometimes of great value and to which Sulphur, 20 to 30 grains to 
the ounce, may be added with advantage. Phenol may be incorporated in 
any of these prescriptions, 5 minims to the ounce, if there is much itching. 
Resorcin, a drachm to the ounce of petrolatum or lanolin with 5 minims of 
Carbolic Acid may be applied several times a day to the affected parts. 



IMPOTENCE — INFLUENZA. 



709 



If this disease occurs in association with pediculosis capitis, any of the 
above ointments may be used, treating the scalp at the same time for 
pediculosis. 



. Pulvis Calaminae 

Pulvis Zinci oxidi aa 5iv. 

Glycerini, 5iv. 

Alcoholis, S j. 

Aquae q.s. § iv. 

M. Sig. — Apply twice daily. 



i. Hydrarg. Ammoniati gr. xl. 

Acidi Salicylici, gr. xx. 

Lanolino 

Petrolati, aa 5 i 

M. Sig. — Apply twice daily. 



Impotence. 

Phosphorus, no remedy more efficient; the pill of Zinc Phosphide the most 
convenient form (B); gr. T V thrice daily. Phosphoric Acid, full doses, with 
gr. ss of Pulvis Cantharidis, an effective combination, especially in impotence 
of old age (B). Kola, as a general tonic. Cantharis, with Iron is beneficial 
(B); in large doses, gtt. xx-xxx, with Iron and Phosphoric Acid or Nux 
Vomica (R); of doubtful efficacy (Wa). Nux Vomica, drop doses of tincture 
in atonic impotence (B) ; in large doses when spermatorrhea (R). Sanguinaria, 
has decided aphrodisiac properties, but is useful only in the functional form 
(B). Serpentaria, in relaxation and feeble erections, will often restore power; 
5ss doses of tincture twice daily (B). Cannabis, is a useful remedy; the 
best combination for functional impotence would be one of Cannabis, Nux 
Vomica and Ergot (B). Yohimbin, a 2 per cent, solution in doses in Tfl,viij 
daily, gradually increased to TT|.xvj, is very reliable in neurasthenic impotence 
(Eulenberg). Ferrum Arsenate, acts as a tonic to the organs, and in full 
doses often benefits cases of functional form (B). Damiana, has been 
brought forward as a genital stimulant and a remedy for impotence, but there 
is probably no ground for any confidence in such claims (Stille). [Compare 
Emissions, Spermatorrhea.] 



1$. Quininae Sulph., gr. xxx. 

Strych. Sulph., gr. ss. 

Ext. Ergotae, gr. xv. 

Mas. Ferri Carb., gr. xlv. 

M. Ft. pil. no. xxx. Sig. — One pill 2 or 
3 times daily. 



1$. Phosphori, gr. ss. 

Ext. Nucis Vom., gr. vj. 

Mas. Ferri Carbonat., gr. xl. 

Ext. Gentianae, gr. xxx. 

M. Ft. pil. no. xxv. Sig. — One pill 2 or 
3 times daily. 



Influenza. 

Rest in bed is essential. Calomel in divided doses, gr. f every 15 
minutes for 6 to 8 doses followed in 8 hours by Magnesium Sulphate 
or Magnesium Citrate, should precede all treatment especially when patient 
is seen early in the attack. Cocaine, a 1 or 2 per cent, solution sprayed into 
the nose, is very efficient in the early stage (R) . Eucalyptus, the Oil, sprinkled 
on blotting paper placed around a large room, was considered an efficient 
prophylactic during the London epidemic of 1891, and was much used in 
offices, shops, etc. Salol, and Safipyrin, as internal remedies, were highly 
extolled during the epidemic of 1891. Acetphenetidin, may be used with 
benefit, for the neuralgic pains. Acetanilid, 2, with Salicylic Acid and 
Ammonium Bromide, each one part, was used with much success during the 
epidemic in Scotland. Sodium Salicylate in doses of gr. v every half hour 



710 



INSOLATION. 



for 6 or 8 doses, then every hour until all pain has vanished, then every 
two hours for a day or two, is very efficient (Parker) ; after a mercurial purge, 
is the best drug to use (Dixon). Ammonium Salicylate, is even better 
than the sodium salt; add Liquor Ammoniae Fort., 5j to Ac. Salicylic, 
gr. lxxx, to make an 8 ounce mixture for tablespoonful doses (Id). Acid 
Acetyl Salicylic, which is known under the trade name of Aspirin, is widely 
used to relieve the aching in the head, back and extremities. Strychnine, 
for the underlying weakness and depression, the real enemy to fight against 
in the grippe, Strychnine is the best remedy we have (Huchard). Sodium 
Benzoate, with Quinine and Caffeine (formula below) in the simple form of 
grippe (Id). Camphor, in solution, hypodermically (formula below), 2 to 4 
times daily, with 3 to 6 of Caffeine and 2 or 3 of Ether, for grippal pneumonia 
(Huchard). Camphoric Acid, in 1 dose of gr. xx-xxx, dry on the tongue 
not over 2 hours before the expected time for sweating, is remarkably efficient 
to prevent it. Bismuth Salicylate or Naphthol, Salol, or Benzo-naphthol, 
as intestinal antiseptics, when such are required (Huchard). Benzoin, the 
compound tincture, § ss-j, inhaled from a pint of hot water frequently (Da C). 
Nitrous Ether, the spirit in doses of 5H SS > m anv convenient vehicle, is a 
popular and efficacious remedy (Wa). Opium, best avoided in early stage, 
but later for the cough, with Ipecac, gives great ease (Wa) ; Heroin or Codeine 
may be used for harassing cough. Boric Acid, as gargle, also borated oint- 
ment or vaselin to the nasal cavities, and great care taken to maintain a 
clean mouth; antisepsis of the nose, mouth and pharynx is very important 
and does much to prevent complications and perhaps broncho-pneumonia 
(Plicque). Coca and Kola, the tinctures, a mixture of equal parts of each, for 
the nervous depression (Id). Ice Bag or Hot Fomentations, for the headache 
(R). 



fy Quininae Hydrobromidi, 

Sodii Benzoat., 

Caff einae, aa gr. xxx. 

M. et ft. pil. no. xxx. 

Sig. — One pill thrice daily. (Huchard.) 



1$. Camphorag, 3ijss. 

01. Olivae (steriliz.), giij. 

M. Sig. — 5ss hypodermically twice or 
thrice daily, for grippal pneumonia. 

(Huchard.) 



Py. Pulv. Ipecac, et opii gr. xvj. 

Quininae Bisulph., gr. xvj. 

Acid Acetyl Salicylic, 3 j- 

M. et ft. caps. no. xvi. 

Sig. — One every 3 hours. 



Insolation. 

Morphine, to control the convulsions (Bevan). Chloroform, by inhala- 
tion cautiously, for the convulsions (Mn). Strychnine, must be avoided 
in heat-stroke, there being a tendency to convulsions in this affection (Chand- 
ler). Digitalis, TTtxl of the tincture hypodermically as soon as possible in 
siriasis, preceded by a small bleeding in plethoric cases showing high arterial 
tension (Chandler). Veratrum Viride, also Gelsemium, as sedatives in 
sunstroke, when the pulse is full and strong (Ely). Bromides, for restless- 
ness and insomnia (Mn) ; courses of the Bromides and Iodides, with repeated 
blistering of the neck and scalp, also careful dieting and general hygiene, for 
persistent headache and other signs of chronic meningitis (Id); Potassium 
Bromide in cold water by enema in sunstroke. Antipyrine and other anti- 



INSOMNIA. 711 

pyretic drugs are to be avoided in all serious cases of siriasis, as they are 
dangerous by their depressant action on the heart (Id). Alcohol in every 
form, must be strictly forbidden in any case of heat-stroke in which the 
cerebral symptoms suggest meningeal congestion or inflammation (Id). 
Stimulation is indicated in the syncopal form, generally called "heat-exhaus- 
tion"; Ammonia held to the nostrils and a stimulant given by the mouth 
or rectum or hypodermically (Id); external stimulation in asphyxial cases 
to the precordium by mustard, also to the feet by hot bottles and hypodermics 
of nitroglycerin, atropine, brandy, camphor or ether (Anders). Cold by 
ice-bag applied to the shaven scalp for a time in heat-stroke, the bowels 
kept free, the food light and non-stimulant (Mn) ; cold sponges, ice sponges, 
cold baths to reduce the temperature, care must be exerted, however, as 
dangerous collapse may ensue from a too long application ; should this occur 
wrap the patient in a blanket and apply hot bottles to the limbs and trunk. 
Venesection, free bleeding when the symptoms are those of intense asphyxia, 
in which death may take place in a few minutes (O). Artificial Respiration, 
when the breathing threatens to become suspended, has given marvellous 
results in some cases. Climate should be changed; as soon as the subject 
of heat-stroke is able to be moved he should go to a cold climate and should 
not return to the tropics while the slightest evidence of cerebral trouble 
remains (Mn). [Compare Cerebral Congestion, Meningitis Cerebral.] 

Insomnia. 

Hydrated Chloral, is quite unrivaled, being the most direct and generally 
useful hypnotic (B) ; acts best in cases of purely nervous type (Wa) ; in doses of 
20 to 30 grains is by far the best hypnotic for many forms of insomnia (R) ; 
is dangerous in old drunkards, in whom the heart and vascular system have 
undergone fatty and calcareous degeneration (B) ; in combination with Opium 
or Morphine it acts splendidly in small dose, each ingredient intensifying 
the hypnotic action of the other (Brodnax) ; children bear it well, especially 
when given with Paregorie. Chloralformamide, 30 grains in 5 j of whisky in 
simple or idiopathic insomnia, or that from nervousness, hysteria, chronic 
alcoholism, but not when due to excitement or severe pain. Croton-chloral, 
is feebler than Chloral and less toxic; as a hypnotic 3j may be given (R). 
Chloralose is more prompt than chloral, and equally efficient in smaller dosage 
(Tyson). Chloretone is a safe and efficient hypnotic for the insane in dose of 
35 to 50 grains (Wade); is more dangerous than Chloral (Impens); is a very 
uncertain hypnotic (W). Paraldehyde in doses of 5j-ij> is one of the most 
efficient and safe hypnotics, being free from depressant action on the heart 
and other unpleasant by-effects. Sulphonal, 10 to 15 grains in milk, 2 hours 
before effect is desired; an admirable hypnotic in many cases, but its efficacy 
decreases with use, and it is of no value in insomnia due to pain. Trional, is 
markedly hypnotic and sedative, acts surely and promptly in the insomnia of 
neurasthenia and organic brain affections; is better than Sulphonal or Chloral 
in many respects (Schultze). A mixture of Sulphonal and Trional, gr. x-xv 
of each, is an admirable hypnotic, the latter producing early sleep and the 
former later sleep. Tetronal, is somewhat less hypnotic than Trional, but 
more of a sedative; the sleep from either lasts 6 to 8 hours, and is generally 
dreamless; neither is of any use when insomnia is due to pain. Veronal gr. 
viij-xv, is efficient, safe, and devoid of by-effects (Fischer) ; gr. x with gr. v of 



12 



INTERTRIGO — INTESTINAL OBSTRUCTION. 



Trional is very effective (B) ; is particularly useful in nervous insomnia, and is 
the safest and most efficient of the synthetic hypnotics; its effects are more 
certain than those of either trional or sulphonal (Saundby). Medinal is 
the most satisfactory and least undesirable hypnotic (Park) ; has no equal in 
this line (Guy ton). Potassium Bromide for insomnia due to cerebral over- 
action (B); it increases the hypnotic effect of belladonna, hyoscyamus, can- 
nabis, ether and chloroform (R). Bromipin gives good results in nervous 
insomnia (Frieser). Opium, 15 to 20 minims of the tincture, or f to J grain of 
Morphine, the most effective hypnotic when insomnia is due to pain; in com- 
bination with Chloral (see above) smaller doses of each are efficient. Opiates 
should be given so as to act at the natural time for sleeping (R) . Apomorphine, 
gr. 3V hypodermically is the average hypnotic dose, should be given when the 
patient is ready for bed; its action lasts from one to two hours, but it often 
starts the patient to a good night's sleep (Douglas) ; is very efficient for the 
insomnia of acute alcoholism (Shannon). Hyoscine, produces sleep after a 
brief period of excitement; gr. t ^-q of the hydrobromide hypodermically is 
excellent for the insomnia of the insane. Duboisine, is even more calmative 
and hypnotic than Hyoscine, and is especially useful when high mental 
excitement exists; gr.^-g- to ^ or -fa hypodermically, may be combined with 
gr. I to i of Morphine. Ethyl Carbamate is a mild and safe hypnotic, 
especially useful for children. Digitalis, is of great use as a soporific in 
sleeplessness at night with drowsiness during the day, both symptoms depend- 
ing on want of tone in the vessels (Br). Cannabis is very uncertain in its 
action (R). Alcohol, sponging the body and at the same time using light 
massage will sometimes induce sleep in cases of obstinate insomnia. Water, 
a tepid bath just before retiring often effective; when head is hot apply cold 
to it, and a tepid bath to the body (B). [Compare Nervousness.] 



1$. Paraldehyde 3ijss. 

Alcoholis (99 per cent.),- • • • §jss. 

Tinct. Vanillas, 3ss. 

Aquas, §j. 

Syr. Simplicis, q. s. ad §iv. 

M. Sig. — A teasp. or two every hour 
until sleep is obtained. 

(Yvon's Hypnotic Elixir.) 



]$. Quininae Sulphatis, gr. lxxx. 

Ac. Sulphurici Diluti, q. s. 

Spt. Athens Nitrosi, . . •. 3iv. 

Syr. Tolu, Aquas, q. s. ad 5ij- 

M. Sig. — A teasp. contains gr. v of Quin. 
Sulph. (Da Costa.) 



]$. Phenolis, 5j- 

Tinct. Iodi Comp., 3"j- 

M. Sig. — 4 drops every 4 hours in suffi- 
cient water. (B.) 



1^. Potassii Bromidi, 3iv. 

Chlorali Hydrati, 3iij- 

Tinct. Asaf oetidas, 3iv. 

Syrupi, 3vj. 

Aquas, ...q. s. ad §vj. 

M. Sig.— Tablesp. every 2 hours until 
sleep is induced. In the insomnia of hys- 
teria. 

]$. Quininae Sulphatis, 

Pulv. Acaciae, aa 3ss. 

Syr. Zingiberis, § iv. 

M. Sig. — A teasp. contains one grain of 
Quin. Sulph. A good formula for children, 
the quinine being suspended, not dissolved. 



1^. Massas Ferri Carb., 3j- 

Arseni Trioxidi, gr. j. 

M. Ft. pil. no. xx. Sig. — One pill thrice 
daily in chronic ague. (B.) 



Intermittent Fever (See Malarial Fever). 
Intertrigo (See Erythema). 
Intestinal Obstruction. 

Opium, J-grain doses every 4 hours, for 2 to 4 days, arrests dangerous 
symptoms, and brings a painless purgation (Brinton, P). Morphine, is the 



INTUSSUSCEPTION — IRITIS. 713 

best drug in paralytic obstruction (Greble). Atropine cured a case of par- 
alytic obstruction (Aronheim) ; also one due to gall-stone (Pritchard) ; its use 
is a grievous mistake in cases of mechanical obstruction (Greble). Bella- 
donna, often successfully employed (P) ; gr. f-J every few hours, when from 
want of tone and partial spasm (Tr). Strychnine, occasionally beneficial; 
cautiously in acute cases (Wa). Mercury, a full dose of Calomel, followed 
in a few hours by Castor Oil and a Turpentine enema, affords relief (Wa). 
Caffeine acts upon the muscular tissue and often proves of the utmost value 
(Wa). Senna, the infusion, in doses of 5 j-iij, is an efficient purgative (Wa). 
Purgation to be refrained from (Brinton) ; is of no service and may be danger- 
ous when the obstruction is due to malignant disease (Tirard). Olive Oil, 
giij-iv by rectal injection, followed after 12 hours by a copious enema of 
warm water and soap, in cases due to fecal impaction (Id). Surgical inter- 
ference the only reasonable method in all cases other than paralytic, when 
enemata, olive oil, and other simple measures have failed (Greble). Diag- 
nosis of the cause is frequently obscure, and measures for relief are largely 
surgical (Tirard). [Compare Appendicitis, Constipation, Intussus- 
ception, Hernia.] 

Intussusception. 

Inflation, of intestines with air (Hippocrates), seems a most reasonable 
mechanical remedy, but is not recommended, as a portion of the intestine 
may remain unreduced, and the trouble may return (Tirard). Irrigation, by 
hydrostatic pressure, is resorted to with success; requires care and gentleness 
(B); hot water (Wa); Ox-gall,' gr. x-xxx in the solution used, is especially 
efficient in cases arising from partial paresis of the bowels (Hawkins); is 
preferable to inflation (Tirard); the knee-chest position is the best posture 
during either irrigation or inflation. Treatment is chiefly surgical. [Com- 
pare Appendicitis, Hernia, Intestinal Obstruction, Typhlitis.] 

Iritis. 

Atropine Sulphate, (1 per cent.), one drop in the affected eye three or four 
times a day to produce mydriasis and prevent the formation of synechia?. 
This should be used as soon as the case comes under observation and should 
be continued until all inflammatory symptoms have subsided. When 
mydriasis is once thoroughly established, the instillations may be reduced to 
one drop twice a day, or just sufficient to insure dilatation of the pupil. 
Homatropine Hydrobrcmide, (2 per cent.), is a useful drug to dilate the pupil 
after synechiae have been formed, one drop being instilled in the eye every ten 
minutes for an hour, or until the synechias yield and the pupil dilates, either 
regularly or irregularly. Cocaine Hydrochloride, (4 per cent.), will also aid 
to dilate a pupil bound down by adhesions and may be used in conjunction 
with homatropine. Duboisine, (J per cent.), may be used as a substitute 
for atropine, although the latter drug is more commonly employed. Atropine 
Sulphate discs or wafers of T ^ ¥ or -g- o¥ grain each placed in the lower con- 
junctival sac 4 or 5 times a day, are of much service in dilating the pupil in 
cases where the intense lachrymation immediately washes a solution of atro- 
pine from the eye, or so greatly dilutes it as to destroy its influence. Atro- 
pine, in the form of an ointment may also be used under these conditions. 



714 IRRITABILITY — JAUNDICE. 

Dionin, (3 to 5 per cent.), one drop in the eye 2 or 3 times a day, is of 
much service to relieve pain. Hot Compresses, applied from twenty min- 
utes to a half hour, 4 or 5 times a day, will also aid in relieving pain. 
Leeches, three or four applied to the temple on the same side as the affected 
eye, will serve to allay pain and relieve congestion. Mercury by inunction, 
5j of the official ointment once daily is of much service in the syphilitic 
variety. Potassium Iodide, gr. x to xl thrice daily may also be used to advan- 
tage. Sweat Baths once daily are of much benefit to the patient, affording 
rapid and thorough elimination through the skin. Sodium Salicylate, gr. x to 
xv, t.i.d., is very useful in the so-called rheumatic form of iritis, and in those 
cases in which no etiological factor is demonstrable. Gonococcic Vaccine 
may be tried in iritis due to gonorrhea. Salvarsan is of service in the syphilitic 
form. Rest in bed, protection from light, light diet, a brisk purge and 
the avoidance of the use of the eyes in all near work, are distinct aids in the 
treatment. 

Irritability. 

Strycmiine, in functional irritability of the nervous system. Chloral, gr. 
v, 2 or 3 times a day, in irritability with nervousness and restlessness (R). 
Opium, gives calm to the nervous system if used in medium doses, but its 
identity should be concealed from the patient lest the opium-habit be formed. 
Potassium Bromide, gr. x-xx or more, with the same amount of Potassium 
Bicarbonate, will often control the irritability of gouty subjects (Tirard); is 
excellent for irritability of the pharynx. Veronal or Medinal are excellent 
sedatives to the nervous system. [Compare Bladder Irritable, Insomnia, 
Nervousness.] 

Jaundice (Catarrhal). 

Ammonium Chloride is a standard remedy for catarrhal jaundice ( W) ; in 
doses of gr. xx every 4 hours (Wa). Ammonium Iodide, gr. j-iij every 2 or 
3 hours in catarrhal jaundice (B). Sodium Phosphate is often used with 
great advantage ( W) ; no remedy superior in catarrhal form, 3 j every 4 hours 
for adults, gr. x-xx for children (B). Salol, is one of the most efficient reme- 
dies in catarrhal jaundice. Lemon- juice, is of value in the catarrhal form. 
Mercury, Calomel, gr. T V every half hour until gr. ss is taken, is probably the 
most successful remedy in catarrhal jaundice (W) ; in attacks with depression, 
sickness and coated tongue, gr. J— | of Gray Powder taken at onset, and re- 
peated three or four times a day, very valuable (R) ; Gray Powder with Ipecac, 
followed next morning by Castor Oil, is well adapted to the jaundice of in- 
fancy and childhood (Wa) ; Mercurials and Podophyllum are better avoided, 
in obstructive jaundice, unless very marked indications for them exist (Da C) . 
Podophyllum in catarrhal and malarial jaundice (B) ; when stools exhibit no 
trace of bile, one dose has cured (Wa) ; is best avoided unless markedly indi- 
cated (Da C). Nitro-Hydrochloric Acid, when jaundice depends on torpor 
of the liver, or is catarrhal in origin (W) ; during convalescence, Tfl.v-x of the 
dilute acid before each meal (Da C). Pilocarpine, gr. J hypodermically every 
other day for three weeks, of great benefit in catarrhal jaundice of persistent 
type (Mitkowsky). Phenol, gr. xx to the 5 of sweet oil, or glycerin and 
water equal parts, for the itching of jaundice, as a lotion. Saline Purgatives, 
as Rochelle salt, to depurate the upper bowel, with alkaline baths, diaphoret- 



JOINT AFFECTIONS. 715 

ics and diuretics (Da C). Rhubarb for children, stools being white or clay- 
colored and pasty (B). Aloes for simple atonic jaundice (B); when hypo- 
chondriasis is prominent (P) . Alkaline Mineral Waters, especially in catarrh 
of duodenum or bile-ducts (B). Diet, no starches or fats; use milk, eggs, 
oysters, beef broth (B); plenty of green vegetables at each meal; use cold 
water freely, avoid high seasoning in food and all liquors. The common dis- 
taste for food in catarrhal jaundice is a good indication to give no food what- 
ever for a day or two and to be content to relieve the thirst with copious 
draughts of water which are usually relished and well borne (Kelly and Pep- 
per, O and M). The treatment is that of the gastro-intestinal catarrh pro- 
ducing the cholangitis (Id). [Compare Biliousness, Calculi, Duodenal 
Catarrh, Hepatic Cirrhosis, Hepatic Diseases.] 

Joint Affections. 

Acetphenetidin, for the pain of polyarthritis; Ichthyol pure, or a 50 per 
cent, ointment rubbed in, produces immediate and remarkable benefit in 
rheumatic or gouty joint affections (W) ; a 50 per cent, ointment instantly 
relieved severe joint pains and soon removed them entirely (Nussbaum). 
Aconite, for pains in inflamed joints (R) ; the liniment locally in chronic ar- 
thritic swellings (Wa). Mercury, the oleate in chronic inflammation of the 
knee (R): Ung. Hydrarg. Ammoniat., diluted, 1 to 4 at first, then 1 to 8, by 
gentle friction 2 or 3 times daily, in chronic articular inflammations, by far 
the best application (P) ; Mercurial plaster, or the plaster of Ammoniac with 
Mercury, as a resolvent for enlarged and chronically inflamed joints (W). 
Thiosinamin is useful to aid absorption of fibrinous deposits in joints due to 
rheumatism (Upson). Iodine, 3hj _ vj ad Glycerini giij, Aq. destil. §iv, in 
numerous obstinate cases of joint affections consequent on rheumatism (Wa). 
Ferrous Iodide, with Iodine, locally, in scrofulous affections of the bones and 
joints (Wa). Iodoform has been used with satisfactory results, in scrofulous 
affections of the joints and bones, by many continental authorities (Wa); 
injected directly into the joint has cured many tuberculous cases of joint 
disease (W). Alcohol, as lotion for inflamed joints. Camphor liniment, is 
a good application for inflamed joints. Salicylic Acid in paste locally, is of 
proven value in many obstinate cases of stiff knees, pains from so-called 
rheumatism, painful ankle and wrist joints, etc. (Aulde). Arsenic, often 
serviceable in rheumatoid arthritis and nodosities of joints: large doses con- 
tinued are necessary (R) . Alcohol, and water, equal parts, an excellent evapo- 
rating lotion (B). Silver Nitrate, a strong solution in Nitrous Ether is the 
most efficient application to check inflammation in small joints if applied 
early to adjacent vascular parts (B). Cod-liver Oil, in strumous subjects 
(R); the remedy on which most reliance may be placed in scrofulous joint 
affections (Wa) ; is almost specific in chronic tuberculous inflammation of the 
joints (W). Turpentine, the liniment a serviceable application in chronic 
enlargement of the joints (Wa). Sulphuric Acid, as irritant ointment, 5 j of 
acid to 5 j of lard, very beneficial in chronic diseases of joints (Wa). Anti- 
mony, Tartar Emetic ointment, a good counterirritant for old enlargements. 
Oil of Gaultheria on lint, covered with gutta-percha to prevent evaporation, 
gives rapid relief in acute and chronic rheumatic joints (Lannois) . Veratrine, 
the ointment for rheumatic joints. Gonococcic Serum or Vaccine is efficient 
in gonorrheal affections of the joints (Schmidt). Counterirritation is ameas- 



7i6 



KELOID — KERATITIS . 



lire of great value. Repeated blistering is often of service in chronic joint 
inflammation, and is better than keeping one blister sore by irritant applica- 
tions when the affection is rheumatic (W). Heat, the actual cautery is a 
valuable method of treating various forms of chronic arthritis (W) ; dry heat 
is of great service in many forms of synovitis, and more prompt and marked 
in cases of small joints than in those of large ones (W). Cold Douche, also 
galvanism and Turkish baths, for stiff joints (R) . Massage, is of great value 
in chronic joint inflammation (W). [Compare Arthritis Deformans, 
Bursitis, Coxalgia, Gout, Rheumatism, Synovitis.] 

]$. Acidi Salicylici, 3 j- 

Adipis Lanse, 5iv. 

Olei Olivae, q. s. 

M. et fiat unguentum. Sig. — Apply lo- 
cally or by rubbing once daily for 3 or 4 days. 

(Aulde.) 



1$. Ichthyolis, gij. 

iEtheris, gj. 

Glycerini, § j. 

M. Sig— Apply to the affected joints in 
gouty swelling of the same. (Charles.) 



Keloid. 

As a rule, there is very little that can be done to remove keloid after it 
has once started. Excision is absolutely contraindicated as it may recur 
much larger than the original condition. A solution of Creosote in Olive Oil, 
20 per cent, has been recommended, injections being made at several points 
in the tumor (Marie). High Frequency Current is at times of some value, 
as is also the Galvanic Current. In the way of drugs, probably the best is 
Ichthyol, 10 to 25 per cent, in petrolatum or in solution. Better results may 
be obtained if there is incorporated with the Ichthyol a small percentage of 
Salicylic Acid and Tincture of Iodine. Mercury Vapor Lamp has in some 
of my cases, and those of other dermatologists, produced very satisfactory 
results, the lens being applied directly to the skin, filtering the rays through 
blue glass. Lead and Soap Plasters have both been used for the treatment 
of this condition. Radium may also be efficacious. Thiosinamin has been 
used by several dermatologists with varying results. X-ray will relieve the 
itching and reduce the size of the Keloid. 

Keratosis Senilis. Old Age Spots. Atrophy of the Aged. 

These spots can be readily removed with the application of Salicylic 
Acid, 30 grains to the ounce of alcohol; or Trichloracetic Acid, full strength, 
neutralized in about one minute with water, is especially efficacious. Re- 
sorcin, 50 per cent, in alcohol, may be frequently applied with good results. 
The skin may be kept softened with frequent applications of Cold Cream 
or Sulphur, \ drachm to the ounce of Lanolin or Petrolatum. Certain of these 
conditions may indicate malignant degeneration in which case more ener- 
getic treatment should be instigated. (See Epithelioma.) Probably one 
of the best treatments we have is the application of Carbon Dioxid Snow. 
This applied with care will leave very little scarring. If there is a tendency 
to the formation of these spots, the skin should be protected from exposure, 
extremes of heat and cold, and more or less frequent massage is indicated. 

Keratitis (Parenchymatous or Interstitial). 

Atropine, (1 per cent.), one drop in the eye three or four times daily, or 
sufficient to cause mydriasis. Dionin, (2 to 5 per cent.), twice daily may give 



LABOR. 717 

relief in the early stages. Mercury in the form of the ointment of the yellow 
oxide, a small portion placed in the conjunctival sac, and the cornea mas- 
saged through the closed lid, is of service to aid in the absorption of opacities 
in the cornea in the later stages. Mercurial inunctions may be used, but 
are of doubtful value. Boric Acid Solution (gr. x to § j) for any accompany- 
ing conjunctival irritation. Potassium Iodide, (gr. v to x) thrice daily 
may be tried. The disease runs a prolonged course and the constitutional 
state must be carefully investigated and if necessary treatment promptly 
instituted. Syrup of Ferri Iodide, Cod-liver Oil, Iron and Quinine or 
Syrup of Hydriodic Acid may be given. Salvarsan may be used, although 
beneficial results are seldom observed before three or four injections have 
been given (Sweet). * The following has been found useful in children and 
young adults. 

T$. Liq. Potassii Arsenitis, 5 j- 

Syr. Ferri Iodidi, q. s. ad gij. 

M. Sig. — Eight drops thrice daily in water. 

Labor. 

Anesthetics, in protracted and painful labor; cautiously with primiparae 
(B); increase the risk of post-partum hemorrhage (W). Chloroform, not 
to complete anesthesia, lest uterine action be interrupted; usually begin its 
inhalation when os is dilated (Simpson). Morphine, gr. J, Scopolamine, 
gr. -j-J-g-, the solution freshly prepared, given hypodermically when labor 
became active, repeated at end of 1 or 2 hours if no marked reaction occurred 
from first dose; in 112 out of 123 cases, it rendered labor distinctly easier, 
17 were practically painless, 70 suffered only slight discomfort (Newell); in 
one case out of 100 it caused death of the child (Bass); used in 1700 cases 
with excellent results and but 2 deaths, neither of which could be attributed 
to the anesthetic (Kronig). Opium, facilitates dilatation, promotes expul- 
sive power of uterus, lessens hemorrhage, stimulates longitudinal and oblique 
fibres of the os (Wa) ; a full dose of Morphine, gr. J, in tedious labors, with 
severe pains, will aid patient greatly and promote progress of the child; no 
bad results ensue; for relief of pains and after-pains, or painful complications 
(Wa); hypodermically in rigid os and cervix (R). Ergot, only when uterine 
inertia, and after the first stage has passed; is dangerous if any obstacle in 
front; dangerous to child by paralysis of fetal heart (B) ; is best given when the 
head has passed the brim of pelvis (Wa) ; should never be given for uterine 
inertia when there is much resistance, either in the bony or the soft parts of 
the mother (W); in full dose when the head is well down on the perineum, 
to prevent flooding (W). Quinine is used instead of Ergot to strengthen 
uterine contraction (R) ; given in the early stage to increase expulsive power 
and lessen the danger of septic invasion (Hammond); gr. viij followed by 
gr. iv in an hour or correct inertia and prevent hemorrhage (Mackness). 
Lobelia, is effectual in rigidity of the os (Burnett) . Gelsemium is the remedy 
for the sharp and unyielding os (Id). Cannabis, the tincture gtt. xxx, as 
stimulant to uterine contractions, more prompt, less lasting, than Ergot 
(Wa). Ipecacuanha, after delivery; to promote natural functions (R). 
Cotton-root, as excitant of uterine contractions, may be more energetic than 
Ergot (P). Amyl Nitrite, has acted admirably in a case of hour-glass con- 
traction of the uterus; seems to antagonize the action of Ergot (Barnes). 



7l8 LACTATION. 

Guaiacol, a few drops rubbed in gently, gives immediate relief to the pains 
(Brodnax). Belladonna, the extract locally to the uterus of great service in 
long-protracted labors from rigidity of os and cervix (H). Gelsemium, 
quiets the nagging pains of the first stage; requires physiological doses (B); 
relaxes spasm in rigidity of the os (Wa). Acetanilid, eases pain and brings 
on profuse sweat which helps to relax muscular rigidity (Brodnax). Chloral, 
of great value to relieve pain; does not interfere with the exhibition of chloro- 
form; should be given in 15-grain doses every J hour till effect produced 
(Wa); the best of all remedies for rigid undilatable cervix, gr. xv every 20 
minutes for 3 doses, perhaps a 4th after an hour's interval (Playfair). Co- 
caine by spinal injection as an analgesic, used in 40 cases with great satisfac- 
tion (Marx); in 50 cases (Doleris). Eucalyptus, the Oil is a valuable anti- 
septic in midwifery (Wa). Creolin in 1 per cent, solution, for washing out 
the uterus (W). Mercury Bichloride is the worst of all antiseptics for use 
in labor, being too dangerous. [Compare Abortion, After-Pains, False 
Pains, Hemorrhage Post-Partum, Lactation, Puerperal Convulsions, 
Mania, Fever.] 

Lactation. 

Pilocarpine, as a galactagogue, gr. § in brandy on retiring, the patient to 
be covered well in bed; is efficient in direct proportion to its diaphoretic and 
sialogogue effects, these being evanescent, but its galactagogue power re- 
mains for weeks, an occasional dose only being required to spur up the secre- 
tion when flagging (Minges); is a galactagogue, and probably the only 
example of this class we possess (M). Antipyrine, is an anti-galactagogue, 
4-grain doses every 2 hours have proven highly efficient. Belladonna, 
internally or externally or both, in excessive lactation (R); Atropine gr. iv 
to §j, Aquae Rosae on lint around the breast to arrest secretion of milk; 
remove when fauces become dry and pupils dilated (B). Camphor, locally 
to arrest the secretion; a saturated solution in Olive Oil or Glycerin, is more 
efficient than Belladonna (Wa). Potassium Iodide, in 25 to 30 grain doses 
internally, for the same purpose, is very effectual (Rousset). Calcium Phos- 
phate and Hypophosphite, in debility from over-lactation (R, Wa). Ammon- 
ium Chloride, for the intercostal neuralgia of nursing women; gr. x-xx, every 
3 or 4 hours (Wa). Quinine, Tannin, are used to arrest the secretion (R). 
Potassium Acetate, gr. x in water 4 times a day, in caked breast, with a 
solution of Boric Acid on gauze covered with oiled silk. Ichthyol locally is 
a valuable application in caked breast, preventing mastitis. Lead water 
and Laudanum, locally in the congestion and engorgement of the third day. 
Lard, hot applications are soothing in the same condition. Purgation, a 
brisk saline purge, with the local applications above mentioned. [Compare 
Abscess, Agalactia, Mastitis, Nipples; also the articles Galactagogtjes 
and Galactophyga on page 34.] 

Excreted in the Milk, when taken by the nursing woman are : the Oils of 
Anise, Cumin, Dill, Wormwood and Garlic, Turpentine, Copaiba, the active 
principles of Rhubarb, Senna, Scammony and Castor-oil, Opium, Iodine, 
Indigo, Antimony, Arsenic, Bismuth, Iron, Lead, Mercury and Zinc. Acids 
given to the mother cause griping in the child. Natural salts, as a rule, and 
the purgative agents above-named, act as purgatives to the child, and 
Potassium salts as diuretics. Turpentine, Copaiba and Potassium Iodide 



LARYNGISMUS STRIDULUS — LARYNGITIS. 719 

given to the mother, can be detected in the urine of the child. Opium given 
to the mother may narcotize the child, and Mercurials in the same manner 
may salivate it (Br). Atropine, Hyoscyamine, the Salicylates and Potassium 
Sulphide, have been found in the milk after their ingestion by the woman. 



]$. Tinct. Aconiti, ttrxx. 

Antim. et Potass. Tart., gr. ij. 

Spt. ^Etheris Nitrosi, 

Syr. Simplicis, aa § j. 

M. Sig. — One teaspoonful in water every 
4 hours. 



Aquae Aurantii Flor., §ij. 

Misce. Sig. — A teaspoonful in a wine- 
glassful of sweetened water, every 2 
hours, for milk fever. (Fordyce Barker.) 



Laryngismus Stridulus. 

Aconite, checks the spasm and relieves the croupous breathing (R). 
Antipyrine, is used with alleged success (W); has proven very serviceable. 
Belladonna, promises to be of value (Wa); Atropine, gr. -5-^ m goblet of 
water (60 doses), of which a teasp. every hour or J-hour will give prompt 
relief (Smith). Bromides, when uncomplicated except with convulsions 
(R) ; full doses will suspend an attack, and moderate doses steadily continued 
will prevent recurrence (B). Ipecacuanha, an emetic dose to cut short an 
attack (B). Lobelia, has been employed (R). Chloroform, quickly cures 
the paroxysm, a few drops on a handkerchief sufficient (B); may often be 
used with advantage; an anesthetic may be necessary to save life (W). 
Chloral, gr. v to prevent or arrest (B) ; the standard remedy in all spasmodic 
disorders, to temporarily arrest motor disturbance (W). Amyl Nitrite, of 
value to cut short the paroxysm. Nitroglycerin will speedily allay the spasm 
(B). Gelsemium, a useful remedy in sthenic cases, as a motor depressant. 
Opium, minute doses may be given with benefit. Quinine, given between 
attacks to prevent (B); a most valuable remedy, in small, repeated doses (P). 
Emetics, Tartar Emetic; Mercuric Sulphate, gr. iij-v, safer and better (R). 
Water, wet pack to neck (B) ; cold sponging twice or thrice daily more success- 
ful than anything else, with out-of-door exercise; cautiously if hoarse voice 
indicates laryngitis (R). Traction on the Tongue at intervals of 18 times per 
minute, by reason of its reflex action, one of the simplest and best methods 
to relieve spasm. After-Treatment requires attention to the rachitic con- 
dition, which is nearly always present. -[Compare Croup, Laryngitis, Ra- 
chitis and make sure of absence of foreign bodies.] 

Laryngitis, Acute Catarrhal. 

Antimony, Tartar Emetic, gr. -^ a ver Y excellent remedy internally 
(Da C). Menthol, in conjunction with Camphor, is largely employed as a 
local application, 1 to 2 per cent, of each in liquid petrolatum by atomization 
(W). Protargol, in 2 per cent, solution as spray, has proved efficient in 
severe cases. Mercury, as calomel to open the bowels, followed by a saline 
purgative. Gelsemium internally, in the spasmodic type (W). Bromides 
in full doses, 5 j-ij daily, to allay the pain and hoarseness. Nitric Acid dilute, 
TUj-ij in water every hour for 5 or 6 hours, in the early stages. Morphine in 
small doses, to allay cough (A). Codeine Sulphate, gr. T V to f repeated only 
to point of relief of distressing cough. Iodine by inhalation, also as a counter- 
irritant painted over the neck (B); painted externally over the front of 
throat, on second or third day. Creosote, TUij; Menthol, gr. iv; Albolene, 
5j, as spray several times a day, in subacute laryngitis. Antipyrine, a 2 



720 



LARYNGITIS, CHRONIC. 



per cent, solution as spray to reduce engorgement, or a 4 per cent, solution 
preceded by Cocaine application. Adrenalin locally, to counteract the 
vascular engorgement (W) . Silver Nitrate, gr. x-xx to the 5 , applied with a 
brush, by aid of the mirror (W). Argyrol, in 10 to 50 per cent, solution 
locally, has given good results (Sauer). Glycerin locally, as a demulcent. 
Leeches to the throat in sthenic cases, or cupping at the nape of the neck, 
valuable as auxiliary to general treatment (Wa). Blisters, a series of blisters 
applied at the rate of one or two a day until six or eight are used. They are 
to be small, J inch in size, and placed over front of neck, corresponding to 
larynx. Scarification, by Mackenzie's laryngeal lancet, of great service in 
the edematous form (Da C). A Purgative and Diaphoretic, with mucilagi- 
nous drinks, if given at the start may be sufficient (Da C). Heat, by poul- 
tices or fomentations (A); hot- water stupes may succeed (Wa). Inhalations 
of hot steam, with Benzoin, the comp. tinct. gtt. x-xv to the § , with gtt. x 
Tinct. Opii, of great service (Da C). Tracheotomy ought not to be delayed, 
if inhalations, leeches, and fomentations fail (Wa) ; is especially indicated in 
sudden attacks of edematous laryngitis, as those occurring in Bright's 
disease (Da C). Ice, steadily applied in bags over the larynx, if tracheotomy 
refused, has succeeded in bad cases; small pieces may be slowly swallowed 
(Da C). [For Croupous Laryngitis, see Croup, membranous; for Spasmodic 
Laryngitis, see Croup, catarrhal. Compare also Laryngismus stridulus, 
Pharyngitis.] 

3 



1$. Mentholis, gr. xx. 

Tinct. Benzoini Comp., §ij- 

Spt. Chloroformi, § j. 

M. Sig. — A dessertspoonful in boiling 

water, for inhalation several times a day. 



Tinct. Aconiti, ngxxx. 

Sodii Bromidi, 5iij- 

Syr. Lactucarii, § jss. 

Aquae DestiL, q. s. ad 5iv. 

M. Sig. — 5 J - oiJj as per age, every hour 
for 6 hours. 



Laryngitis, Chronic. 

Phenol, in cases where long-standing hyperemia with diminished secre- 
tion, 3 j - ij to the 5 of glycerin is a most successful application (Mackenzie). 
Silver Nitrate, a solution of gr. x or xx to the 5 , applied locally by the aid of 
the laryngoscopic mirror (W); formerly much used, but is objectionable 
(B); should be used with great caution, and only when a particular point 
can be seen for it with the laryngoscope (Da C). Ferric Chloride, a solution 
of 3 j _ ij in the § of glycerin, as a local application (A). Zinc Chloride, gr. 
xx-xxx to the 5 of glycerin; alternation of topical remedies is of great value 
(A). Copper Sulphate, gr. xx to the § of water, locally twice a week (Da C). 
Bismuth Subnitrate, by insufflation, is highly recommended in the worst 
forms of laryngitis (Tr). Bicarbonate of potassium and bicarbonate of 
sodium of each 10 to 15 grains to the ounce of water as a nasal douche or 
spray three or four times daily because of the almost always associated catar- 
rhal conditions of the nose, nasopharynx and pharynx. Benzoate of sodium 
5-grain doses three or four times daily, if secretions are profuse yet tena- 
cious; has direct action on mucous membrane. AJumnol, 3 per cent, solu- 
tion, as a spray; highly beneficial. Iodine painted over the neck as a 
counterirritant, and inhalation of its vapor (B). Benzoin, inhaled from 
boiling water, is of great service (Tr). Functional Rest of the voice often 
requisite, especially in tuberculous and syphilitic laryngeal ulceration (A). 
Chronic Laryngitis, includes many disorders of the larynx, which of late 



LARYNGITIS. 721 

years have been differentiated as thickened vocal cords (chronic laryngitis 
proper), ulcers, polypi, cysts, cauliflower growths, tuberculous and syphilitic 
lesions, in all the voice being similarly affected. [Compare Cough, Dyspha- 
gia, Syphilis.] 

Laryngitis, Edematous. 

Potassium Iodide may produce edema of the larynx and should be 
promptly stopped if this condition occurs. Cocaine, a strong solution as 
spray if the symptoms are urgent, followed by scarification of the epiglottis 
(O). Scarification, by laryngeal lancet, of paramount value (A). Trache- 
otomy, if the above fail (A). The high rate of mortality is due to the fact 
that tracheotomy is as a rule too long delayed (O). [Compare Croup, 
Laryngitis. Important to treat any underlying cardiac, renal or pulmonary 
condition.] 

Laryngitis, Tuberculous. 

Argyrol in 20 per cent, aqueous solution by intratracheal injection cleanses 
the ulcers and promotes healthy granulations. Cocaine, locally to relieve 
pain and dysphagia, especially when much ulceration or perichondritis pres- 
ent; in the later stages its use prolongs life. It has to be increased in strength 
to be effective. Resorcinol, a strong solution locally, very beneficial in 
tuberculous and other ulcerations of the larynx (Tymowski). Zinc Sulphate, 
in solution mixed with a 1 or 2 per cent, solution of Cocaine, in the early 
catarrhal stage (Neumann). Silver Nitrate, in powder or solution locally 
(R). Bismuth Subnitrate, by insufflation is highly efficient (Tr.) Iodo- 
form, in large insufflations has surprising anodyne effect when extensive 
tuberculous ulceration exists (Neumann); with powdered Talc in small 
quantity, and gr. J of Morphine to each §ss of iodoform, as insufflation. 
Ichthyol locally, relieves the pain (Berens). Formalin, 3 to 5 per cent, in 
freshly made solution, one of best local applications. Guaiacol is a good 
application in 20 per cent, solution, increased to 80, or even full strength 
(Coulter); Guaiacol 25, Menthol 10, Olive Oil 65, is often useful (S. Solis- 
Cohen). Orthoform 1 part, Anesthesin 1, Suprarenal substance 2, and 
Iodoform 2, is the best combination for insufflation, especially where there is 
painful ulceration (Id). Menthol, is of great value, a solution of 1 in 10 
of pure olive oil brushed freely over the part daily, a solution of 1 in 5 be- 
ing used after the first week. Lactic Acid, is reported by many authorities 
as highly successful, even curative; a solution of 10 per cent., gradually 
increased to 75 per cent., brushed over the affected surface after swabbing 
with Cocaine, or a few drops injected into the larynx by a laryngeal syringe; 
is excellent, lasting good results having been obtained thereby (Whitla); 
Lactic Acid 50, Phenol 10, Formaldehyde 7 parts by weight, as a paint to 
affected spots, is anesthetic and curative (Barwell). Scarlet Red 10 per 
cent, solution in equal parts of Sesame Oil and Petrolatum locally applied, 
tends to heal ulcers and relieve dysphagia. Scraping the ulcerated spots be- 
fore applying lactic acid, done by me in 200 cases with 28 cures (Ehring). 
Tracheotomy, where deep and extensive ulcerations exist beyond the reach 
of local treatment. Diet, thick liquids are more easily swallowed than 
thin ones, and if the patient lies on a couch or bed with his head hanging 
down over the side while swallowing, this is rendered easier (Wolfenden) ; 
feeding should be done by the soft rubber tube when much dysphagia 
46 



722 



LENTIGO, FRECKLES — LEPROSY. 



exists which does not yield to cocaine. Blocking of Internal Laryngeal 
Nerve with 75 per cent, alcohol abolishes dysphagia from 3 to 42 days or 
longer and can be repeated as often as necessary (Lukens). 

Lentigo, Freckles. 

In a person whose skin will freckle from exposure to the wind and sun, 
prevention is possible to a great extent by Anointing the face before exposure 
with a greaseless cream which should be rubbed in thoroughly and a con- 
siderable amount also left on. In extensive cases of this condition, it is 
necessary in order to effect a cure, to produce a certain amount of desquama- 
tion. Probably the most commonly used being Mercuric Chloride applied 
in the strength of 1 to 4 grains to the ounce of water or alcohol and applied 
freely to the face. For more extensive desquamation, strong preparations 
of Salicylic Plaster may be used but there is always danger of permanent 
scarring in the use of this drug. Hydrogen Peroxide applied freely to the 
face may produce some amount of bleaching. Applications which will 
blister the skin such as Capsicum, Cantharides, etc., will remove the freckles 
for the time being but exposure will cause a return of the condition. 

]$. Hydrarg. Chlor. Corros., gr. iv to viij. 

Tinct. Benzoin, 5ij- 

Zinci Sulphat., gr. xx to xl. 

Alcoholis, §ij. 

Aquae, q. s. § iv. 

M. Sig. — Apply frequently. 

(Stelwagon.) 



1$. Hydrarg. Chlor. Corros.,... gr. vj. 

Acid. Acetic, Dilut., 5ij. 

Sodii Boratis, gr- xl. 

Aq. Ros., §iv. 

M. Sig. — To be applied night and morn- 
ing, at first with gentle brushing; afterward 
by rubbing. (Bulkley.) 



Leprosy. 

Prophylaxis. — There seems to be little evidence to show that insects 
play any part in the transmission of leprosy. Flies may be a factor and 
they should be prevented from coming in contact with the discharges from 
leprous ulcerations. In all of the ordinary insects the bacilli seem to dis- 
appear in a very short time, with the exception of the cockroach, for which 
reason it would seem advisable to destroy these pests, which can be easily 
done by sprinkling around a little sodium fluoride (Stitt). Leprosy tends 
to spread where there is marked personal uncleanliness and close contact 
with lepers in overcrowded quarters, and many authorities consider the 
free use of soap and water the most important means of avoiding infection 
(Id). While segregation is generally considered the one proven prophylactic 
measure there are those who question its value (Id). Arsenic, with 5 or 6 
times the quantity of black pepper, in esteem in India (Wa) . Chaulmoogra 
Oil, is credited with a few cures and many cases improved; the oil is mixed 
with Psoralea corylifolia as a liniment, and is also used internally (Wa); 
TTlviij-x in capsules, gradually increased to a daily maximum of 200 drops; 
also hypodermically to 5 j daily (Mn) ; known and used in China for centuries. 
Antileprol, a preparation of chaulmoogra oil, which is better borne by the 
patient, may be given in doses approximating 120 grains by mouth daily or 
60 grains subcutaneously (Stitt). Gurjun Balsam, Wood Oil, as ointment 
and emulsion, has been used with success in alleviating the disease, by Dr. 
Dougall, Port Blair, Andaman Islands; the ulcers of 24 lepers healed thereby: 
doses of Tfl.v-x (O). Ichthyol, used internally in increasing doses, with 
vigorous rubbing of the arms and legs twice daily with a 10 per cent, oint- 






LEUCOCYTHEMIA — LEUKEMIA — LEUCORRHEA. 723 

ment of Pyrogallic Acid in Lanolin, and the cheeks and trunk with Chrys- 
arobin, 10 per cent, in Lanolin, also applying to the forehead and chin a 
plaster of Chrysarobin, Salicylic Acid and Creosote, changed every day. 
This treatment, continued for a month, and followed by a course of warm 
baths before being resumed, has cured several cases (Unna). Sodium 
Salicylate, in doses of gr. xv four times a day, gradually increased for six 
months or a year, if commenced early in the disease, sometimes effects a cure 
(Danielssen). Thyroid, caused marvelous improvement in a case of nerve 
leprosy during 3 years of its use (Mn). Silver Nitrate, is said to act as a tonic 
alterative, and to control leprosy for a limited period (Pf). Europhen, 5 
per cent, in oil, cured a case some years ago on the Island of Madeira 
(Goldschmidt). Mercury, the Oint. of the Red Iodide, diluted 1 to 10, 
or gr. j of the salt to 3 v of unguentum, gives very good results ( Wa) ; the 
Bichloride by injection, gr. -J- weekly, used with some benefit (Crocker). 
Thiosinamin, in 5 to 20 per cent, soap or plaster, locally for leprous lesions 
(Unna). Roentgen Rays, used on 13 cases at Manila for a year, resulted in 
3 cures, 7 improved, and 3 not improved (Wilkinson). Specific Products. 
Many so-called specific products, whether of the nature of extractives, as 
Leprolin or Nastin, or of bacterial vaccines, have been tried with results 
which have not tended to gain the confidence of conservative men (Stitt). 
The product which has been given most general trial is Nastin which is a 
neutral fat, extracted from a streptothrix growth, obtained by Deycke from 
leprous nodules (Id). It is combined with benzoyl chloride and is con- 
tained in ampoules containing from one-half to one-fifth of a milligram (Id). 
Hygiene and Diet, are the most important factors in retarding the progress 
of the disease; personal cleanliness is important, and the avoidance of all 
food which is liable to irritate the skin, as condiments, shell-fish, etc. (Jack- 
son) ; unsound fish is a frequent cause of the disease (Hutchinson) ; nutritious 
food, frequent baths and great cleanliness, will do much to prevent its 
manifestations (R). 

Leucocythemia — Leukemia. 

Arsenic, in as full doses as can be borne, may be of service, though hitherto 
ineffectual (Gowers); in large doses is the best remedy (O). Atoxyl is 
worthy of trial, it having caused diminution in the size of the spleen and 
lymphatic glands, with improvement of the general condition (Cohnheim). 
Iron, is of little value (B) ; large doses may do good in the early stage, with 
careful diet, and Ergot to contract the spleen (Da C). Roentgen Rays 
cured a case of spleno-medullary leukemia, the only case known by me to 
have recovered (Senn) ; have given wonderful results in both the lymphatic 
and spleno-medullary forms (Finzi); cured 10 cases out of 26 of myelogenous 
leukemia, the spleen diminishing to normal size and the blood assuming its 
usual picture, but the lymphatic form proved quite refractory (Grawitz). 
Splenectomy has been performed in a number of cases, almost invariably 
with fatal result; is absolutely unjustifiable and is also useless (Muir); 
performed 43 times with 5 recoveries (Wilson). [Compare Anemia, 

LVMPHADENOMA.] 

Leucorrhea. 

Iron, the Iodide, internally and externally has proven serviceable; the 
Mistura Ferri Composita, when anemia and general debility (Wa) ; the styptic 



724 



LICHEN PLANUS. 



preparations locally (R); the Ammonium Sulphate in doses of gr. v thrice 
daily, often gives marked benefit in atonic leucorrhea (W), Iron, Arsenic, 
and Quinine, in pill, when anemia, in cases due to excessive lactation, etc. 
Phosphates, for the cachexia (B); Calcium Phosphate, gr. j-ij several times 
daily, of great value in checking profuse discharge (Wa). Ergot is said to be 
useful in some cases (R). Sumbul, is recommended in the atonic form (P). 
Myrrh, given with Iron or Aloes, is beneficial (P). Balsams of Peru or Tolu, 
internally, are used with benefit (P). Copaiba, has been used with success 
(P). Pulsatilla, 5-drop doses ter die for a few weeks; also a teasp. of the 
tinct. in a pint of cold or tepid water, as vaginal enema daily, when pain in 
the loins, depression of spirits, loss of appetite (P). 

Phenol in 5 per cent, solution, as an injection in vaginal leucorrhea (R). 
Creosote may be substituted for phenol when the discharge is fetid (W). 
Hydrastis, the fluidextract undiluted, applied topically, quickly improves 
in uterine and vaginal leucorrhea (B). Silver Nitrate, in solution locally, 
also tampon saturated with 5j each of Alum and Bismuth, when leucorrhea 
due to granular vaginitis (Parvin). Glycerin, is largely employed for vaginal 
leucorrhea, and for erosions and ulcerations of the cervix uteri (B); the best 
vehicle for other agents (E). Borax, 3 j to Oj of water, as vaginal wash for 
the leucorrhea of pregnancy (Parvin). Cresol, the official Liquor Cresolis 
Compositus, 2 per cent, in water, makes a good injection, especially in puru- 
lent leucorrhea. Bismuth Subnitrate in mixture with mucilage, gr. xx to 
the §, may be used as an injection (W); or as a vaginal suppository (B). 
Resorcinol, in 1 to 15 per cent, solutions locally (W). Copper Sulphate, in 
solution, as injection (R). Tannic Acid, in chronic cases serviceable as 
injection, 3 SS m 5 y iij of claret wine (B); if os ulcerated, a suppository of 
tannin and cacao-butter to mouth of uterus (R). Iodo-Tannin, is an excel- 
lent application, 5j of iodine to §j of tannic acid, a sufficient quantity to be 
packed dry around the cervix (B). Iodine, the tincture diluted, as an altera- 
tive and stimulant application (W). Alum and Borax, make a useful injec- 
tion in vaginal leucorrhea (R). Belladonna, with Tannin as bolus when 
neuralgia or ulceration of the os; when disease due to over-secretion of mu- 
cous glands about the os and much pain present inject Sodii Bicarbonat., 
3j; Tincturae Belladonnae, §ij; Aquae, Oj (R). Potassium or Sodium Bi- 
carbonate, 5j in Oj aquae as injection, especially when discharge alkaline 
and copious (R). Potassium Permanganate, has no special advantage; is 
used in solution, gr. ij to the § (B). Potassium Chlorate, 3 j to Oj of water 
as injection in simple cases (Parvin). Injections, water at 6o° F. to prevent 
recurrence (R); hot water injections are the best tonic for the pelvic vessels 
to relieve venous congestion; use with elevated hips (E). [Compare Endo- 
metritis, Uterine Ulceration, Vaginitis.] 



I£. Sodii Bicarb., 5 j. 

Tinct. Belladon., 5ij. 

Aquae, Oj. 

M. Sig. — Vaginal wash for watery leu- 
corrhea. (Ringer.) 



1^. Alumini Sulphatis, 

Zinci Sulphatis, aa 3ij- 

Glycerini, § vj. 

M. Sig. — A tablesp. to a quart of water, 

as astringent wash. 



Lichen Planus. 

As many cases of lichen planus follow severe nerve strain or debili- 
tated conditions, it is necessary to build up the patient's health and 



LITHEMIA. 725 

strength as rapidly as possible and for this reason, systematic exercise, pref- 
erably out of doors, is of the utmost importance. Arsenic, in this disease, 
not only is of value for its effect on the constitution but seems to exert a 
specific influence on the disease itself and should be given in Fowler's Solu- 
tion, two drops t.i.d., increasing one drop a day until 10 drops are reached 
and the dose held there or gradually decreased, according to symptoms. 
Liquor Carbonis Detergens or Picis Mineralis Ccmp., first 25 per cent, in 
water and gradually increased to full strength, is one of the most efficacious 
external remedies that we possess. It may be incorporated 2 drachms to 
the ounce in petrolatum with 5 minims of Phenol and Boric Acid to stiffen. 
Oil of Cade is effective but its objectionable odor excludes its use. Lysol, 
4 drachms to the tub of water, has considerable influence on the itching. 
Phenol is an extremely valuable drug in helping to allay the itching. Sodium 
Salicylate is of value in the treatment of this disease. If it is particularly 
inflammatory or is situated in the moist surfaces where there is consider- 
able chafing, soothing lotions such as the Calamine-Zinc Oxide Ointment 
(see "Eczema") or the Boric Acid dusting powder (see "Erythema Inter- 
trigo") may give considerable relief. For Lichen Planus Hypertrophicus 
or the verrucous type, Salicylic Acid Plaster (Unna's) 33 J per cent., may 
be used to destroy it. Liquor Potassae, 20 to 30 per cent, strength and 
thoroughly washed off with water, may start the destruction of this tissue. 
The X-Ray may be used for the same purpose. The Mercury Vapor Lamp 
with the lens applied directly to the skin with a blue filter is of some value. 
Personally, I have found that the actual Cautery is the best treatment of 
all. If the area is small, a local anesthetic is all that is necessary but if it 
is of considerable size, a general anesthetic must be administered. I have 
used this method in several cases with the most gratifying result. 

Lithemia. 

Salicylates powerfully promote the excretion of uric acid and may be used 
with the utmost confidence in all troubles due thereto (Haig); they aid in 
keeping down the diathesis (W); the Strontium salt is the most valuable, 
especially in chronic gouty conditions and in lithemia with intestinal indi- 
gestion (W). Piperazin is one of the best eliminants, and relieves the pru- 
ritus of the uric diathesis; has not maintained its original reputation (W). 
Piperidin, the Tartrate increases the solubility of sodium biurate in the serum 
to a greater extent than any other agent (see page 394). Lithium Salts are 
much employed, but are of uncertain value (W); the Citrate, gr. xx thrice 
daily, is very efficient (Da C); the Carbonate invaluable (Wa); the Bromide, 
in solution of Potassium Citrate given after stomach digestion is completed, 
one of the very best agents (Aulde) ; Lithium clears the blood of uric acid but 
drives it into the tissues, and diminishes its excretion (Haig). Alkalies are 
useful, especially the Potassium salts; alkaline mineral waters have a deserved 
reputation (B); the Potassium salts increase oxidation process in the system, 
and are often very serviceable (W). Sodium Phosphate as a laxative, is 
frequently very useful in lithemia (W); is a good solvent of uric acid and 
promotes its excretion if given with alkalies or when there is a good supply 
of alkalies in the blood and tissues (Haig). Colchicum, the wine in doses of 
TTlxv twice or thrice daily is very useful (Wa) ; the combination of Colchicine 
with Oil of Gaultheria in capsules is said to be a useful remedy. Buchu with 



726 



LOCOMOTOR ATAXIA. 



an alkali, has proved beneficial (P). Pichi is of great value in lithemia with 
cystitis (Wyman). Arsenic, in small doses, is useful (Da C). Nitric Acid, 
10 minim doses of the dilute acid in half-glass of water thrice daily, with an 
occasional dose of Pil. Rhei Compos, at bedtime, is the most efficient treat- 
ment for patients who will not diet themselves (Hughes). Purgatives, 
especially alkaline mineral waters, to clear the portal system (Da C). Drugs 
increasing the excretion of uric acid are Alkalies, Salicylic Acid and its com- 
pounds, Sodium Phosphate, Piperazin, Quinine, and Belladonna (Haig). 
Exercise is very important, sedentary habits are injurious; alcohol in any 
form is poison to a lithemic (Da C). Diet, breadstuffs and cereals foods form 
the best diet (Haig) ; occasionally abstain from animal food, also from tea, 
coffee, meat soups, sugar in excess; drink water freely. [Compare Calculi, 
Dyspepsia, Gout.] 



1$. Lithii Bromidi, §ss-j. 

Liq. Potassii Citrat., giv. 

Syrupi Simplicis, gij. 

M. Sig. — A teasp. in a wineglassful or 
more of water, 2 hours after each meal. Re- 
duce the dose after a week. 



]$. Potassii Nitratis, 3j- 

Fluidextr. Pichi, § j. 

Elixir Simpl., §iij. 

M. Sig. — A teasp. every 2 hours. 



1$. Tinct. Belladonnae Fol.,.. . . Tigxviij. 

Vini Colchici Rad., 3ij. 

Liq. Potass. Citrat., .q. s. ad §iv. 
M. Sig. — A dessertsp. well diluted, 
every 3 hours. 



. Vini Colchici Rad., 3ij- 

Fluidextr. Phytolacca, 3j- 

Potassii Acetatis, 5iij- 

Aquae, q. s. ad § vj. 

M. Sig. — A tablesp. four times daily. 



Locomotor Ataxia. 

Antipyrine or Acetphenetidin for lancinating pains: the former relieves 
them remarkably; the use of Morphine for the pains should be avoided as 
long as possible (Osier). Acetanilid, is admirable for relief of the pains (B). 
Acid Acetyl Salicylic or so-called Aspirin, has been highly praised as an anal- 
gesic in the fulgurant agonies (W). Bromides prevent the laryngeal crises 
by depressing the adductor centre of the larynx in the cerebral cortex, and 
by quieting reflex action. Potassium Iodide or Corrosive Sublimate, in 
full doses, often retards the progress of the disease (Da C). Mercury, the 
Benzoate in daily doses of gr. §-| hypodermically, diminished the ataxia in 
six cases, and otherwise caused a slight improvement (Lemoine); the Ben- 
zoate or Biniodide, gr. f-§ daily by injection in early cases, causes the case 
to become benign, and finally checks the symptoms (Faure) ; neither mercury 
nor potassium iodide has anything like the same influence that they have 
over the ordinary syphilitic lesions (O). Hyoscine is serviceable in the 
crises (Winnett). Intraspinal Therapy in tabes is the most popular method 
at the present time of employing Salvarsan or Neosalvarsan. These drugs 
should not be injected directly because of dangerous toxicity. To over- 
come this Swift and Ellis devised a technic in which these drugs are injected 
intravenously, blood serum subsequently withdrawn and injected into the 
spinal canal. [See Arsenic] The technic is described by Kolmer as follows : 
''From 0.6 to 0.9 gm. of salvarsan or neosalvarsan is injected intravenously. 
One hour later 40 c.c. of blood are withdrawn directly into centrifuge tubes 
and allowed to coagulate, after which it may be centrifugalized. The fol- 
lowing day 12 c.c. of serum are pipeted off and diluted with 18 c.c. of sterile 
normal salt solution. This 40 per cent, serum is then heated at 56 C. for 
one-half hour. After lumbar puncture the cerebrospinal fluid is withdrawn 



LUMBAGO. 727 

until the pressure is reduced to 30 mm. cerebrospinal fluid pressure. The 
barrel of a Luer syringe (which has a capacity of about 30 mils) is at- 
tached to the needle by means of a rubber tube about 40 cm. long. The 
tubing is allowed to fill with cerebrospinal fluid, so that no air will be in- 
jected. The serum is then poured into the syringe, and permitted to flow 
slowly by means of gravity into the subarachnoid space. At times it is 
necessary to insert the plunger of the syringe to inject the last 5 mils of 
fluid. It is important that the larger part of the serum should be injected 
by gravity, and if the rubber tubing is not more than 40 cm. long, the pres- 
sure cannot be higher than 400 mm. Usually the serum flows in easily 
even under a low pressure. . By the gravity method the danger of suddenly 
increasing the intraspinous pressure to the danger-point, such as might 
occur with rapid injection with a syringe, is avoided." Ogilive's modifica- 
tion of the Swift-Ellis method is described on page 51. The use of intra- 
spinal injections of autoserum (salvarsanized) has affected an improvement 
in a large number of cases and many observers claim for it a distinct value. 
The estimate of its ultimate effect can be determined only by much longer 
observation than has been possible since the inauguration of the treatment. 
Co-ordinated Movements, to re-educate the co-ordinating power of ataxic 
subjects by definite exercises, produce great improvement in locomotion 
(Frenkel). Electricity is of very little benefit (O); the galvanic current re- 
lieves pain; faradic stops wasting of muscles (B). Water, one of the most 
efficient agents; friction with a cloth dipped in water of 60-65 F., a cold com- 
press to head; 4-8 minute bath of 70-7 5 ° gradually to 6o°, then shower-bath 
and frictions (R). Rest, as complete as possible, must be insisted on; with 
good, nutritious diet, milk being very desirable (Da C). 

Lumbago. 

Salicylates, the standard remedy in all forms of myalgia. Phenacetin 
and Salol, 5 grains of each, often very serviceable. Iodides, if referable to 
syphilis, mercury, copper, tin, or lead poisoning (B). Potassium Iodide 
in subacute form (W) ; in obstinate cases (O). Alkalies, the alkaline mineral 
waters and restricted diet in gouty cases (O). Ichthyol in 10 to 50 per cent, 
solution externally, is superior to any other remedy (Schweninger) ; frequently 
gives prompt and surprising results (Eulenberg). Ammonium Chloride, 
is very efficient in doses of gr. xx thrice daily for 2 days or until signs of con- 
gestion of the nasal mucous membrane appear, then to be replaced by 
Quinine, gr. v, thrice daily for a week (Waugh). Antipyrine, gr. vij, hypo- 
dermically, completely banished it in a very bad case at the Hotel Dieu, 
Paris. Morphine, hypodermically, to relieve pain (R) ; gr. J with Atropine 
gr. -gV) hypodermically, will frequently cure lumbago in two or three hours 
(Da C). Capsicum, a strong infusion applied on lint, and covered with oiled 
silk, very efficient in recent lumbago (R) ; a Capsicum plaster is a very efficient 
application. Belladonna, as plaster, very valuable for persistent lumbago 
remaining in a small spot (R). Formic Acid gtt. v of a 2 per cent, solution 
hypodermically, preceded by gtt. viij of a 1 per cent, solution of cocaine, 
injected in several places, gives immediate relief and is promptly curative 
(Couch). Ether Spray, externally as freezing mixture (R). Chloroform 
Liniment, affords relief (Wa). Acupuncture, occasionally gives instant relief 
(B) ; not when high fever (R) ; in acute cases is the most efficient treatment, 



728 



LUNGS, GANGRENE OF LUPUS VULGARIS. 



of extraordinarily prompt efficacy in many cases (0). Heat, by hot douche 
to seat of pain (B); or by very hot poultices for three hours, then the skin 
covered with flannel and oiled silk; or a hot flat-iron (R). Galvanism, the 
constant current (B); is highly useful; faradization almost as successful 
as acupuncture (R); the heat from electric lamps will often give prompt 
relief. Cupping, dry cups often give relief and are a valuable adjunct to 
internal treatment. Strapping from the thigh upward with overlapping 
strips of adhesive plaster, is of great value, especially when it is necessary 
for the patient to be up and about. Diet depends on the underlying condi- 
tion. Rest in bed is important in severe cases. Massage is often employed 
with benefit. Sacro-iliac relaxation, varicocele, displacements of uterus, 
etc., etc., are causes of backache frequently diagnosed as lumbago. 



fy Collodii, 

Tinct. Iodi., 

Spt. Ammoniae, aa part. aeq. 

Sig. — Paint over the part with a camel's 
hair brush. (Burggraeve.) 



]$. Potassii Acetatis, 5iv. 

Sodii Salicylatis, 5iij. 

Aquae Gaultheriae, ... q. s. ad §iij. 
M. Ft. solutio. Sig. — One teaspoonful 
in water every four hours. (Levy.) 



]$. Ammonii Chloridi, 5j- 

Fluidextr. Cimicifugas, 

Syr. Simplicis, aa §j. 

Aq. Laurocerasi, q. s. ad §vj. 

M. Sig. A dessertsp. every 4 hours. 



1$. Methyl Salicylatis, §j. 

Spiritus Chloroformi, §ss. 

Linimenti Saponis,..q. s. ad §iij. 
M. Ft. linimentum. Sig. — To be rub- 
bed in thoroughly for 10 minutes, night and 
morning, over the affected region. (Levy.) 



Lungs, Gangrene of. 

Creosote, by inhalation, to obviate the fetor (R). Phenol, in spray as 
inhalations, used with marked benefit (Wa). Mineral Acids, especially 
Nitro-hydrochloric, with Quinine, the main reliances in chronic pulmonary 
gangrene (A). Stimulants, as malt liquors, with general tonic treatment, 
are necessary (A). Ammonium Carbonate, one of the most reliable remedies; 
is best given in decoction of Cinchona (Wa). Myrtol in doses of Tflj-ij 
several times daily, is an efficient disinfectant and alterative. Eucalyptus, 
the Oil with Alcohol, equal parts of each, of which 3j as inhalation by 
steam atomization, is useful (Wa). Turpentine, the spirit on boiling water 
inhaled for fifteen minutes every two hours, successfully employed (Skoda). 
Guaiacol, has been used hypodermically to remove the odor, with asserted 
good results (O). Treatment is very unsatisfactory; surgical interference 
may be indicated if the gangrenous region can be localized (O). Diet and 
nursing are important, and the patient's condition demands the greatest 
care in this respect (O). [Compare Phthisis, Pneumonia.] 



Lupus Vulgaris. 

As this disease is produced by the tubercle bacillus, it is frequently 
necessary to advise hygienic dietetic care though a certain percentage of the 
patients suffering from Lupus Vulgaris or any form of tuberculosis cutis, 
is very healthy in other ways. In any event, they must be kept in as good 
physical condition as possible and if tonics such as Iron, Quinine and Strych- 
nia or Arsenic are indicated, they should be given. In very extensive cases 
of this disease, patients derive considerable benefit from the same treatment 



LUPUS ERYTHEMATOSUS. 729 

as is given to those suffering from tuberculosis of the lungs. In other words, 
change of climate, rest and forced feeding. Arsenic in the form of the paste 
or ointment is used at times though not as frequently as formerly. In 
order to be of value, the paste or plaster must be so strong that it is 
accompanied by a great deal of pain during the entire time of its application. 
If much inflammation is produced by the application of strong remedies, 
they should be withheld for a few days and a soothing lotion such as the 
Calamine-Zinc Oxide (see Eczema) or the Saturated Solution of Boric Acid 
applied. Carbon Dioxide Snow is of great value applied directly to small 
areas with considerable pressure lasting from 30 to 60 seconds. If the lesions 
are small, the actual Cautery has proved with me and others to be of greatest 
value, the patient either being given a general anesthetic or if the lesions 
are very small, a local one. Care must be taken to burn well beyond the 
edge of the lesion. I have removed several by this means and while there is 
considerable scarring, it is not much worse than that obtained by the use of 
caustics and light treatments. Diachylon Ointment applied constantly 
for several days is reported to be of value. The Finsen Light perhaps is the 
best remedy we have for the treatment of this disease but, unfortunately, this 
treatment requires the constant attention of a nurse and is very little used 
in this country. In Copenhagen, where one entire hospital is devoted to 
the treatment of this disease, the results are very satisfactory. Very good 
results have been obtained by the use of the Mercury Vapor Lamp, several 
cases having been apparently permanently cured. The lens was pressed 
directly to the skin through a blue filter with an exposure of from \ 
to 1 hour. Liquefied Air has cured many cases but its expense and the 
difficulty in transportation makes its use almost prohibitive. Mercurial 
Plaster has been recommended. Pyrogallic Acid, 20 per cent, strength, 
applied for 3 days, will destroy the diseased tissue, after which healing 
ointments should be used. Radium is employed but not with the same fre- 
quency as the X-ray though with apparently equally good results. Resor- 
cin, 50 per cent, in alcohol, may be tried, painting the affected parts once 
daily or every other day until ulceration appears. Salicylic Acid, 20 to 30 
grains to the ounce, has been recommended by Marshall. Thyroid Extract 
has been given in some cases with very gratifying results (Pringle). Tri- 
chloracetic Acid applied full strength to the area and neutralized with water 
in from 30 to 60 seconds, has proved of value in some cases. The treatment 
should not be repeated oftener than from 5 to 7 days. Tuberculin In- 
jections are not used now so much as formerly but many cases were re- 
ported as cured within the time in which it was in vogue. The X-ray is 
used with very satisfactory results. 



Lupus Erythematosus. 

If there is any indication for internal treatment, it should be followed 
along the lines of the individual case. If tonics are needed, they should 
be given, but the principal part of the treatment should be directed to 
the external applications. Alcohol is absolutely forbidden as the use of 
it dilates the capillary vessels and increases the inflammation of the affected 
areas. This also applies to rich and highly seasoned foods. Arsenic 
may be of value internally as a tonic. Calamine-Zinc Oxide Lotion (see 



73° LYMPHADENOMA — HODGKIN S DISEASE. 

Eczema) is of value as many of these cases do well under mild lotions. 
The Carbon Dioxide Snow applied to several areas leaving the healthy skin 
between is one of the most important adjuncts to our armamentarium at the 
present time. If this method is used with caution, first ascertaining the 
sensitiveness of each individual patient's skin by giving an exposure of not 
more than 20 seconds and gradually increasing the time, a great deal of 
benefit can be derived with a minimum amount of scarring. Collodion has 
been recommended either applied alone or with 5 per cent. Salicylic Acid 
incorporated. This should be painted on every other day. The Desicca- 
tion Method or Fulguration is advocated by some and most satisfactory 
results are claimed by them. The High Frequency Current has been used 
in a few cases with success. Ichthyol externally may be used in full strength 
or in the form of Ichthyol Varnish (see page 610), but its brown color which 
stains everything and fills up the mouths of the hair follicles makes it very 
objectionable. Tincture of Iron painted over the entire surface is of some 
value but is not used as often now as formerly. The Mercury Vapor Lamp 
has been used with some degree of success in the treatment of this disease. 
Lotio Alba (see Acne), is of value when the mildly stimulating effect of 
Sulphur is desired. Pure Phenol applied to several small areas at a time 
may be tried with caution and after the expiration of a week or 10 days, 
may be re-applied (G. H. Fox). Bulkley has recommended the use of 
Phosphorus. Pyrogallic Acid, 5 to 8 per cent, in petrolatum, is sometimes 
of value as it has a selective action on diseased tissue. Quinine and Salicin 
in 5- to 10-grain doses, have been recommended by many observers. Resorcin 
in alcohol applied directly to the lesions twice a week is sometimes of benefit 
but care must be taken that too deep ulceration is not produced. Sulphur 
is used to a considerable extent, either in an ointment base or in lotions. 
This may be combined in the strength of 10 per cent, with Tincture of 
Saponis Viridis rubbed thoroughly into the skin and allowed to dry on. 
Liquefied Trichloracetic Acid should be applied full strength to small areas 
of not more than a half inch in diameter and allowed to remain on 30 to 60 
seconds and neutralized with water. Repeated applications of this have 
been successful in many cases and produces little scarring. The X-ray is of 
great value in many cases. 

Lymphadenoma— HodgkhVs Disease. 

Arsenic is by far the most successful remedy, both in acute and chronic 
cases, several having been recorded in which the glandular swellings have 
disappeared and the patients have recovered under its influence (Murray); 
large doses TTlxv-xx of Fowler's solution, arrived at by gradual increase, 
should be maintained until some physiological effect is produced (Ty); 
injected into the lymphoid masses has given good results, especially when 
not well borne by the stomach (Id) ; is the only drug which has a positive 
value (O). Phosphorus, has had good effects in a few cases, and should be 
used if arsenic is not well borne (Gowers). Iodine and Potassium Iodide, 
have been used but with little benefit; the latter may be distinctly harmful 
(Murray). Quinine, Iron and Cod-liver Oil, as tonics; every means must be 
employed to support the patient's strength (O). Organic Extracts, of spleen, 
thymus and other glands, are being tried but with no very decisive results as 



LYMPHANGITIS MALARIAL FEVER. 73 1 

yet (Murray). Vaccines made from organisms isolated from the glands have 
been used in a few cases with reported improvement. Local Treatment, by 
applications to or injections into the diseased glands, has reduced their size 
but has no influence on the progress of the disease (Id); is of doubtful benefit 
(O). Morphine should be given for the pressure pains (O). Extirpation of 
the diseased glands, in suitable cases, especially where the enlargement is 
confined to one group, when the spleen is not greatly enlarged and when 
there is neither fever nor marked anemia, may arrest the disease and is the 
proper treatment (Murray); if the number of red corpuscles is below 60 
per cent, removal should not be attempted (Gowers). [Compare Anemia, 
Leucocythemia.] 

Lymphangitis. 

Belladonna, the extract softened with glycerin and freely applied, is of 
great service; when pain is severe a poultice may be applied over the extract 
for a few hours only (Wa). Lead, Liq. Plumbi Subacet. Dilutus, as an 
external application, constantly applied, to soothe and restrain the inflamma- 
tion (Wa). Iodine, in strong tincture, applied around the glands, to prevent 
suppuration (Roberts). Quinine, or Salicin, with alcoholic stimulants 
freely, in septic cases (Id). Ichthyol is very valuable in the treatment of 
recent lymphatic enlargements (Agnew). Calx Sulphurata of value for 
glandular enlargements in children (R). Lymphangitis is generally asso- 
ciated with more or less lymphadenitis. [Compare Bubo, Glandular Af- 
fections, Scrofulosis, Tuberculosis]. 

Malarial Fever. 

Prophylaxis. — There are three methods in the prevention of malaria, 
all of which may be combined, as was the case in the Canal Zone region of 
Panama. These are: (1) Destruction of anopheline mosquitoes. (2) Pro- 
tection of the individual from the bites of mosquitoes and (3) Quinine pro- 
phylaxis. For a discussion of these methods the reader is referred to Stitt's 
Diagnostics of Tropical Diseases from which the following has been taken. 
Treatment. — The Cinchona bark was first introduced into Europe in 1640 
and has its name from Countess Cinchon, wife of the Peruvian Viceroy, who 
was cured of a fever by this bark in 1683 (Stitt). At present quinine or some 
salt of the alkaloid is used in malaria instead of preparations of cinchona, and 
the various methods of using this drug are described by Stitt as follows: "By 
Mouth. — This is the usual method and is the one to be preferred in all cases 
where other methods of administration are not necessitated. It is usual to 
give the quinine in capsules or cachets, the pills and tablets being often so 
hard that they do not dissolve in the alimentary tract. The method usually 
in vogue in military services is to give quinine sulphate in acid solution. 
This method is trying to the stomach. By Subcutaneous Injections. — 
This method is liable to be followed by necrosis and abscess formation or 
fibrous indurations. Quinine and urea hydrochloride is preferable either 
for subcutaneous or intramuscular injection. James has recommended very 
dilute solutions for subcutaneous injections (1-150). There are practical 
objections to this method. It is usual to give about 1 gram (15 grains) of a 
soluble salt in 10 c.c. of water. The present view is that subcutaneous in- 
jections deserve condemnation. Intramuscular Injections. — Many prefer 



732 MALARIAL FEVER. 

this method to the subcutaneous. It is best to inject the solution into the 
gluteal muscles above the ischial tuberosities. Of course in the use of quinine 
salts through the medium of the hypodermic needle everything must be 
aseptic and the skin of the patient painted with iodine. Intravenous Injec- 
tions. — Bass and many others think that when quinine cannot be admin- 
istered by mouth it should be given intravenously. Not only is there the 
objection of inflammatory reactions or necrosis when the drug is given sub- 
cutaneously or intramuscularly but the absorption of the drug is so slow that 
the patient may die before we obtain the desired effect. Ross condemns the 
subcutaneous method and recognizes the advantages of the intravenous 
method over the intramuscular one when rapidity of action is desirable. 
In giving quinine intravenously Bass thinks that 10 grains at one time is 
sufficient and that a 20-grain dose is not without danger. When used in 
cerebral malaria he repeats the 10 grains intravenously in 8 hours if the drug 
cannot then be given by mouth. Bass thinks that theoretically amyl ni- 
trite might relax the cerebral capillaries which are obstructed by parasite 
infected red cells and thus enable the quinine in the circulation to reach such 
cells. The best known method of administering quinine intravenously is that 
of Bacelli. In this method 1 gram (15 grains) of a soluble salt of quinine is 
given in ioc.c. of water. MacGilchrist has shown experimentally that such a 
strength of quinine (1-10) will coagulate blood serum. In my opinion this is 
a dangerous method and should not be used. There is no doubt as to the 
necessity for using the intravenous channel in cerebral or algid types of 
perniciousness when intramuscular injections do not give results. The 
generally accepted method is to use a salvarsan technic with a dilute solu- 
tion of quinine, giving 1 gram (15 grains) of some soluble salt of quinine in 
250 mils salt solution. MacGilchrist considers the very soluble acid salts as 
hemolytic and prefers to give quinine base — 3 pints of a solution of the alka- 
loid, containing about 12 grains. Some authorities recommend the adminis- 
tration per rectum of a soluble salt of quinine in about 3 times the usual 
dose by mouth or hypodermically. It is considered applicable in cases 
where there is marked vomiting. It certainly is the least satisfactory way of 
giving quinine. Dosage and Length of Treatment. — In Panama the standard 
treatment is to give from 3 to 5 grains of calomel followed by 2 ounces of 50 
per cent, magnesium sulphate. So soon as the diagnosis is made give 15 
grains of quinine 3 times daily (45 grains in 24 hours) and continue such 
treatment for a week or until the temperature has been normal for 5 or 6 
days. Then give 10 grains 3 times daily for 10 or 12 days. Tonics of 
iron, arsenic and strychnine are valuable in treating the anaemia, but it is 
not advisable to add small doses of quinine to such tonic mixtures. In 
Nocht's method we give the quinine in small doses repeated several times in 
the day, as 3 or 4 grains given 5 or 6 times daily. Such treatment is thought 
advisable when there is a tendency to haemoglobinuria or when giving quinine 
to pregnant women. There is frequently hesitancy in giving quinine to 
pregnant women but unless the malaria is controlled the patient will be apt 
to abort. Potassium bromide is thought to control the ecbolic influences 
of quinine. In a benign malarial infection Manson prefers to wait untfl the 
hot stage has been passed and the patient is beginning to perspire, his idea 
being that the headache and other symptoms are aggravated and that very 
little advantage is gained by treatment during the early part of the paroxysm. 
He gives 10 grains at the onset of the sweating stage and afterwards 5 grains, 



MALARIAL FEVER, CHRONIC MALARIA. 733 

3 or 4 times daily, for the following week. He then gives a daily tonic con- 
taining arsenic and iron, with a quinine treatment every seventh day for 
about 2 months. For regularity he advises the quinine treatment on Sun- 
day giving a dose of salts in the morning followed by three 5-grain doses 
during the day. Manson notes the danger of large doses of quinine as pro- 
ducing not only serious disturbances of sight and hearing but pronounced 
cardiac depression as well. There are many who speak highly of Warburg's 
tincture in treatment. It is both laxative and sudorific. The dose is \ 
ounce (15 mils) which contains about 5 grains of quinine sulphate and 4 
grains of extract of aloes. As a rule, it is better to give the quinine and the 
laxative as such. More recently the tendency has been to give large doses 
of quinine, not only for its greater curative value but, as well, for the preven- 
tion of relapses. Craig, however, states that in his experience with aestivo- 
autumnal infections he has yet to see a single case, in which treatment was 
promptly instituted, that did not recover with a daily treatment of 30 grains. 
Drugs Other than Quinine. — Salvarsan and Neosalvarsan have been ex- 
tensively used and with some success in benign infections but without 
material effect in malignant tertian ones. Some have thought that salvar- 
san aided the specific action of quinine. It has been claimed that Radium 
and X-ray Treatment, when directed to the spleen, assist the action of 
quinine. Methylene Blue, next to quinine, has been considered as the most 
valuable drug. It is given in 2 -grain doses every 4 hours. Surveyor has 
recommended Picric Acid in the treatment of malaria in doses of 2 grains 2 
or 3 times daily. Recently Hectine, a remedy somewhat similar to the 
Cacodylates, has been strongly recommended by the French. It is given 
intramuscularly in 2-grain doses. It is said to be valuable when there is a 
leucopenia as it has a tonic action. It has been recommended to combine 
this treatment with quinine. It is said to be a good substitute for quinine 
in "blackwater fever." 

Malaria, Chronic. 

Arsenic plays an important role in chronic malarial disease (B); dimin- 
ishes splenic engorgement, and combined with Iron is rapidly curative of 
many affections due to malaria (Boudin); is a powerful prophylactic against 
malaria, and in chronic malarial poisoning, with frequent return of fever and 
neuralgia, its continued use is of great benefit (Fayrer) ; is of especial value in 
nervous affections due to malaria, but large doses are required (Wa). Atoxyl 
alone is useless, but as an adjunct to quinine it shows unquestionable efficacy 
in cachexia and chronic forms of malaria (Vassal). Salvarsan and Neosal- 
varsan are beneficial in some cases. Sodium Cacodylate is a valuable remedy. 
Quinine is less efficient in chronic malaria than when the infection is recent, 
but in periodical affections depending on the malarial cachexia it is of spe- 
cific value, large doses being required (B) ; the indiscriminate use of quinine 
as a prophylactic in malarial countries is attended with great danger, seri- 
ously weakening the action of the heart and so inuring the subject to its 
action that it has no longer any value of importance as a remedy (Koch). 
Salicylates, of Quinine and Cinchonidine are especially effective in chronic 
malarial disease (B). Methylthionine is the most serviceable substitute for 
Quinine in malaria; in 425 cases where it was the only drug employed there 
were 83 per cent, of recoveries; is especially indicated where hematuria, the 
"black-water fever" (W). Sulphur is a useful remedy in malaria, given 



734 MALTA FEVER — MANIA. 

internally in any form, as Potassa Sulphurata, also Sulphur Dioxide or Sul- 
phuretted Hydrogen by inhalation, and Sulphur baths (Diesing). Eucalyp- 
tus, is of high utility to reconstruct damages in the organs of assimilation 
(B). Nuclein, has been used with benefit (Vaughn). Baths, the vapor- 
bath and Turkish baths are efficient aids to medicinal treatment in breaking 
up chronic cases, and may of themselves cure such by inducing profuse per- 
spiration (Da C). [Compare Hemoglobinuric Fever, Intermittent 
Fever, Remittent Fever.] 



1^. Cinchonidinae Salicylat. , 5ij- 

Arseni Trioxidi, gr. j. 

Ferri Sulph. Exsiccat., gr. xx. 

M. ft. pulv. no. xx. Sig. — One powder 

in wafer thrice daily. 



1$. Quininse Sulph., gr. xl. 

Ferri Sulph. Exsic, gr. xx. 

Arseni Trioxidi, gr. j. 

M. ft. pil. no. xx. Sig. — One pill thrice 
daily. 



Malta Fever. 

Prophylaxis. — Disinfection of all excreta, especially urine, and the 
materials which come in contact with the patient; the boiling of goat's milk 
or killing of infected goats, and the recognition of the possible role of carriers 
are the principal considerations in prevention. Castor Oil or Calomel, as a 
laxative at the beginning of treatment (Jackson). Sodium Salicylate, for 
brief periods, for the rheumatoid pains, but is inferior to opium (Id). Opium 
for the pains; Antipyrine and its congeners should be avoided (Id). Drugs 
cannot abort or cut short the disease, which is long and tedious (Id) ; drugs 
do not seem to have any influence (O). Treatment is symptomatic, general 
measures as for typhoid fever are indicated (O). Vaccine and Serum 
Therapy, the use of an autogenous vaccine during the afebrile period is 
recommended by Bassett-Smith. The dose from 50 to 200 millions. Re- 
cently, an anti-melitensis serum, from animals injected with the nucleo- 
protein material from the organisms, has been used with some success 
(Stitt). Hydrotherapy, either the bath or the cold pack every third hour 
when the temperature is above 103 F. (O). Diet, fluid food during the 
febrile period, pure water freely, lemonade, and fresh vegetables; nourish- 
ing food when the temperature is low and during convalescence. Climate, 
a change of climate seems to promote convalescence (O); a mild, bracing 
climate, avoiding damp and cold; a sea voyage may hasten recovery 
(Jackson) . 

Mania. 

Stramonium, of value; allays irritation and induces tranquil sleep; in 
wild and furious but intermittent delirium, also in nymphomania (P); 
many facts seem to confirm its reported value (Tr). Daturine, gr. yiirVir 
hypodermically in acute mania, but is less useful than Atropine or Hyos- 
cyamine (Wa). Duboisine, gr. ^ hypodermically in acute mania (Gubler); 
is more sedative and hypnotic than the other alkaloids of the group and 
acts well in doses of gr. T fo at first, gradually increased to gr. 3V Bella- 
donna is useful, especially in monomania with fixed hallucinations, though 
a large dose causes a temporary insanity (Tr.) ; one of the very best remedies 
in all hyperemic conditions of the brain (P). Hyoscyamus, in violent 
intermittent forms, to procure sleep and calm violent delirium (R) ; delirium 
with hallucinations but not congestion; in milder and less inflammatory 






MASTITIS. 735 

forms, also in hypochondriacal monomania (P) . Hyoscine, finds its greatest 
and most useful application in the treatment of maniacal violence and 
noisiness, and is a drug for emergencies of this kind (Weatherly) ; it seems to 
have some curative effect as well as general sedative action (W) ; enormous 
doses, gr. T \ to -jfo as a curative remedy in acute insanity (Costons). Vera- 
trum Viride, successfully combats the excitement in acute mania (B). Cam- 
phor, has been used successfully; its action is uncertain (P). Opium with 
Tartar Emetic is satisfactory for many cases; also Morphine hypodermic- 
ally to induce sleep (R); its narcotic effect is of doubtful utility, better in 
insanity with depression (P) ; will not produce narcotism in many such cases, 
even in 2-grain doses. Apomorphine, gr. -gV~i hypodermically, as a sedative 
and hypnotic (Rabow). Chloral stands in the first rank as a calmative 
and hypnotic (Palmer); has induced mental improvement in mania (B). 
Trional in doses of gr. xxx every 2 to 4 hours, is a reliable remedy for maniacal 
excitement (Palmer). Bromides are used in puerperal mania, that of preg- 
nancy, nymphomania and other forms (R); the combined use of Potas- 
sium Bromide and Tinct. of Cannabis, equal parts, 3j of each thrice 
daily for weeks and months, has proved very efficient in acute and 
periodical mania, senile mania, and other forms (Clouston). Paraldehyde, 
as a hypnotic, in doses of 5ss-j, is often decidedly useful (R); larger doses 
are necessary, an average one is 5jss. Coniine, most suitable to acute 
mania, quiets muscular action; doses of TTLss— iij, or hypodermically, beginning 
with gr. T V> with Morphine conjointly injected, is very successful (R). 
Digitalis, 5ss-5j of tinct. valuable in acute and chronic mania, especially 
when complicated with general paresis and epilepsy (Maudsley); caution! 
watch the pulse for any marked intermittence (B) ; a very valuable palliative 
in acute mania (Van der Kolk). Ergot, large doses, 5ss-j of fluidextract, 
to reduce excitement, shorten attacks, widen intervals between them, and 
prevent exhaustion, hence is very useful in recurrent and epileptic forms, 
and in chronic mania with lucid intervals (Crichton Browne). Iron, as a 
restorative, is frequently used in chronic mania with benefit, the tincture of 
the Chloride in 5-10 minim doses (B). Gelsemium, is useful in mania 
with great motor excitement and wakefulness; large doses required, Tfl,xv-xx 
of tincture. Croton Oil, as a purgative, TTlf-J every hour, as revulsive in 
mania from cerebral congestion (R). Cimicifuga, is often efficiently used in 
cases of mania occurring during the puerperal or pregnant condition (R). 
Chloroform, may be necessary to control very violent cases temporarily; its 
inhalation need not be carried to complete anesthesia. Galvanism, of the 
head and cervical sympathetic, has produced distinct improvement (B). 
Cold Douche, in maniacal delirium, the patient being in a warm bath during 
the application of the douche to the head (R) . Venesection free, in robust 
cases, might be tried in Bell's mania, even though bodily prostration is apt 
to come on early and be profound (O). Unfortunately, as asylum reports 
show, Bell's mania is almost uniformly fatal (O). 

Removal from home, from sympathetic friends, and from surroundings 
connected with the origin of the malady, is a prime necessity to a cure. 
[Compare Delirium, Insanity, Puerperal Mania.] 

Mastitis. 

Aconite or Veratrum, to depress the circulation. Belladonna, Atropine 
locally [see Lactation] or combined with Morphine and Chloral, when 



73^ MEASLES. 

much pain (B); especially as liniment to check secretion of milk when 
inflammation is imminent (R) ; or when breasts are distended by milk (P) ; 
when inflammation has set in, continuous application of Belladonna for 24 
hours often arrests it; also useful when abscess has formed; fomentations in 
addition, but skin must be dried well before the Belladonna is rubbed in 
(R); Tfl.v-x of tinct. internally at the same time (P). Camphor, a satu- 
rated solution in glycerin locally, in mammary congestion threatening ab- 
scess (Wa). Calcium Sulphide, internally in mammary abscess; occasion- 
ally increases pain (R). Hyoscyamus, as plaster, to relieve painful disten- 
tion from milk (P). Iodine, tinct. and ointment to remove indurations of 
breasts after inflammation (B). Mercury and Morphine, the Oleate locally 
in mammary abscess (R). Digitalis, the infusion locally as fomentation 
in severe inflammation of the breasts, causes it to yield speedily (Fairbank) . 
Ichthyol with an equal part of water, gently rubbed in, is very efficient 
(Schmitz) ; a 30 per cent, mixture with mucilage applied early will prevent 
suppuration (Akerblom) ; in ointment to fissured breasts diminishes the pain 
of nursing (Behren). Ammonium Chloride, 5j in Spt. Rosmarini Oj, as 
lotion on linen cloths, constantly applied, especially in induration after 
the abscess has suppurated (Wa). Tartar Emetic, in small and frequent 
doses, given early, is beneficial (Wa). Purgation, by mild salines, is bene- 
ficial. Breast-pump may be required if milk continues to form. Bandage 
the breast for pressure, and place an ice-bag over the bandage. Opening 
by incision in the line of the ducts, as soon as pus has formed; use dressing 
forceps or grooved director if abscess is deep, and pack with gauze. Oil 
frictions in first stage of inflammation of breasts, from circumference towards 
the nipple (L). Rest, by supporting mammae with strips of plaster, and 
bandaging the arm to the side, to prevent motion (T). Alcohol, over proof, 
applied by sponging until part is cold; renew if high heat returns. Heat, 
applied by a basin lined with flannel saturated with hot water, to relieve and 
prevent suppuration. Suction, Bier's apparatus proved very satisfactory 
in 12 cases (Hartmann). [Compare Abscess, Lactation.] 



Measles. 

Aconite, for febrile symptoms, and especially to arrest the catarrhal 
pneumonia (R) ; a valuable remedy (P) ; the best drug when fever is very 
high, J-drop doses of the tincture every 2 hours (Da C). Ammonium Car- 
bonate, dissolved in a solution of the Acetate is much vaunted; when feeble 
circulation, cyanosis, delirium, gr. v-x to §ss-§j Liq. Ammonii Acetatis 
(B); gr. iij-vj or vij, every hour or two, in Cinnamon-water or milk; one of 
the reliable remedies (W). Camphor, the water with Liq. Ammon. Acetatis, 
excellent when cough and catarrh the most urgent symptoms (A). Ipecac- 
uanha, for cough and catarrh, gr. j-ij every 4 or 6 hours (A). Antimony, 
preferred to Ipecac by some (A). Quinine, in small doses, gr. j-iij, for the 
adynamia, or large doses, gr. xv, for hyperpyrexia and catarrhal pneumonia 
(B). Cod-liver Oil and Iron, to scrofulous children, a long course of such 
medication after convalescence (Da C). Purgatives, must be given with 
caution (R); the milder purging salts, as Magnesium Sulphate, to be pre- 
ferred (A). Mustard, as bath on sudden retrocession of rash (R); often 
increases the fever without benefiting the pneumonia or other complica- 



MELANCHOLIA. 737 

tions (A). Water, cold affusion at commencement; packing, especially 
when retrocedent (R); hot foot-baths for convulsions (A); tepid bath with 
cold douche to head, if cerebral symptoms are severe (Da C). Ichthyol in 
25 per cent, ointment with lard, over the entire body twice daily, gives ex- 
cellent results in abating the disease (Strisover). Inunction with Cacao- 
butter is very grateful to the patient and reduces the temperature (B); a 
firm fat rubbed over the hands and feet to relieve the heat and tightness of 
the skin (R). Diet, a low diet chiefly of fluids, giving no animal food. 
Hygiene, complete disuse of eyes, strict cleanliness (A). Convalescence 
is the most important stage of the disease; watchfulness and care may pre- 
vent the serious pulmonary complications (O). [For Sequelae see Bron- 
chitis, Cough, Ophthalmia, Otorrhea, Pneumonia.] 



fy Phenolis, 

Acidi Acetici, aa 3 j~3 jss. | J\. Tinct. Tolutanae, 3ij 

Tinct. Opii Deodorati, 

Spt. Chloroformi, aa 3j- 

Aquae, q. s. ad Sviij. 

M. Sig. — A tablespoonful every 4 hours, 
until fever abates. (Keith.) 



Syr. Senegae, 3ss. 

Acidi Acetici, 3 jss. 

Syr. Pruni Virg.,.. . q. s. ad %iv. 
M. Sig. — A teaspoonful as required for 
cough after convalescence. 



Melancholia. 

Bromides, sometimes afford relief which no other agent will; no indica- 
tions (B); Potassium Bromide for townspeople, especially women with un- 
endurable despondency (R). Bromipin, has given good results. Arsenic, 
gives great comfort in the melancholia of aged persons, is best when com- 
bined with small doses of opium, thus — Liq. Potas. Arsenit, ttlij, Tinct. 
Opii, TTliij-v ter die (B). Opium, gives good effects (B); especially when 
paroxysms of acute anguish and despair, or when suicidal impulse (Wa); 
Morphine hypodermically is of great benefit in some persons who have a 
peculiar idiosyncrasy therefore (R); is of marked service (Robertson). 
Lactic Acid, the bacilli have done well in some cases (Id). Calomel should 
be given and the bowels periodically purged (Id). Paraldehyde in doses 
of 3ij is a perfectly safe hypnotic; its action can be assisted and prolonged 
by Potassium Bromide in doses of 5 ss— ij (Id). Veronal has been the most 
useful hypnotic in the writer's experience (Id). Erythrol Tetranitrate in 
J-grain doses twice daily, slowly increased, to reduce the blood pressure, 
often the cause of insomnia in melancholia (Id). Camphor has been highly 
recommended (R) . Musk and Castoreum are employed in melancholia with 
benefit (R). Cannabis, sometimes relieves (B). Phosphorus, depression 
from overwork (R). Chloral, as hypnotic, has been followed by marked 
amelioration and cure (Wa). Valerian, in hysterical or suicidal melancholia, 
is often beneficial (Wa). Caffeine has been useful (B). Iron, as restora- 
tive, the tincture of the Chloride (B). Cocaine, a useful tonic and especially 
beneficial in nervous affections accompanied by depression (Br). Cimici- 
fuga, in puerperal or uterine despondency, of singular value (P). Thyroid 
Extract may be tried, but is not likely to be successful (W) ; in increasing 
doses until a maximum of gr. lx is reached on the fourth day, followed by a 
decrease of gr. xv each day, is of great service in cases which tend to become 
chronic (Robertson). Alcohol will often relieve, but great danger of form- 
ing the habit (W). Water-cure, shower-bath for 15-20 seconds, or warm- 

47 



738 MENINGITIS. 

bath, 95 F. for 30 minutes; the shower or cold douche may be usefully 
employed in cases where reaction takes place after it (W). [Compare 
Hypochondriasis, Hysteria, Insanity.] 

Meningitis, Cerebral. 

Aconite, is as serviceable in this as in the other acute inflammations; 
during the stage of excitation, the tincture, gtt. ij with gtt. v of the tincture 
of Opium, every 2 hours, gives admirable results (B). Belladonna, in all 
hyperemic conditions of brain and spinal cord, one of the very best remedies, 
especially during the period of excitement (P). Hyoscyamus, valuable in 
subacute form (P) ; for nervous irritability during convalescence (A). Gelse- 
mium, extremely useful; Tfl,v of fluidextract every 2 hours (B). Mercury, 
as ointment gives good results in children (A) ; Calomel in small, frequent 
doses, so as to bring the system under it quickly, a most valuable remedy 
apart from its purgative effects (W) ; the Unguentum Hydrargyri rubbed for 
30 minutes into the skin on the front of the abdomen, groins and arm- 
pits, repeated after 12 hours if no evidences of improvement or salivation; 
such unmistakable benefits follow the free use of mercury that to withhold 
this remedy in desperate or apparently hopeless cases is unjustifiable (Whitla). 
Potassium Iodide in large doses where vomiting and gastric derangement are 
absent, and in the later stages of syphilitic meningitis may be very valuable 
(Id); has cured (Niemeyer). Ergot, the fluidextract in 3ss doses with an 
equal quantity of Potassium Bromide, every four hours, to diminish the vascu- 
lar excitement (B). Potassium Bromide, in the convulsions following simple 
meningitis (R). Opium, in small doses; by clinical evidence proved to be the 
best remedy, especially for acute stage before exudation, or during the 
stage of excitation (B); when collapse, it may sustain the vital powers; with 
Tartar Emetic has proved most beneficial, but should be used with caution, 
as it may do great harm (Wa). Purgatives, as soon as possible, unless ex- 
haustion; Calomel and Jalap the most active and searching (A); Croton Oil 
as a derivative and revulsive, also locally to the shaven scalp, is productive 
of the best results (Wa). Venesection, or arteriotomy (temporal artery) 
give good results (B); when high cerebral excitement and vascular action 
(A) ; in the early stage of sthenic cases, especially if Aconite or Veratrum are 
contraindicated. Lumbar Puncture to relieve cerebral pressure, if symptoms 
thereof are marked. Blisters, on nape of neck if coma, after active symp- 
toms are subdued (A); useless, and cause needless suffering (O). Water, 
cold water for hyperpyrexia (C) ; pounded ice in bag or bladder, as a cap to 
the head (R). There are no remedies which in any way control the course 
of acute meningitis (O). [Compare Meningitis, tuberculous.] 

Meningitis, Cerebro-spinal. 

Opium, in small doses is the most effective remedy; its utility ends when 
effusion occurs and stupor and coma ensue (R); large doses (Valleix); gr. 
j every hour in very severe cases (S) ; has been used in France and Germany 
with much success (Tr) ; is the best remedy in doses of gr. j every hour for 
4 days, even such doses will not narcotize the patient in this disease (Da C). 
Bromides to guard the Opium and enable the latter to be pushed, doses of 
gr. xx every 4 hours (Id). Antipyrine was very efficient in the epidemic 



MENINGITIS, SPINAL. 



739 



among the Boer prisoners (Freeman). Aconite, is useful combined with 
Opium (B); affects the cranio-spinal axis from 3d nerve to phrenics, the 
region where this disease is most manifest (Harley). Gelsemium, extremely- 
valuable, Tfl,v of fluidextract every 2 hours, to maintain constant physio- 
logical effect (B) ; is efficient for the delirium. Belladonna, in all hyperemic 
conditions of brain and spinal cord, especially during stage of excitement 
(P). Iron, the tincture of the Chloride, in 20-30 minim doses, every two 
hours, suggested by the similarity of the disease to erysipelas, has made 
many successful cures without leaving any sequelae (Klapp). Hydrocyanic 
Acid, dilute, Tflj-ij with gr. iij-v of Sodium Bicarbonate, every 3 or 4 hours 
for severe vomiting (Delaneld). Quinine in large doses at the commence- 
ment (B); has been exhaustively tried in this disease and failed (Da C). 
Urotropin in dose of gr. x or xv speedily appears in the cerebro-spinal fluid, 
where it exercises a distinctly prophylactic influence against meningeal in- 
fection (Crowe). Potassium Iodide for the sequelae, a long course of Iodides 
is the best treatment during the convalescence (Da C). Turpentine by 
enema as a derivative (B). Counterirritation by the actual cautery freely 
applied to the back, relieves the pain (A) ; a valuable method in the chronic 
form (W). Cold to the spine, the most satisfactory treatment (Radcliffe) ; 
to the head and upper spine for 5 minutes only at a time, for the headache 
and tetanic symptoms (Da C). Heat to the body, except the head and neck 
(Id) ; hot-water bottles or hot sand-bag to the trunk and extremities to keep 
up the body warmth; bath of io2°-io6° F. for a short time only (A). Vene- 
section, or arteriotomy (the temporal artery) is probably of service (B); 
leeches to the temples and back of the neck if the patient is vigorous, to 
relieve the terrible headache (Da C). Lumbar Puncture and hot baths, have 
cured cases of the suppurative form (Netter) ; a valuable diagnostic measure 
(O). Intraspinal Injections have been tried, and in one case Cushing 
opened and drained the spinal canal (O). Guaiacol by inunction, 1 part to 
1 2 Lanolin- vaseline, of this a quantity containing gr. xij-xv of guaiacol gently 
rubbed into the cleansed skin each day, using a definite rotation to avoid 
inflaming the skin; successful in a severe case (Arnold). Flexner's Serum 
injected directly into the spinal canal, after the spinal fluid has been per- 
mitted to escape; 30 mils the maximum dose, to be repeated daily for 3 or 4 
days. [See article on Serums in preceding section of book. ] Diet, nutritious 
and suitable food at short intervals, day and night (A); tonics with fresh 
air and good diet during convalescence (A). Ventilation, of dwellings, the 
best sanitary precaution when the disease is epidemic (Simon). 



1$. Morphinae Sulph., gr. ss. 

Ac. Sulphurici Aromat., 5j. 

Tinct. Cinchonae Co.,. .. .ad. gvj. 
M. Sig. — Tablesp. every 2 hours for a 
boy 1 2 years old. {Meigs & Pepper.) 



1$. Potass. Iodidi, 5iv. 

Tinct. Gentian. Comp., 
Syr. Sarsaparillae Co.,. . . .aa gij. 
M. Sig. — Teasp. thrice daily, to pro- 
mote absorption during convalescence. 



Meningitis, Spinal. 

Aconite, is very useful (B) ; with an Ergot and Opium impression to reduce 
the amount of blood in the vessels of the cord (Da C). Potassium Iodide, 
in the chronic form, with the Bichloride of Mercury when a specific history 
present (Hammond). Belladonna, strongly to be relied on, even when 
brought on by external violence (P). Purging, by Magnesium Sulphate, 



74° MENINGITIS, TUBERCULOUS — MENORRHAGIA. 

combined with Tinct. Hyoscyami (A). Quinine, when paralysis occurs, 
in 3-grain doses thrice daily, with J- grain doses of Ext. Belladonnas, 
or 20-30-grain doses of Potassium Iodide, and flying blisters along the 
spine (Da C). Opium, in some form, must be used for pain (Bastian). 
Mercury, gr. T V of the Bichloride, with increasing doses of Potassium 
Iodide, to promote absorption of inflammatory products, if the inflam- 
mation subsides (Bastian) ; a mercurial impression often benefits the paralysis 
(Da C). Mercury is the only drug which has any influence on the acute 
process; it is best given by inunction (Risien Russell). Cold, by ice to spine 
is deemed necessary, and no doubt alleviates the pain, though heat would 
be a more rational application for the inflammation (Bastian). Lumbar 
Puncture may be used as a therapeutic measure (O). [Compare the 
preceding article.] 

Meningitis, Tuberculous. 

Potassium Iodide, is the routine remedy, to be administered in ordinary 
typical cases, full and frequently repeated doses are necessary, gr. j every 2 
hours for a child of 2 years (Whitla) . Potassium Bromide, combined with 
the Iodide in double the dose of the latter, is advantageous (Whitla). Mer- 
cury, mercurial inunction should be used heroically as long as there is any 
reason to doubt the diagnosis, in the hope that the case may be one of simple 
meningitis (Whitla). Magnesium Carbonate, 3 j-ij saturated with Lemon- 
juice, every 2 or 3 hours, a useful purgative in hydrocephalus (Wa) . Turpen- 
tine, in doses of Tfl,v-x withTTlxx-xl of Castor Oil, or terebinthinate enemata, 
in incipient hydrocephalus (Wa). Purgatives, in small doses, every 4 or 6 
hours after having overcome the constipation, to maintain action for some 
days; a single dose of Calomel, followed up by Magnesium Sulphate at short 
intervals; their value can hardly be overrated (Wa). Leeches, on crown of 
head rather than on temples, when much febrile action; inadmissible if 
patient is much debilitated; sometimes serviceable (Wa). Lumbar Punc- 
ture, in one case, a man of 20 years, 60 mils of cloudy fluid containing tubercle 
bacilli were removed, and the patient recovered (Furbinger). Prognosis is 
fatal usually; cases of recovery have been reported by reliable authorities, but 
they are extremely rare, and there is always a reasonable doubt as to the 
correctness of the diagnosis. I have never seen a case recover which I 
regarded as tuberculous (O). [Compare Hydrocephalus.] 

Menorrhagia. 

Opium, has specific action in reducing the uterine circulation and 
should be pushed in severe cases (Lutaud). Cotarnine is a powerful 
vaso-constrictor and is almost specific in uterine hemorrhage (Boldt); 
is efficient in uncomplicated cases (Gartig); the Hydrochloride gr. j every 
2 or 3 hours, or gr. ss 4 times daily for a few days before the expected 
period in habitual cases. Hydrastinine arrests uterine hemorrhage and is 
successfully used in menorrhagia (W); gr. j of the Hydrochloride hypo- 
dermically for immediate effect, by the mouth for prolonged action. Ergot, 
large spongy uterus; Bromides better (B); Ergotin, gr. j or ij in glycerin and 
water, undoubtedly efficacious as hypodermic injection (P) ; in all forms (R) ; 
minim doses of the fluid extract are very beneficial (Smith) ; is perhaps the 
most generally efficient remedy known (W). Bromides usually arrest 
promptly (B) ; that of Potassium most useful in young women if loss occurs 



MENSTRUAL DISORDERS. 



741 



at period only; commence the Bromide a week before and discontinue when 
discharge ceases till a week before the next term; if loss occurs every two or 
three weeks give Bromides continuously in 10-grain doses, but more when 
organic changes in womb (R, Wa). Potassium Chlorate or Bromide, in 
doses of gr. xv thrice daily, combined with Ergot, has an almost infallible 
influence over uterine hemorrhage, unless caused by cancer, polypi, adherent 
placenta, or other similar affections (Tait) . Cannabis, often successful (R) ; 
gtt. v-x of tinct., thrice daily, productive of extraordinary success (Wa); 
has a stimulant action on the uterine muscular fibre, and may be given in 
combination with Ergot (B). Quinine, has been recommended (R); after 
Ergot it is the best agent, in 6-grain doses every 3 hours (Parvin). Salo- 
quinine is very efficient in profuse menorrhagia. Digitalis, very useful, 
especially when from heart disease, in plethoric subjects (R); 3j~jss of infu- 
sion will arrest menorrhagia when unconnected with disease (P, R) ; probably 
stimulates the uterine muscle (W). Aloes, when constipation, tends to 
cause pelvic hyperemia (W); with Iron in debilitated and relaxed subjects 
(B). Calcium Chloride gr. vij every 2 hours increases the coagulability of 
the blood and is an efficient hemostatic (Gross). Calcium Phosphate in 
anemia due to excessive menstruation (R); in the menorrhagia of anemic 
subjects (Schonian). Ipecacuanha, in full emetic doses (Wa); is excellent 
(B); Ergot is better (P). Savin, enlarged, relaxed, and passively congested 
uterus (B); in 5-10 drop doses of tinct. in water every half -hour to three 
hours, has proved useful (P); when menorrhagia due to want of tone in 
uterus (R). Erigeron, the Oil in doses of Tfl.x is efficient (Wa); is especially 
valuable (W) ; Tfl,iij-v, is the best remedy for continual oozing. Cinnamon, 
the Oil in drachm doses (R); in doses of 5ss, efficient for oozing. Rue, in 
cases of low vascular tonus (B). Iron, in cases due to anemia (B); Monsel's 
solution in full strength locally, when bleeding is due to polypus or is from 
the cervix. Turpentine is often serviceable in passive hemorrhages. Gelatin 
increases the coagulability of the blood, may be used both internally and 
locally (W). Cimicifuga, in passive form, the blood being coagulated and 
dark colored (P); for accompanying headache (R). Ammonium Chloride 
for the headache (R). Magnesium Sulphate, very small doses with a little 
dilute Sulphuric Acid and syrup, is exceedingly useful (Wa). Mammary 
Extract, gave signal satisfaction as an internal remedy in two cases of menor- 
rhagia with dysmenorrhea and enlarged uterus (Bell); is of benefit (Shober). 
Thyroid Extract may prove of service (W). Adrenal Extract internally, 
probably causes uterine contraction (W) ; Adrenalin Chloride, 1 to 5000, may 
be used locally on sterile cotton. Water, a hot-water bag to the lower dor- 
sal and lumbar vertebrae (R) ; cold sitz-bath, feet in warm water, especially 
valuable; 6o°-65° F., for 5-15 minutes, patient then quickly dried and put to 
bed. [Compare Metrorrhagia.] 



1$. Fluidextr. Ipecac, 5ij- 

Fluidextr. Ergotse, 3iv. 

Fluidextr. Digitalis, 5ij- 

M. Sig. — A half teasp. to a teasp. as 

required until emesis occurs. (B.) 



gr. xij. 
gr. vj. 



fy Ext. Ergotae (Squibb) , . . 

Ext. Opii, 

M. et div. in pil. no. xij. 

Sig. — One pill every hour, in profuse 
menstruation of atonic type. 



Menstrual Disorders. 

Aconite, gtt. j of tinct. every half-hour or hourly promptly restores the 
discharge when suddenly suppressed from chill (P, B, R, Wa); as emmena- 



742 METRITIS — METRORRHAGIA. 

gogue (Tr). Savin, a powerful uterine tonic; as emmenagogue certain, 
powerful, safe (P). Ferrum, in anemic subjects (B). Aloes, as emmena- 
gogue. [See Amenorrhea.] Cocculus Indicus, for irregular menstruation 
with colicky pains and scanty discharge; should be given for a few days prior 
to and during period (P) ; Tfl,ij-iij of a saturated tincture thrice daily. Opium, 
in suppression from violent mental emotions, a valuable remedy (Wa); in 
many menstrual disorders it proves invaluable, but must be cautiously ad- 
ministered lest the habit be formed. Saloquinine in doses of gr. xxx, is very 
efficient for menstrual colic. Cimicifuga, relieves heat and pains in the head, 
flushings of the face, pains in back and limbs, when occurring as the result 
of menstrual perversion (Wa). [Compare Amenorrhea, Dysmenorrhea, 
Menorrhagia, Climacteric Disorders.] 

Metritis. 

Opium, by suppositories or enema is more effectual than if administered 
internally (Wa) . Aconite, is invaluable in early stage of simple inflammatory 
fevers (P). Ichthyol in 5 per cent, mixture with glycerin or vaginal tampons, 
is of great value in chronic parametritis, subacute and chronic perimetritis, 
and other uterine affections of inflammatory origin (Freund). Ergot in 
subacute or chronic cases (W). Creosote, as a disinfectant, especially in 
puerperal metritis (W). Heat, to the feet, and by large poultice to the abdo- 
men; also hot water vaginal injection literally for hours if possible, repeated 
at short intervals; the only means of aborting an attack of cellulitis (E), 
which is the condition generally present in cases which are usually supposed 
to be acute metritis (Playfair). Turpentine, as hot epithems; few measures 
are more generally serviceable (Wa). Linseed Poultices, produce great 
relief to pain and favorably affect the course of the disease (Duncan). 
Leeches, to the hypogastric region, may be required in patients of full 
habit. [Compare Endometritis, Puerperal Fever.] 

Metrorrhagia. 

Cotarnine is a powerful uterine hemostatic and is efficient in all forms of 
uterine hemorrhage, in doses of gr. j of the Hydrochlorate every 2 or 3 hours 
(Boldt) ; efficiently controls the hemorrhage in all cases where there is absence 
of tumors, secundines, etc., in the uterus (Berger). Hydrastinine is a power- 
ful uterine vaso-constrictor, and is efficient (see under Menorrhagia). 
Ergot in full doses every hour is the most valuable remedy (R). Iodipin 
hypodermically, proved curative in a severe and long-standing case of uterine 
hemorrhage (Keith). Atropine hypodermically, in profuse metrorrhagia 
after abortion or of obscure origin; may require as many as four injections 
to cause cessation of the flow (Squibb). Salipyrin, in doses of gr. xv thrice 
daily, employed in fifty cases of metrorrhagia from various causes, with best 
results in cases following labor or abortion (Orthmann). Ipecacuanha, 
possesses considerable energy in arresting flooding (P) ; in full emetic doses, 
gr. xx in evening, followed by an acidulated draught in the morning (Wa). 
Hamamelis, when persistent oozing (R). Cannabis, often arrests metror- 
rhagia especially when at climacteric; tincture gtt. v-xx ter die (P); has had 
extraordinary success in number and rapidity of cures (Wa). Sulphuric 






MILIARIA — MILIARY FEVER. 



743 



Acid, sometimes very effective, especially when due to fibroid or polypus; 
Ac. Sulphurici Dil., gt. v-xx, well diluted (B) ; long and extensively prescribed 
(Wa). Cinnamon, is used with good effect (P); has specific action on the 
uterus (T). Magnesium Sulphate, often succeeds (B). Calcium Chloride 
in doses of gr. vij every 2 hours, increases the coagulability of the blood and 
is efficiently hemostatic (Gross). Savin in doses of gtt. v-x of the tincture 
in cold water every half -hour (P). Iron, the styptic preparations as injec- 
tions into the uterus (B) ; especially Monsel's solution [see under Menorrha- 
gia]. Ice applied to the abdomen or within the uterus (B) ; Ice in every way 
the first thing to try (Wa). Rest, absolutely necessary. Dry Cupping, 
over the sacrum, is found useful (R). [Compare Menorrhagia, Uterine 
Tumors.] 



T$. Fluidextr. Ergotae, gss. 

Fluidextr. Senec. Aur., 

Fluidextr. Viburn. Prunif., aa 5j., 

01. Myristicae, ttjjxx. 

Syr. Simplicis., q. s. ad 5 vj. 

M. Sig. — A dessertsp. every \ hour until 
relieved then reduce the dose. Keep the 
head low, and apply cold over the hypogas- 
trium. 



1$. Cotarninae Hydrochl., gr. xv. 

Ergotini (Bonjean), gr. xxx. 

Ext. Gossypii, gr. xxx. 

M. fiant capsulae no. x. Sig. — One cap- 
sule every 2 or 3 hours. 



1$. Cotarninae Hydrochl., gr. x. 

Fluidextr. Ergotae, 5iv. 

Elix. Simplicis, q. s. ad §ij. 

M. Sig. — 3ij every 2 hours. 



Miliaria — Prickly Heat. 

Frequent bathing is necessary and of more value if Bicarbonate of Soda, 
2 to 4 ounces to the tub of water, is added; in place of this Bran, a teacupful 
in a salt bag, may be used. The parts affected must be thoroughly dried 
by Patting, not by rubbing, before any form of treatment is applied. As 
a rule Dusting Powders and Lotions are of more value than ointments. 
The Bismuth-Lead Lotion (page 656) is of great assistance in treating this 
disease. Boric Acid in saturated solution is of particular value, especially 
if Phenol is added. Calamine and Zinc Oxide Lotion (see Eczema) is of value 
at times. Lysol, \ to 1 ounce to the tub of water will relieve the itching 
temporarily. Phenol, 5 minims to the ounce of water will relieve the itch- 
ing. Salicylic Acid, 10 grains to the ounce with equal parts of Powdered 
Starch and Boric Acid is one of the best dusting powders at our command. 
Starch, a teacupful to the basin of water, sopped freely over the body, will 
act as a very efficient temporary relief. Talc is useful when incorporated 
with other drugs as a dusting powder, though it possesses little remedial 
power of itself. 

Miliary Fever. 

Aconite, for the hyperpyrexia (R, P). Cooling Drinks, purgatives and 
antiphlogistics, in mild cases; malignant ones sometimes occur, and are 
dangerous (A). Lime-water applied by sponging, is very useful; or a lotion 
of Zinc Oxide suspended in Lime-water, gr. xl to § j, painted on the affected 
parts of the skin, and permitted to dry thereon (E. Wilson). Miliary Fever, 
the Sweating Sickness, is an infectious disease of doubtful nature, which 
was very fatal in England in the 15 th and 16th centuries, but of late years 
has been confined entirely to certain districts in France and Italy (O) . 



744 - MUSCLE VOLITANTES MYELITIS. 

Muscae Volitantes. 

Muscae Volitantes are due to shadows cast on the retina by fibrillar 
floating in the vitreous body, and are most visible to myopic persons; they 
do not merit attention unless very abundant, or steadily increasing (C). 
Digestive disturbances should be corrected. Rest of the eye necessary. 
Neutral-tint glasses may be worn to render the muscae less visible, if trouble- 
some. They have no clinical importance, and probably depend on minute 
remains of the embryonic tissue in the vitreous humor. Those annoyed by 
them should be recommended not to look for them, as when they do so others 
are apt to become visible (Swanzy). 

Myalgia. 

Arnica, the best agent for contused muscular fibre; also for shake, con- 
cussion, shock; TTlv-x every 2 or 3 hours in water (P) ; a few drops of tincture 
internally, removes stiffness, after packing with cold, wet sheet (R) . Cimici- 
fuga, often succeeds wonderfully, as often fails; no indications for its use 
(B); general bruised sensation (R). Ammonium Chloride, in 10- to 20-grain 
doses, the most efficient remedy (Anstie) ; is effective (R) ; when due to cold 
or a bruise. Salicylates, in rheumatic and gouty cases. Potassium 
Iodide in old cases due to rheumatism. Potassium Citrate or Acetate, in 
doses of gr. xx, with plenty of water, may be used with benefit. Veratrine, 
the ointment externally may control (B). Belladonna, as liniment, is often 
successful (R). Gelsemium, frequently cures, but large doses are neces- 
sary, Tflv-xx of the fluid extract every 3 hours (B). Coca, to relieve the sense 
of fatigue (P). Iodine, ointment for pain and tender muscles of the chest, 
when skin may be pinched without pain (R). Chloroform Liniment, with 
friction, often affords great relief (Wa). Firing, sometimes very beneficial 
(B). Packing with dripping wet sheet (R). Counter-irritation, by firing, 
aquapuncture, acupuncture (B). Massage is highly efficient, requires no 
particular skill, a good rubbing is all that is necessary. Electricity, the 
constant current (B). Baths, Turkish, in aching muscles, from over-exertion 
(R). Poultices, very hot, followed by applications of lint and oilskin (R). 
Rest, is the remedy, of course (Wa) ; rest and support to weak muscles are 
important until they regain tone; especially in painful muscular affections 
following prolonged or excessive exertion, or in the soreness or stiffness 
which occurs during convalescence from any long illness, or accompanying 
general debility, and generally better after repose, but increased with fatigue. 
[Compare Lumbago, Pleurodynia, Rheumatism muscular.] 

Myelitis. 

Belladonna, is decidedly effective, especially when disease is brought on 
by external violence (P). Ergot, most successful: large doses are necessary 
(B) . Electricity, in chronic, not in recent form (B) . Silver Nitrate in chronic 
inflammations of the cord, is still employed but is of doubtful value (W). 
Phosphorus is often of value in myelitic paraplegia from excessive venery 
( W) . Sodium Phosphate hypodermically, was employed with great benefit 
in a case of syringo-myelitis. Electricity, should be strictly forbidden until 



MYXEDEMA — NAUSEA. 745 

the inflammation has subsided (W). Water-cure, Ice-bag, to spine, feet in 
hot water; or better, hot douche to spine (B). Cold, externally, by ice-bags 
along the spine, with cupping or leeching if much localized pain or tenderness ; 
spoon feeding and a sparing amount of stimulants, also copious warm ene- 
mata to relieve the bowels and act as derivatives. Little, if anything, is 
to be done with drugs. Posture should be prone, or on side; absolute rest 
(Bastian). No drugs have the slightest influence upon an acute myelitis, 
and even in subjects with well-marked syphilis neither Mercury nor Iodide 
of Potassium is curative (O). [Compare Locomotor Ataxia, Meningitis 
Spinal, Spinal Paralysis.] 

Myxedema. 

Thyroid Extract, or the thyroid gland itself, fed to the patient daily, is 
dow the recognized treatment, and produces the best results. Tonics, 
as Iron, Arsenic and the Hypophosphites, with diaphoretic drugs, as Pilo- 
carpus, and daily baths, formed the early treatment of this affection (Ord). 
Exposure to Cold, aggravates all the symptoms and causes great weakness 
and depression, even though the patient is not conscious of any discomfort 
from the impact of cold air, by reason of the thickened and insensible condi- 
tion of the skin. Even while reaping so great a benefit from the use of the 
thyroid, we are still bound to shield our patients from exposure to cold (Ord). 

Nails, Ingrowing. 

Alkalies, The Liquor Potassii Hydroxidi, 3 ij to 5 vj of water, on cotton- 
wool, applied to margin of nail at ulcerated surface, to soften the nail in 
ingrowing toenail (B). Glycerin, or Silver Nitrate, on a fold of lint, to the 
ulcerated surface (C). Picric Acid in saturated solution freely, after remov- 
ing the offending corner of nail is very efficient (Milward). Lead Car- 
bonate, a piece softened between the fingers, and applied as plaster beneath 
the fungous cushion, cures in a few days (Tr). Operation, a portion of the 
nail, together with its root, should be cut away. This can be done under 
local anesthesia. 

Nausea. 

Creosote is employed as a nerve paralyzant in nausea due to excessive 
irritability (W) ; also in reflex nausea. Phenol is equally efficient, acting in 
the same manner, but must be used with more caution. Hydrocyanic. 
Acid, TUi-iv of the dilute acid in §j of water, is useful (Beale). Ammonia, 
TTliij-iv of Aqua Ammoniae in a winegl. of water when the feeling of nausea 
is most troublesome, may cure the ailment (Id). Hydrargyrum, a small 
dose of Blue Pill or Calomel will sometimes cure very obstinate nausea, 
although many other remedies have failed (Id). Cocaine, a 2 per cent, 
solution sprayed high into the nasal passages, so as to reach the terminal 
filaments of the olfactory branches, is specific against nausea, its influence 
lasting several hours (Ingraham). Chloroform, TTlij-v on sugar, will relieve 
some kinds of nausea (B). Chloretone gr. iij every J hour for 2 or 3 doses, 
is very efficient in the sickness accompanying menstruation (Hutton). 
Ipecacuanha, has no rival in sickness of pregnancy, scarcely less useful in 
that of chronic alcoholism; very small doses, gr. 3^ of powder or TTL j of wine 
(P); TTlj of wine in 3j of water every fifteen minutes, in sick stomach of 



746 NERVOUS AFFECTIONS. 

nervous origin as that of pregnancy, is very successful treatment (W). 
Lime-water is valuable in nausea due to acidity of the stomach. JEther, 
the Compound Spirit, is efficient in the nausea due to excessive use of tobacco. 
Calumba, in nausea of languid stomach with flatulence has considerable 
reputation (P). Cinnamon or other aromatics, cloves, Nutmeg, Pepper, 
Peppermint, oil of Pimenta, etc., relieve nausea (P). Tartaric Acid, as 
effervescing draught, with a few drops of Tinct. Opii, Tinct. Calumbae, or 
Dilute Hydrocyanic Acid added, when from morbid gastric irritation (Wa) . 
Bismuth Subnitrate, or the Liquor Bismuthi, when the salt in substance 
disagrees, is a remedy of established value in nausea and vomiting arising 
from gastric disorders; may be combined with Hydrocyanic Acid (Wa). 
Olive Oil given immediately after anesthesia in 30 cases, checked or pre- 
vented nausea in all except one (Graham). Counter-irritation, by a mustard 
poultice applied over the region of the stomach and liver for 20 minutes 
every 3 or 4 days (Beale). Heat, hot water on spongio-piline, worn for an 
hour or two, will frequently be found efficacious (Id). Cold, by a com- 
press or ice-bag, over the stomach, is often very useful. [Compare Dyspepsia, 
Headache bilious-sick, Sea-sickness, Vomiting.] 

Nervous Affections. 

Nux Vomica, in one-drop doses of the tincture every 5 minutes, is promptly 
efficient in relieving many affections of reflex neurotic origin, as cough, 
dyspnea, syncope, palpitation, flatulent dyspepsia, eructations, especially 
when occurring in hysterical subjects (Macfarlan). Arsenic, of especial 
value in nervous affections resulting from malaria, in which large doses are 
required; Tfl.x of Liq. Arsenicalis, increased to TTlxxx thrice daily (Wa). 
Asaf oetida, is a remedy of much value in nervous affections connected with 
uterine derangement, also in dyspeptic hypochondriasis and other nervous 
affections; may be combined with bitter tonics and mild aperients (Wa). 
Potassium Bromide, takes precedence in epilepsy, epileptiform convulsions, 
hysterical convulsions and spasms, tetanus; is of great value in chorea, in- 
sanity, acute mania, insomnia, delirium tremens, some forms of neuralgia, and 
the numerous symptoms of vaso-motor disturbance, such as numbness, cold- 
ness, deadness, pricking sensations, indefinable but distressing sensations 
in abdomen, hypogastrium or epigastrium; feelings similar to rigors, with 
anxiety, palpitation or fluttering of the heart — all due to interference with 
the local circulation (Reynolds). Valerian and Valerates, are thought to 
exercise some special influence over nervous affections, especially the Am- 
moniated Tincture of Valerian, from which every good that can be expected 
from the valerates will be more certainly obtained (W). Caffeine, is of 
signal value in neuralgia, hemicrania and other nervous affections (Shaf ter) ; 
grain doses in solution hypodermically afford great relief in dorso-intercostal 
neuralgia attending shingles, and insomnia (Anstie). Cocaine is a powerful 
nerve stimulant, destroying the sense of fatigue, and often evincing marked 
analgesic power in neuralgiae; is effective in melancholia and hypochondriasis, 
also locally in nerve pain over a limited area; it acts as an excitant upon the 
central nervous system (R). Opium, is a remedy of marked value in in- 
sanity, melancholia, mania, and all nervous affections accompanied by pain 
(W) ; gives general repose to both the body and mind, and produces marked 
improvement in melancholia and despondency (R). Santonin, in convul- 






NERVOUSNESS. 747 

sions, epileptiform seizures, and affections regarded as choreic, the result 
of reflex irritation from worms (Wa). Phosphorus, of occasional utility in 
affections of the nervous system induced by mental exertion or over-excite- 
ment; the danger from use is its liability to produce fatty degeneration of 
the internal organs (Wa). Sodium Phosphate, hypodermically, employed 
with great benefit in a case of syringo-myelitis, also in one of unilateral abasia- 
astasia: is considered by Luton to be possessed of reconstructive power 
equal to that of the animal extracts. Physostigma, given for six months or 
longer, in small doses, gr. T V of the extract every 3 hours, is useful in many 
nervous affections, as locomotor ataxia, writer's cramp, and paraplegia 
due to myelitis (Murrell). Shower Baths, cold, are often beneficial in 
nervous affections unconnected with disease of the brain. [Compare 
Chorea, Diabetes, Epilepsy, Headache nervous, Hemicrania, Hemi- 
plegia, Hysteria, Insomnia, Locomotor ataxia, Mania, Melancholia, 
Myelitis, Nervousness, Neuralgia, Neurasthenia, Neuritis, Paralysis, 
Paralysis agitans, Spinal paralysis.] 

Nervousness. 

Opium, calms the nervous system and gives general repose to both body 
and mind (R); small doses, identity of drug to be carefully concealed lest 
the opium-habit be formed. Antipyrine, is efficient for nervous irritation. 
Strychnine, affords relief in functional irritability of the nervous system, 
manifested by restlessness and wandering neuralgic pains (B); especially 
useful as a tonic in nervousness from over-use of tobacco (H). Potassium 
Bromide, especially for women who are despondent, irritable, and sleepless, 
from overwork, grief, and worry; often connected with migraine (R); gr. 
ss-j of any Bromide every } hour, is very efficient for the nervous disturb- 
ances of children (Smith). Bromipin gives good results in nervous insomnia 
and various other conditions due to nervous excitement (Frieser). Valerian 
is extremely useful as a sedative to reflex excitability, calms nervousness, 
does much good in fevers where restlessness, fidgets, anxiety (P). Camphor 
is very useful (W); is a powerful reducer of reflex excitability (P). Chloro- 
form, the Spirit internally (R). Chloral, in great restlessness and debility 
(R). Aconite, gtt. j of tinct. at bedtime, repeated if needful, for restlessness 
and "fidgets" of men as well as women (R). Caffeine, for restlessness due to 
great lowering of nervous power (P). Musk, serviceable in nervous affec- 
tions "when due to uterine derangement (Wa). Sumbul, often invaluable 
in restlessness of pregnancy; TTlxxx-xl of tinct. with a little Chloric Ether as 
a draught (P). Water, warm sponging to induce sleep and calm rest- 
lessness in convalescence; also, cold sponging (R). [Compare Insomnia, 
Irritability.] 



]$. Strychninae Sulphatis, gr. j. 

Quininae Sulphatis, 5 j- 

Tinct. Ferri Chloridi, 5 v. 

Ac. Phosphor. Dil., 

Syrupi Limonis, aa gij. 

M. Sig. — A teasp. in water thrice daily. 



]$. Ammonii Valeratis, 



]$. Potassii Bromidi, gj. 

Fluidextr. Guaranae, § jss. 

Syr. Tolutani, § iij. 

Aquae, q. s. ad gvj. 

M. Sig. — Teasp. to a dessertsp. three or 
four times daily. To relieve nervousness. 



fy Extr. Sumbul, 

Ferri Sulphatis, aa gr. xx. 



Quininae Valeratis, Asafcetidae, gr. x 



Ferri Valeratis, aa gr. xx 

M., fiant pilulae no. xx. Sig. — One or 
two pills thrice daily. (Goodell.) 



Arseni Trioxidi, gr. ss. 

M., fiant pil. no. xx. Sig. — One pill 
thrice daily, after meals. (Goodell.) 



74§ NEURALGIA. 

Neuralgia. 

Antipyrine, is prescribed in all forms of neuralgia (M) ; is highly efficient 
in neuralgia of the 5 th nerve associated with neuritis (B). Acetanilid, is 
used with success in facial and intercostal neuralgias (M); is highly useful 
against pain due to inflammation of nerves (B). Acetphenetidin, is especially 
useful in the fugacious and variable neuralgias so common in the hysterical 
and neurotaxic (M) : of the three drugs named Acetphenetidin is the safest 
and most efficient in doses of 8-10 grains. Salipyrin has been employed with 
excellent results; a dose of gr. viij being often sufficient. Phenocoll, is used 
successfully, especially for the neuralgic pains of epidemic influenza (grippe). 
Salol, is very efficient in some forms. Salicylates, in large doses, cured a 
case of tic douloureux of 12 years' standing (Dercum). Saloquinine in 
supraorbital and trigeminal forms, gr. xxx given 4 hours before the time of 
expected attack to prevent recurrence (Tauszk). Acid Acetyl Salicylic, or 
so-called Aspirin, is an excellent remedy (Gorges) ; of service in nervous as well 
as rheumatic types (W). Opium, internally, or Morphine hypodermically, 
in the vicinity of the affected nerve, the best treatment; caution! morphine- 
habit (B) ; gr. ^V to j often relieves and frequently cures after a few repeti- 
tions (P) ; no remedy promises more speedy and permanent relief than Mor- 
phine by subcutaneous injection in sciatica, lumbago, tic douloureux and 
other neuralgic affections (Wa). Heroin is efficient in various neuralgic 
affections as a palliative analgesic. Aconite, when arterial excitement 
(B); in congestive neuralgias, has important role (P); as ointment or lini- 
ment, especially when fifth nerve affected; also in neuralgic headache (R); 
a remedy of great value (Wa); a perfect physiological remedy against 
neuralgia, especially those forms which are based on congestive or subinflam- 
matory affections; but its action is often slow, so that Morphine must be 
given with it as a palliative. Aconitine, with Veratrine as an ointment 
locally, a good application (Da C); internally the best agent of all in essential 
neuralgia; should be combined with Quinine in intermittent forms and those 
which resist quinine alone. Veratrine as ointment in facial neuralgia and 
sciatica (R); is frequently of much benefit (P). Atropine hypodermically 
in the vicinity of the nerve (B); of especial utility in tic and sciatica, also 
in peri-uterine and dysmenorrheal forms (B); in spinal and intercostal, also 
as liniment or ointment in facial neuralgia (R). Belladonna gr. ij of the 
extract every hour until giddy, then a less dose continued for several days 
(Tr). Quinine large doses, gr. v-xx in sherry, just before the attack in 
periodical neuralgia, whether malarial or not; useful also, in small, frequently 
repeated doses, in other types, especially of supra-orbital nerve (P); has 
selective action upon supra-orbital form (Spender). Arsenic, cures by its 
influence on bodily nutrition; directly so in neuralgia of malarial origin, 
though inferior to Quinine (B); in various neuralgias, also in angina pectoris 
(R). Adrenalin as ointment or solution, 1 to 1000, Tflj-ij, applied along the 
course of the nerve, gave remarkably efficient results in many cases of 
superficial neuralgia (Carleton). 

Nux Vomica, is most useful in visceral neuralgias, as gastralgia, hepatal- 
gia, etc., the tincture with carminatives in the former affection; or Strychnine, 
gr. y^-q to -fa twice or thrice daily; in all forms of neuralgia this remedy 
should be used in small doses (P) ; large doses of Strychnine hypodermically, 
with rest, give good results (Dana). Phosphorus, gr. fa every few hours, 
has made very effective cure (B); gr. y^ to - X V every 3 hours; very useful in 



NEURALGIA. 749 

all forms, especially when uncomplicated (R) ; always a good remedy, except 
for cases due to cold or inflammation, and those not depending on depraved 
nutrition (H). Physostigmine, very efficient in neuralgia of the eyeball, a 
solution of gr. ij to the § by instillation. Cannabis, |-| gr. doses of extract 
2 or 3 times a day; especially for neuralgic headache (P); found useful (R); 
Cannabis and Cimicifuga, for gouty and rheumatic subjects (0). Iron, when 
from anemia; tincture of the Chloride, TTlxxx-xl ter die, also chalybeate 
waters (B) ; only moderate doses required (R) ; in chlorotic subjects, of whom 
nearly all will have neuralgia (Tr). Iodides, for neuralgia of fifth, dependent 
on syphiloma of the nervous system, pain, nocturnal chiefly (B). Bromides, 
benefit some kinds, especially ovarian (B); Potassium Bromide occasionally 
relieves (R). Bromipin is often effective and has decided advantages over 
the ordinary bromides (Losio). Ammonium Chloride, half-drachm doses in 
facial and other neuralgiae, is much used (R) ; a very efficient and diffusible 
stimulant, gr. xx~5j at first, repeated every hour during the attack (H). 
Chloroform, as anesthetic to relieve pain, is occasionally useful locally, also 
as spray for uterine neuralgia (R) ; Tflv-xv of pure Chloroform by deep injec- 
tion into vicinity of affected nerve, a very efficient method of dealing with 
long-standing cases (B); used in one case it caused symptoms so severe as to 
imperil the life of the patient ( W) . Croton-chloral is very effective in tri- 
geminal neuralgia (Liebreich) ; has failed to sustain itself and is but little used 
( W) . Chloral-camphor painted over the painful surface (R) ; has been com- 
mended (W). Caffeine hypodermically is analgesic (Mays); has been found 
useful in cervico-brachial neuralgia (P). 

Cocaine, as a hypodermic injection, a 4 or 5 per cent, solution is very 
effective if administered in the vicinity of the aching nerve (R) ; also by 
instillation in neuralgia of the eyeball, and whenever it can be applied to the 
mucous surface in the vicinity of the pain. Guaiacol, a few drops rubbed in 
gently, gives immediate relief in ciliary neuralgia (Brodnax). Phenol, pure 
by subcutaneous injection, used in 600 cases, many obstinate ones were 
effectually controlled and cured (Bacelli). Ichthyol hypodermically is 
analgesic and valuable in neuralgic pains due to inflammatory exudations 
(Damiens) ; externally and internally in intercostal form (Schmitz) ; most 
successful in chronic neuralgia of bones, muscles and joints accompanied by 
difficulty in moving (Nussbaum). Amyl Nitrite, inhaled in dysmenorrheal 
neuralgia (B) ; and when of 5 th nerve (R). Nitroglycerin, has often afforded 
great relief (Wa); in the minor form of trigeminal neuralgia, larger doses 
may be tried (O) . Osmic Acid, a one per cent, aqueous solution with glycerin 
to prevent change, of which 5 to 10 drops hypodermically, has made strik- 
ing cures of inveterate neuralgiae, with no ill effects resulting (Shapiro); if 
employed at all it should be injected directly into the exposed trunk of the 
affected nerve (Wright). Formic Acid gtt. v of a 1 per cent, solution, by 
deep injection alongside the nerve, preceded by gtt. viij of a 1 per cent, solu- 
tion of Cocaine, is remarkably efficient (Couch). Gelsemium, successful in 
neuralgia of 5th (B); especially dental branches (R); of value in trigeminal, 
ovarian (W) ; in suitable cases small doses answer as well if not better than 
large ones (Pf); Tfl.iij of the tincture every § hour often succeed miraculously 
with no ill results in neuralgiae about the head and face (Smith) ; no better 
remedy in tic douloureux, but must be given in large doses, Tfl.x-xv of a strong 
tincture or fluidextract (H); is highly recommended (O). Sumbul, for 
Certain types, is of more value than any other remedy; facial, sciatic, or 



75° NEURASTHENIA. 

ovarian neuralgias, in women of nervous constitution, often yield to it at 
once (P). 

Peppermint, the Oil, painted over the part in facial neuralgia (R) ; espe- 
cially the Chinese oil, which contains a large excess of Menthol, a very useful 
application in superficial neuralgias (W). Turpentine, has cured tic doulou- 
reux and sciatica (B); often of wonderful service (P). Potassium Chlorate, 
for facial neuralgia (B). Alcohol, containing much volatile ether; care must 
be taken in prescribing it lest the habit be formed (R) ; 80 per cent, alcohol, 
1-4 mils by injection into the nerve, has cured many cases instantly 
(Kiliani); alcohol injections in the regions of the foramina, used in 10 cases 
with most excellent results (Leszynsky) ; in trigeminal form, 80 to 90 per 
cent, alcohol, with Cocaine to limit pain, injected locally with wonder- 
fully good results (Donath). Valerian, serviceable in facial neuralgia of 
hysterical type (P). Capsicum, a strong infusion on lint with gutta- 
percha (R). Ergot, much employed in visceral forms, especially gastralgia 
(P); is said to be useful (R). Counter-irritation, Mustard poultices in neu- 
ralgic pains (P) ; blisters to a posterior branch of the spinal nerve-trunk from 
which the painful nerve issues (Anstie) ; the thermo-cautery is invaluable, 
particularly in zona and the more chronic forms of neuralgia (O) . Wet Pack, 
is of great benefit, especially in sciatica. Intense Cold, produced by a spray 
of Ethyl Chloride, or concentrated Carbonic Acid gas, directed along the 
nerve from special apparatus, immediately relieves the pain, and usually 
cures ( Jacoby) . Galvanism of the affected nerve, one of the most important 
curative measures; a continuous current of 4 to 8 cells down the nerve gen- 
erally answers best, though some cases are helped more by a rapidly inter- 
rupted faradic current: Electricity is of no value in cases dependent upon 
organic lesions, and in any individual case is purely experimental (W). 
Roentgen Rays often relieve when the- trouble is not of central origin 
(Finzi). Injections of normal salt solution in the vicinity of the disturbed 
nerve are highly efficient (Schleich) ; the solution should be chilled before 
injection (Schlesinger). Diet, animal fats necessary, as cod-liver oil, butter, 
cream, in as large quantity as can be digested. Cod-liver Oil, when low 
nutrition, faulty assimilation (W). Rest often needed, with protection 
from cold and damp, also flannel clothing, bathing and shampooing. 
[Compare Gastralgia, Hemicrania, Hepatalgia, Otalgia, Ovaralgia, 
Sciatica, Tic Douloureux.] 



For Internal Use. 
fy. Tinct. Aconiti, 

Tinct. Colchici Sem., 
Tinct. Cimicifugae, 

Tinct. Belladonnae Fol.,. . .aa part, seq 
M. Sig. — 6 drops every hour until re- 
lieved. (Metcalf.) 



For Local Use. 

1$. Aconitinae (Duquesnel), gr. v. 

Veratrinae, gr. xv. 

Glycerini, 3ij- 

Cerati, 3vj. 

M. Sig. — To be rubbed over the part 
carefully avoiding any abraded surface. 
(Da Costa.) 

fy. Mentholis, gr. xlv. 

Cocainae Hydrochlor., . . gr. xv. 

Chlorali Hydrati, gr. x. 

Petrolati, 5v. 

M. ft. ung. Sig. — For local use. (Potter.) 

Neurasthenia. 

Ammonia, the Aromatic Spirit has proved very serviceable; §ss-j in 
water thrice daily (Wa). Arsenic, is often very serviceable; Fowler's or 
P earson's solution, in doses of TTtiij-v, in water, after each meal. Strychnine, 



NEURASTHENIA. 7 5 1 

a remedy of great promise, when combined with a rigid system of diet and 
mental discipline (Marshall Hall); slowly ascending doses of Strychnine for 
one or two years, sometimes give excellent results in chronic neurasthenia 
(W). Bromipin is recommended by various clinicians (W). Digitalis, as 
a general tonic when the circulation is feeble (W). Sparteine, a valuable 
sedative, when cardiac palpitation (Pawinski) . Phosphorus is frequently of 
service (W); its value is exaggerated (O); of occasional utility in nervous 
breakdown from over-study ( Wa) . Glycerophosphates are said to be more 
easily assimilated than phosphorus. Caffeine, gr. j or more in a cup of 
coffee, to relieve brain weariness and nervous exhaustion (Wa). Cocaine, 
in §-grain doses proves serviceable in nervous exhaustion (R); danger of 
cocaine-habit if identity known to the patient. Coca, as a stimulant has 
been used with benefit, but only for a short time, and acts deleteriously 
unless given in small doses (W). Ichthyol in doses of gr. v-x, when vaso- 
motor instability is a prominent symptom (Rankin). Musk is a valuable 
remedy, it stimulates the nervous centres when exhausted, without producing 
any very pronounced symptoms (W). Opium sometimes yields permanent 
relief, its prolonged use is never necessary (O); cautiously and secretly, lest 
habit be acquired. Nuclein, is useful in many cases (Vaughn). Electricity 
is often of signal service, chiefly for its suggestive influence on the patient's 
mind (Rankin). Hydrotherapy is indicated in nearly every case if it can be 
properly applied, especially the wet pack for the insomnia and the general 
condition (O). Much can be done at home, but a special sanitarium is 
necessary for systematic treatment (Id). Diet should be chosen from the 
most readily assimilable food, calling for a minimum amount of digestive 
work. As a rule, neurasthenics eat too much and drink too little; plenty of 
water, at least a liter and a half per day, is the best drink; it maintains the 
arterial tension, irrigates the tissues and assists the excretion of debris. 
Milk should be prohibited, also vegetable soups, peptones and extracts of 
meat. The albuminoid element of the food should not exceed one-fifth of the 
total (Vigoreaux). Counterirritation, the actual cautery along the spine 
has rendered excellent service in several cases of neurasthenia accompanied 
by neuralgia of the superficial branches of the spinal nerves; its action is 
doubtless often a mental one, and it renders the carrying out of the rest-cure 
more thorough than when attempted without something to enforce quiet. 
Rest-cure, with forced alimentation and systematic massage to keep up the 
muscles while holding the nervous system as inactive as possible, will do more 
than medicine in these cases. Many such will recover under the discipline 
and quiet of a hospital or sanitarium alone; while others are greatly bene- 
fited by removal from home influences and cares, and from association with 
certain persons who irritate them. [Compare Adynamia, Exhaustion, 
Gout, Hysteria, Spinal Irritation.] 

Tonic and Stimulant. 



Artificial Serum. 

1$. Sodii Phosphatis Pur., 5iij- 

Sodii Sulphatis Pur., gr. lxxx. 

Sodii Chloridi Pur., gr. xxx. 

Phenolis, Cryst., gr. v. 

Aq. Destil. Bullient., ad §iv. 

Dose, njjxv hypodermically. 

T%. Strychninae Acetatis, gr. j. 

Ac. Acetici Diluti, tt^xx. 

Alcoholis, 5ij- 

Aquae Destil., 3vj. 

Sig. — Ten drops thrice daily. {Hall.) 



. Tinct. Kolae, Bjss. 

Ac. Citrici, gr. xx. 

Sodii Arseniat., gr. j. 

Tinct. Cocas, q. s. ad giv. 

Dose, 3j at each meal. 



1$. Ac. Phosphorici DiL, 5 j. 

Elixir Calisayae (U. S. Disp.), § yj. 

Elix. Ammonii Valeratis, Bij. 

Glycerini, § iij. 

Vini Xerici, q.s. ad Oj. 

M. Sig. — 5j thrice daily. 



752 NEURITIS — NEVUS . 

Neuritis. 

Strychnine, internally, is of value, and may be given in increasing doses 
(0); hypodermically, in multiple peripheral neuritis, is of great advantage; 
no case remembered in which it failed to cause improvement (Walker). 
Acetanilid, is so effective that it seems to have specific action (B). Anti- 
pyrine and Salicylates, are recommended in the acute cases with fever (O); 
Salicylates in the rheumatic form (W). Saloquinin has been highly recom- 
mended (W). Aspirin is an excellent remedy in polyneuritis. Arsenic may 
be employed (O) ; Potassium Iodide and Mercury, if there is a history of 
syphilis (O). Aconite is sometimes useful in acute neuritis from exposure 
to cold (W). Atropine injected into the contracted muscle, is especially 
useful for the violent contractures and spasms of traumatic cases (W). 
Adrenalin, the Chloride in solution, i to 2000, applied to each painful spot, 
very effective in a case of neuritis of the palmar and plantar terminals, fol- 
lowing typhoid fever (Carleton). Counter-irritation, Blisters applied along 
the course of the nerve, are often of service; the actual Cautery is valuable 
in chronic neuritis (W). Stimulants should be interdicted in alcoholic 
neuritis (O). Massage is probably the most reliable means at our command 
in the later stages, when the atrophy is marked and the pains have lessened. 
Contractures may be gradually overcome by passive movements and ex- 
tension. The interrupted current is useful when the acute stage has passed 
(O). Phototherapy, the ultra-violet rays relieve pain in acute and chronic 
cases, and effect recovery in the acute ones (Rosenberg). [Compare 
Alcoholism, Beriberi, Neuralgia, Spinal Irritation.] 

Nevus. 
Naevus — Angioma; Naevus Vascularis; Birthmark. 

Carbon Dioxide Snow has almost entirely taken the place of Liquid Air 
and is of great value in nearly all forms of naevi, excepting the flat Port wine 
mark or so-called " strawberry" mark, in which the results, as a rule, are not 
so good. It can be obtained from the large cylinders which are used by the 
druggist in charging soda water tanks or in the small tubes which are used 
to inflate automobile tires. With a very simple apparatus, the snow can be 
collected, moulded and applied directly to the parts with a varying amount 
of pressure for 20 to 60 seconds. The results are frequently very brilliant 
and with little or no scar formation. Electrolysis was formerly used by 
many but Carbon Dioxide Snow and Radium have almost supplanted its 
use. Fulguration and Desiccation are producing very satisfactory results 
in the hands of experienced men and under a general anesthetic a large deep 
growth may be removed. Injections of Hot Water directly into the naevus 
have been found to be fraught with so much danger and uncertainty that they 
are very little used. Liquid Air was formerly used to a considerable extent 
but is very expensive, difficult to transport and requires great care in its 
application. Radium may be used, the tubes being strapped on for a 
varying length of time. Those who have used this method claim that the 
results are more satisfactory than with any other method as the scarring 
which is always a factor is very slight. Trichloracetic Acid applied with a 
finely pointed applicator or toothpick may be pressed into the growth, 



NIGHTMARE — OBESITY. 753 

producing a gradual obliteration of the dilated vessels. In cases with one 
or more large dilated veins, they may be exposed and sutured. 

Nightmare. 

Potassium Bromide, in nightmare of adults, and children's attacks of 
night screaming often associated with squinting; the digestive organs may 
also require attention (R). Camphor-water, a teaspoonful or two the most 
suitable medicine (H). Sleep, in abundance, may prevent nightmare (H). 
Diet, light; avoid late meals and indigestible food. 



Nodes. 

Mercury, the Oleate of Mercury and Morphine externally, is very valuable 
(R). Potassium Iodide, as ointment in conjunction with internal use, in 
syphilitic nodes of children; also in non-syphilitic periosteal thickenings 
(R); in syphilitic nodes it holds the first place, especially when pains are 
worse at night and increased by heat of bed (Wa). [Compare Exostosis, 
Periostitis.] 

Nymphomania. 

Hyoscine is useful in all cases of sexual excitement, through its influence 
on the spinal centres (W). Heroin is distinctly anaphrodisiac, and of value 
in various forms of sexual excitement (Strauss). Potassium Bromide, 
when from plethora; not useful when relaxation, or from cerebral lesion (B); 
large doses required, at least gr. xx ter die (R); an abundance of evidence 
testifies to its value (W). Tobacco, to nausea, effectually cures, but is 
horribly depressing (B). Camphor, in considerable doses said to control 
inordinate sexual desire (R) ; at present not much relied on (Wa) . Lupulin, 
seems worthy of fair trail (Wa). Sulphur, or dilute Sulphuric Acid inter- 
nally, when arising from hemorrhoidal congestion, not an infrequent cause 
(Wa). 

Obesity. 

Thyroid Extract will reduce weight temporarily more certainly than 
any other drug, but the system soon becomes accustomed to it, and then the 
patient is likely to relapse (W); has been employed in several cases with 
uniformly good results ; in one reported case small doses of this extract with 
Quinine, Theobromine, and a course of mineral water, produced a loss of 
from 2 to 6f pounds weekly. Vinegar, only successful at expense of serious 
injury to the body (R). Saccharin as a sweetening agent, is free from 
the objections to sugar (W.) 

Banting Dietary is alone sufficient to improve the condition; its chief 
feature is the exclusion of the two elements, starch and fats, from the food; 
therefore bread (except toast), or the crust of a common loaf, potatoes, sweet 
roots, butter, sugar, cream, and alcoholic beverages, should be avoided. 
In one year, on this diet, Mr. Banting reduced his weight 46 pounds, and his 
girth about 12 inches; at the same time, his numerous corporeal infirmities 
were greatly mitigated or altogether removed; but it cannot be recom- 
48 



754 ODONTALGIA. 

mended indiscriminately. This was the method of Hippocrates, avoiding 
all fats, starches, and sugars; in fact, all roots or vegetables which grow under- 
ground. Schweninger or Oertel method is similar, using chiefly albuminous 
food, excluding fat and carbohydrates, limiting the fluids drank, especially 
at meals, and enforcing exercise. Meat Diet, very successful in 42 cases, the 
diet being confined to rump-steak, hot water and codfish, for 14 days, abso- 
lutely excluding everything else (Smith). Exercise, daily, in the open air, 
is necessary, and if carried on systematically is the most efficient and least 
injurious method of reducing an excess of adipose tissue. Hydrotherapy, 
Using the electric cabinet for sweat baths followed by a needle bath and a 
vigorous massage four times weekly will aid considerably in reducing the 
weight. [Compare Abdominal Plethora.] 

Odontalgia. 

Sodium Bicarbonate in solution on plugs of cotton in painful cavities, or 
applied to the gums, to appease agonizing toothache (Duckworth). Sodium 
Salicylate, gr. xv every 4 hours, is highly efficient for toothache started by 
taking cold, also for the periostitis in which the tooth becomes loosened and 
projects so as to be exquisitely tender when eating (Coley); may be given 
with the utmost confidence in toothache due to periostitis in gouty subjects 
(Haig). Methyl Salicylate locally to the face over the painful tooth and 
its roots, promptly relieves and removes such irritation, in many cases ob- 
viating the necessity for using salicylates internally (Id). Aconite, as oint- 
ment or liniment for facial neuralgia due to diseased teeth, will succeed 
quickly if at all (R, Wa). Arsenic, as escharotic to destroy pulp; when used 
for pain may be mixed with Opium; it sometimes at first aggravates pain 
(R, Wa) ; a very minute quantity is efficient to devitalize the nerves and is 
practically painless. Cocaine in 4 per cent, solution on cotton applied to a 
cavity causes instant relief. Chloral-camphor has been recommended (W) ; 
equal parts of Chloral and Camphor rubbed together and placed in the pain- 
ful cavity (R). Creosote mixed with Tannic Acid or Opium or Chloroform, 
and placed in the cavity of a decayed tooth, will often given relief (R). 
Guaiacol, a few drops rubbed into the gum gently, gives immediate relief 
(Brodnax) . Oil of Cloves applied on cotton in the cavity (P) ; will frequently 
stop toothache (W) ; Chloretone, dissolved in Oil of Cloves and applied on a 
pledget of cotton, is a good application. Tannic Acid in ethereal solution, 
is a good application to a carious tooth (B). Phenol pure, with an equal 
part of Collodion, as jelly for the temporary filling of a decayed tooth (R). 
Opium mixed with Tannic Acid or Creosote, and inserted into the cavity 
(R). Coniine in alcoholic solution inserted into cavity (R). Staphisagria, 
the alcoholic solution dropped into the cavity (P). Alum, a solution in 
Nitric Ether, 5ij to 3vij, is said to be an effectual application (B); Alum 
and salt powdered and placed in the cavity, excellent when nerve exposed. 
Xanthoxylum, a domestic remedy (B). Capsicum, a strong infusion on lint 
(R). Gelsemium, useful in some forms (R). Zinc Chloride, to destroy 
exposed painful pulp (R). [Compare Gums, Teeth.] 

1^. Camphorae, I 1$. Creosoti, ttjjxv. 

Chlorali Hydrati, 01. Caryophylli, 3ss. 

Phenolis, 01. Menth. Piperit, 5 j : 

Glycerini, aa part. seq. j Camphorae, 5ijss. 

M. Sig. — To be applied on cotton after Alcoholis, q. s." ad gij- 

cleaning the cavity. (Brodnax.) M. Sig. — Toothache Drops. 



ONYCHIA AND PARONYCHIA — OPHTHALMIA NEONATORUM 755 

Onychia and Paronychia. 

Silver Nitrate, a strong solution in Nitrous Ether, painted over the 
adjacent tissue, will abort if applied early (B); frequently causes resolution 
of the inflammation (Wa). Lead Nitrate, dusted over night and morning 
(R); relieves pain and hastens healing process (B). Turpentine, applied 
on a piece of lint or other absorbent material, stops the pain at once, and 
seems to abort the felon. Mercury, as ointment, for 10 minutes in every 
hour; poultices in interim (R). Corrosive Sublimate, and Zinc Sulphate, 
equal parts, intimately mixed, and sprinkled thickly over the diseased surface 
in onychia maligna, covered with a pledget of lint wetted with Laudanum, and 
not removed for 8 or 10 hours; gives pain for an hour, but results in separa- 
tion of a slough, leaving a healthy granulating surface behind (Geo. B. Wood). 
Arsenic, gr. ij ad 5 j Adipis, as ointment, almost specific in onychia maligna 
(Wa). Tartar Emetic, will shorten course and render it milder (R). Iodo- 
form, oint. or powder dusted on (B); or i part to 9 of Ether applied by a 
dropper, in syphilitic onychia (Fox). Iodine, a strong alcoholic solution 
locally will often subdue the disorder (Wa). Chloral, a solution locally, 
an antiseptic and to promote healing (B). Sodium Chloride, common salt 
roasted until the chlorine is driven off, equal parts of this, Castile Soap and 
Venice Turpentine, as a poultice, is a very efficient application. Phenol 
pure, to benumb surface during incision (R) ; which should be carried down 
to the bone, especially in tendinous whitlow (D). Cocaine, hypodermically, 
will accomplish the local anesthesia more thoroughly if delivered deeply into 
the tissue. Ichthyol in 50 per cent, ointment rubbed in, has arrested several 
cases in the beginning (Gadde). Picric Acid in saturated solution on cotton 
to the bottom of the cavity, is very effective in perionychia affecting the root 
of the nail (Milward). Glycerin as the Cataplasm of Kaolin, an excellent 
application for a felon. Heat, by poultices, is a very beneficial application. 
In Opening a felon avoid the lines of the arteries on the sides of the fingers, 
and that of the flexor tendons, which is the median line on the palmar sur- 
face; the incision should be made midway between these lines. If the sheath 
of the tendon be opened the tendon may slough, and the finger be rendered 
useless (Ashhurst).' Removal of the nail may be necessary in obstinate 
cases of onychia, the raw matrix being dressed with powdered Lead Nitrate. 
[Compare Nails, ingrowing]. 

Ophthalmia Neonatorum 

Treatment is similar to that employed in adult gonorrheal conjunctivitis. 
Iced Compresses are very useful at the start, although care must be exercised 
not to use them too continuously. Hot Compresses may be substituted if 
there is corneal infiltration. Frequent Irrigation is most important, and for 
this purpose, Boric Acid Solution, Mercuric Bichloride (1-10,000) Normal 
Salt Solution, Potassium Permanganate (1-500), sterile water and other 
cleansing and antiseptic solutions may be used. Argyrol (20 per cent.) is 
of value, 3 drops being instilled in the eye every two or three hours. Silver 
Nitrate (1 per cent.) may be applied to the everted lids once daily, and any 
excess solution neutralized by salt solution, and slough removed. Atropine 
(1 per cent.) must be used if the cornea becomes infiltrated. Glycerite of 
Tannin (20 per cent.) may be applied in the later stages. The general 



75 6 OPIUM HABIT. 

health of the infant should receive attention. Isolation and Prophylaxis 
are very important and the physician and attendants must take precautions 
to protect their own eyes during examination and treatment (see Conjunc- 
tivitis, gonorrheal). The treatment of corneal complications is that of 
infected corneal ulcer (see Cornea, Ulcer of). 

Opium Habit. 

There are two plans of treatment which have found general acceptance. 
These are described by Dr. Hare as follows: "The first of these is the 
gradual diminution of the morphine so that at the end of three or four 
days, or a week, none of the drug is permitted. If this method is carried 
out the patient usually develops after a few days, or sooner, great restlessness 
and irritability, not infrequently active purging, and profound mental and 
physical depression. Cramps in the extremities also add to the suffering. 
Under these circumstances it is necessary to support the patient by the use of 
Hot, Stimulating Foods, such as broths highly seasoned with pepper and salt, 
the use of Digitalis and Strychnine if the circulation fails, and the employ- 
ment of Hyoscyamus or Hyoscine to diminish irritability of the nervous sys- 
tem. The employment of Alcohol, Cocoa, Wine, or similar stimulants for the 
purpose of aiding the patient at this time is unwise, because he is prone to 
develop the alcohol or cocoa habit. If the diarrhea is so violent as to require 
control, Aromatic Sulphuric Acid with a vegetable astringent, like the fluid- 
extract of Hematoxylon, may be used. Hot Compresses may be applied 
about the painful limbs. Great mental excitement may be relieved by 
Chloral, but the danger of producing the chloral habit is not to be forgotten. 
In place of chloral, Sulphonal or Trional may be used. Occasionally nerve 
quiet can be produced by wrapping the patient in a hot, wet blanket, care 
being taken that the Hot Pack is not continued so long as to produce cardiac 
depression. 

A second method of treatment is one which has been largely employed 
in the last few years, and for which we are chiefly indebted to a Texas phy- 
sician, Dr. Lott. This consists in putting the patient where we can have him 
under absolute control, and in the administration of full doses of Hyoscine 
hypodermically, giving him as much as T ^ of a grain every two hours, if 
need be, until a condition of nervous quiet is produced. In the writer's 
experience these large doses fail to produce sleep, and instead cause a condi- 
tion in which the patient lies awake but stupefied, and often mumbles con- 
tinuously. Curiously enough the mouth does not become as dry as one would 
expect from the administration of such a powerful drug in these large doses. 
Should the circulation seem at all feeble, Strychnine may also be given. 
The idea in employing hyoscine is to use that quantity which is necessary 
to keep the patient under control, and to prevent suffering. These doses 
may be continued for a number of days, at the end of which time they are 
gradually diminished and the patient is permitted to return to his normal 
condition as the effects of the hyoscine pass away. Ey this means the acute 
mental and physical suffering caused by the sudden withdrawal of morphine 
is avoided, and in some instances the patient actually seems to be cured of 
his malady, although, of course, there is great danger in every case of his 
speedily returning to its use, particularly if any nervousness or mental stress 
is experienced. So common is it for the habitue to go back to the employ- 



ORCHITIS — OTALGIA. 



757 



ment of this drug habit that many men of experience have gone so far as to 
assert that no case of the morphine habit is ever permanently cured. This 
view is, however, undoubtedly incorrect. The writer has seen a number of 
cases in which permanent cure certainly took place." 



Orchitis. 

Magnesium Sulphate, a saturated solution on wrapping applied con- 
tinuously to the testicles, gives extraordinarily good results (Tucker); 
rapidly reducing the inflammation (Harrison). Belladonna, int., and as 
oint. ; extract j ad iij Adipis, when inflammation has subsided (Wa). Sodium 
Salicylate, in gonorrheal orchitis, subdues the pain in a few hours. Iodine 
tinct. locally to remove swelling after the acute stage has passed (B). Iodo- 
form, i part in 10 of vaselin, as ointment to reduce enlargement, a very 
efficient application. Mercury, the Oleate locally (B); Calomel gr. iij with 
Ipecac gr. x, at once, followed by a saline next morning, and smaller doses of 
Calomel and Ipecac every six hours, with Morphine gr. J hypodermically 
into cellular tissue of scrotum (McElroy). Ammonium Chloride, makes a 
good evaporating lotion in solution with alcohol and water (R). Silver 
Nitrate, a strong solution to the scrotum, with gentle pressure (Wa). Tartar 
Emetic, in acute orchitis (R). Guaiacol, pure, as a local application for 
the pain; or i part in 10 of vaselin locally, and Salol internally (Bocchi). 
Alcohol, with equal quantity of water, as evaporating lotion (B). Ice, bene- 
fits the inflammation and relieves pain (B). Potassium Iodide, in syphilitic 
cases; gr. iij-v thrice daily to remove induration resulting from severe attack. 
Gonococcic Vaccine, small doses quickly relieve the pain and cause a rapid 
abatement of the symptoms (Eyre). Leeches to the perineum, is a good 
method in acute cases. Strapping and suspension of the testicle, to reduce 
inflammation, in cases which cannot lay up in bed. Rest, in bed during 
acute stage, with elevation of the testicle and pelvis, and cessation of all 
active treatment for the gonorrheal affection. Orchitis may occur in malaria, 
mumps, gonorrhea, gout, typhoid fever, syphilis, tuberculosis, variola, and 
injury, as by bruising on horseback or otherwise. [Compare Epididymitis.] 



1$. Ammonii Chloridi, gr. xl. 

Alcoholis, Aquae, aa 5ij- 

M. Sig. — Lotion, to be applied on thin 
cloths to the part. 



]$. Hydrarg. Ammoniat., 5j- 

Cerati Simplicis, § j. 

M. ft. unguent. Sig. — Apply locally, 
with gentle friction. 



Otalgia. 

Aconite and Opium, equal parts of the tinctures, a few drops well down the 
external meatus, will usually subdue the pain. Blistering Fluid, or Croton 
Oil Liniment behind the ear, often relieves earache (R). Phenol, in solution 
i to 40, ten drops by instillation into the ear (Gould). Morphine in solution, 
gr. iv. to the §, with gr. j-ij of Atropine, is an excellent application (B). 
Atropine, gr -fo in 5 XX of water, a teasp. every three hours for a child in the 
acute otitis media of children from coryza, very successfully used to abort the 
otitis and relieve the earache (Miot) ; a solution locally is especially applicable 
in the earache of children from whatever causes, gr. j to the §, of which 
gtt. iv dropped into the ear to remain for 10 or 15 minutes. Cocaine, a 4 
per cent, solution sprayed over the tympanic membrane through the external 



75§ OTITIS — OTORRHEA. 

meatus, and forced into the Eustachian tubes by inhaling the spray and then 
expanding the tubes bv Valsalva's method; this repeated every three minutes 
is a very sure method of curing otalgia (R). Dry Heat by the hot- water 
bag or bottle, or a hot stone wrapped in flannel, or a bag of hot salt, or any 
other convenient method. Olive Oil often used warm, as a local application, 
but it is of no service and may do harm by undergoing decomposition and 
becoming favorable soil for the growth of aspergillus or other vegetable 
fungi. [Compare Otitis.] 

1$. Chlorali Hydrati, 

Camphorae, 

Phenolis, aa gr xx. 

Olei Ricini, %j. 

Sig— Pour into the ear (after warming) enough to fill it; cover with cotton 
wet with warm water, and a cloth wrung out of hot water. (Brodnax.) ■ 

Otitis. 

Aconite, quickly relieves the pain (R); should be used internally and 
locally. Phenol, in a 20 per cent, solution instilled into ear in moderate 
otitis, relieves the pain at once and checks progress; a solution in glycerin 
is best (Rohrer). Atropine, in the acute otitis media of children, is very 
efficient (Miot). Resorcinol in 1 to 5 per cent, solution locally in chronic 
otitis (W). Naphthol in weak solution, 1 to 200 locally; or Beta-naphthol, 
as antiseptic application (W). Potassium Permanganate solution, gr. j to 
the 5 , as a wash in otitis media. Bismuth Subgallate, as a dusting powder 
in purulent otitis media, is an efficient application. Borax and Phenol, as 
Dobell's Solution (see page 534), by spray to naso-pharynx once or twice 
daily, to soften secretions and permit their outflow (Gould). Boric Acid or 
Thymol Iodide, dusted over after removing secretions and drying (Smith). 
Petrolatum Liquidum with a few drops of Eucalyptol, or a grain or two of 
Menthol, by moderate spraying to the naso-pharynx (Gould). Vaccines pre- 
pared from the organisms present are very efficient in the suppurative otitis 
media of scarlatina (Weston). Vaccines, autogenous vaccines prepared from 
carefully made cultures of the diseased tissues, secured with the aid of an 
ear speculum, may prove of some value in the treatment of subacute and 
chronic suppurative otitis media (K). Injections may be given every 5 to 
7 days, a slight increase in discharge after the first 1 or 2 doses is of good 
import, and indicates a slight focal reaction (K). Incision of the mem- 
brana tympani, not a simple puncture, is the logical measure for evacuation 
of pus from the tympanic cavity (Smith). Blisters behind the ears, either 
kept discharging or repeated, are often very useful (Wa). Leeches, behind 
the ear, afterwards a small blister upon the same place, when the leech-bites 
have healed (H). Warm Douche frequently to the ear, to secure cleanliness, 
then dry the part thoroughly (Roosa) . Inflation and aspiration of the middle 
ear, also syringing and douching the naso-pharynx, must be avoided in acute 
catarrhal otitis media, lest pathogenic germs be forced into the middle ear 
(Gould). [Compare Otalgia, Otorrhea.] 

Otorrhea. 

Salol and Camphor, equal parts, heated together, have given good results 
in suppuration of the middle ear; the application causes neither pain nor 
inflammation (Pegon). Bismuth Subgallate, on cotton tampon, introduced 



OVARALGIA. 759 

after thorough syringing with a 3 per cent, solution of Boric Acid, and careful 
drying with absorbent cotton, the best means of combating an acute or chronic 
otorrhea, outside surgical measures (Chaniavsky) . Boric Acid, finely pul- 
verized, as astringent and disinfectant application; may be mixed with pulv. 
Alum, and just enough powdered Lycopodium to keep it dry; this packed 
carefully through speculum, after washing with a weak and tepid alkaline 
solution. Phenol in 1 to 40 solution, as wash by syringe, once or twice daily 
is enough in the worst cases (Gould). Creosote locally in fetid otorrhea, 
instead of phenol (W). Hydrastis, Tfl.x-xx of the fluidextract to the 5 of 
solution, is a valuable local application (W). Potassium Permanganate in 
dilute solution, gr. j-v to the 5, as a disinfectant and germicidal wash (W). 
Formalin solution, 1 to 1000 or 1 to 2000 as wash, in place of phenol (Gould). 
Mercury, the brown citrine ointment in chronic cases (B). Mercurol in 1 
per cent, solution by syringe in middle ear diseases, acts well on the purulent 
discharge without irritating (Burnet). Acetanilid by insufflation daily, 
after cleansing the canal, is highly efficient in chronic purulent otitis media 
of children (Melzi). Lead solutions, as astringents, are much employed (B). 
Silver Nitrate solution locally, gr. iv to the 5 (B); gr. x to the 5 (Roosa). 
Argyrol in 50 per cent, solution, freely in the tympanic cavity, is effect- 
ive and painless. Protargol in 2 per cent, solution, is very efficient in 
chronic otorrhea (Van Hoesen). Picratol, Tfl.v of a 1 per cent, solution every 
2 hours locally, is very efficient (Yale). Copper Sulphate, solution of gr. j 
to the § locally (Roosa). Tannin, the Glycerite, locally, is successful (B); 
especially in children (Wa). Zinc Sulphate, locally, in solutions of gr. 
ij-viij to the § (B); gr. j-x to the § (Roosa). Cadmium, gr. ij-Bj rose- 
water (B). Liquor Sodae Chlorinatae, TUxv-xxx ad 5 j aquae, when discharge 
fetid; is highly useful as injection (Wa). Quinine, with Sulphuric Acid, 
advisable in otorrhea after scarlatina (Wa). Absorbent Cotton, on holder, 
may be used every few hours by the patient to keep pus removed from the 
canal. Syringing with warm salt water, once daily, as absolute cleanliness 
is essential in the treatment. Politzer Bag inflation, is a useful adjunct in 
keeping secretions out of tympanum and breaking up adhesions (Roosa). 
Ossiculectomy may be required in obstinate cases, to favor drainage and 
better local treatment of the middle ear by antiseptics (Gould). [Compare 
Otitis.] 

Ovaralgia. 

Codeine, has especial value against ovarian pain (Freund), whether of 
inflammatory or neuralgic origin, in doses of gr. f at least. Opium, often 
the cause; if use stopped entirely improvement may ensue (E); one of the 
best remedies in ovarian pain, of non-inflammatory character (Graily Hewitt). 
Atropine, subcutaneously, the best remedy for pain in the pelvic viscera 
(Wa). Camphor, with Cannabis, of great service in relieving ovarian pain, es- 
pecially when spasmodic in character (Wa). Conium, or, better still, its 
alkaloid, used as a vaginal pessary, in all cases of ovarian pain, w T hether neu- 
ralgic or inflammatory, is quite a specific (Meadows). Ether, the compound 
spirit, in doses of TFJxxx-xl as a palliative (Anstie). Gelsemium has much 
evidence in favor of its value (W) ; deserves a trial, its power is great but not 
certain (W). Ammonium Chloride formerly used in ovarian neuralgia, 
but has not given satisfaction (W). Hot water, as vaginal injections night 
and morning; sunlight baths, fresh air (E). Leeches over the groin, or in- 



760 



OVARITIS — OXALURIA . 



side the thigh, when ovarian pain persistent, or tenderness and aching (Wa). 
Surgical, Battey's operation as a last resort (E). [Compare Dysmenorrhea, 
Ovaritis.] 

Ovaritis. 

Tartar Emetic, as ointment for counter-irritation over seat of disease, in 
subacute ovaritis; at the same time a pill of Opium, Hemp and Camphor 
(Hewitt). Opium, in suppository or enema, more effectual than internally 
(Tilt). Mercurial Ointment, combined with Camphor and Belladonna, over 
the seat of the disease by friction (West). Hydrated Chloral as glycerite, 2 
to 5 per cent, on vaginal tampon to reduce local sensibility before proceeding 
to Ichthyol treatment (Freund). Ichthyol in 5 per cent, glycerin mixture 
on vaginal tampons, is valuable in chronic ovaritis (Freund). Picratol, gr. 
ij-iij in vaginal suppository, or as a saturated glycerin solution on tampons 
to relieve congestion and pain (Yale). Ergot with Potassium Bromide and 
rest, valuable in chronic ovaritis (Tait) . Ovarian Extract in conditions due 
to partial or entire arrest of the ovarian functions from disease. Parotid. 
Extract, used as an internal remedy in six cases of enlarged and tender ovary 
with menorrhagia, etc., with signal success (Bell). Turpentine, hot turpen- 
tine epithems applied over the seat of the disease (Wa). Ice, in bag, over 
seat of pain, when intolerable, and patient too much reduced to bear leeches; 
is often of benefit (Wa). Poultices of Linseed meal, as light as possible, often 
produce great benefit in ovarian inflammation. Blisters, in subacute ovar- 
itis are often of great service, placed over the region or to the cervix 
uteri (Wa). Enemata, of warm water, simple or medicated, in subacute 
ovaritis, are warmly recommended; thev should be retained as long as pos- 
sible (Wa). 



]$. Ext. Opii, gr. iij. 

Ext. Cannabis, 

Camphorse, aa gr. vj. 

M. ft. pil. no. vj. Sig. — One pill twice 
daily. (Graily Hewitt.) 



fy. Ung. Hydrargyri, 5vj. 

Camphorse, gr. xl. 

Ext. Belladonnas Fol., 3ij- 

M. ft. unguent. Sig. — To be rubbed in 
twice daily. (West.) 



Oxaluria. 

Nitric Acid has been used with advantage but is much inferior to nitro- 
hydrochloric acid (W). Nitro -hydrochloric Acid in a few days produces a 
surprising revolution (W); also in sciatica and other forms of neuralgic 
rheumatism accompanied with oxaluria, full doses, TTLvj-x, of this acid, with 
an occasional brisk purgative, and cold douche followed by friction (Wa). 
Magnesia in considerable quantity, aids in the solution of the oxalates 
(Brown). Citric Acid acts on the calcium base of the oxalates and prevents 
the formation of calcium oxalate crystals, hence lemons and oranges are 
beneficial, though most acid fruits are injurious (Id). Potassium Citrate in 
plenty of water is sometimes advisable, combining with calcium and forming 
a double soluble salt (Id). Zinc Sulphate, often very serviceable for irrita- 
bility of the nervous system associated with dyspepsia and oxaluria (Bird). 
Alkalies when uric acid is associated with oxalic acid in the urine in excess 
(Tirard). Bromides in full doses at bedtime for insomnia, and ordinary 
tonics during waking hours when the depression is extreme (Id). Exercise 
in the open air is important (Id). Diet should be free from articles rich in 



OZENA — PAIN. 



761 



oxalic acid or oxalates, as rhubarb, spinach, tomatoes and strawberries, which 
are particularly prone to produce oxaluria; while figs, beets, potatoes, tea, 
coffee, and cocoa, though containing considerable quantity of oxalates, 
rarely produce oxaluria (Brown). [Compare Dyspepsia.] 



Ozena. 

Mercury, the Ointment of the Nitrate in syphilitic form; the White or 
Red Precipitate with 58 times its weight of sugar, snuffed after clearing the 
nose, in non-syphilitic forms (R). Potassium Permanganate, solution 
5j to Oj as an injection or spray (B); affords an elegant disinfectant and ger- 
micidal wash (W). Iodine, a dilute solution of the tincture as an alterative 
and stimulant application (W); with Phenol as inhalation (B). Phenol 
in 1 per cent, solution inhaled from an atomizer (B). Bromine 5j to the 5 
of Alcohol, vaporized by the heat of the hand, as an inhalation (B). Ichthyol 
in 2 to 5 per cent, aqueous solution as injection, after removing crusts by 
irrigation with tepid water, followed by swabbing with a 25 to 30 per cent, 
solution (Ertler) ; locally and internally acts more quickly and certainly than 
cod-liver oil in the scrofulous ozena of children (Hoffmann). Hydrastis, the 
fluidextract locally (B); in solution 5j to § viij locally, also the tincture Tfl.v 
internally thrice daily (P). Silver Nitrate, a solution, gr. v-xx to the §, 
applied behind the veil of the palate (B). Alum in solution, 5j to the pint, 
for irrigation (R). Glycerite of Tannin, by irrigation (R). Salicylic Acid, 
in very weak solution, 1 to 500, as cleansing, astringent, and disinfectant 
wash, used byretro-pharyngeal syringe, and followed by applications of 
Calomel, in powder, to the ulcerated portions of the mucous membrane 
(Massei). Hydrogen Dioxide, the solution as spray, is a most excellent 
application. Salol, has done good service, as insufflation. Strontium Iodide, 
has been used in scrofulous ozena, with varied results. Cubeb, the Oleo- 
resin, gtt. xv-xx on sugar after each meal, to restrain the secretion and per- 
haps modify its character (Cohen). Calcium Chloride, gr. xxx-lx with §j 
Decocti Kameriae; of which 3ij~iij> diluted with equal quantity of water, 
should be injected twice daily after cleansing with salt and water (Cohen). 
[Compare Catarrh, chronic nasal.] 



1$. Hydrarg. Ammoninat., gr. iv. 

Pulv. Sacchari Albi, §ss. 

M. Sig. — To be used as a snuff, after 
thoroughly blowing the nose. In ozena, 
whether syphilitic or not. {Trousseau.) 



1$. Sodii Bicarb., 5 jss. 

Liq. Antisep., 5 vj. 

Aquae, §j. 

M. Sig. — Use with the Bermingham 
nasal douche as a wash. In hypertrophic 
rhinitis with ozena. (Osier.) 



Pain. 

Opium, is the most efficient of all analgesics and is universally used to 
relieve pain from any cause except acute inflammation of the brain (W); 
opiates soon lose their power in any particular dose, and require increasing 
dosage to sustain their analgesic influence, hence in chronic cases all other 
means should be exhausted before resorting to them (R). Morphine, 
is the most analgesic alkaloid of opium; hypodermically in the vicinity of 
the nerve is efficient when not so by the stomach (B); the morphine-habit 
must be kept in mind; a single injection thereof is sometimes curative in 



762 PAIN. 

sciatica and other neuralgias; the conjoined administration of Morphine and 
Antipyrine is much more efficient in pain than the use of either agent alone. 
Codeine, has a special influence over abdominal pain and that of the ovaries, 
and is not liable to give rise to a drug habit. Dionin in 4 to 7 per cent, solu- 
tion locally, is the best analgesic for the eye. Belladonna, is the best remedy 
for every kind of pain in the pelvic viscera (Anstie). Atropine, hypodermic- 
ally in local pain, neuralgia, sciatica; when it succeeds, has more lasting 
effect than morphine (R) ; for sciatica, tic douloureux (B) ; has little value 
unless the pain be due to spasm or some cause situated so that the remedy 
can be brought into direct contact with sensory nerve-endings (W). Du- 
boisine may be used instead of Atropine (B). Cocaine, as a local anesthetic 
to mucous surfaces, or hypodermically for minor operations involving a small 
area, as circumcision, eye operations, has no equal; a 4 per cent, solution is 
generally employed (R) ; also as a general anesthetic by spinal subarachnoid 
injection. Eucaine is fully as efficient as cocaine and much less toxic 
(Schleich) ; in medicinal doses is harmless and does not affect the heart (Rei- 
chert). Antipyrine, is a most efficient analgesic in doses of 10 to 15 grains, 
being especially adapted to neuralgia, migraine and the pains of gouty and 
rheumatic origin, but is of no value in pain due to a local inflammation, 
it may be used hypodermically. Acetanilid, is highly efficient in doses of 4 
to 7 grains for the pains of locomotor ataxia and those of rheumatic origin, 
also locally as a dry dressing for painful wounds, ulcers, etc. ; it is the active 
ingredient in a host of recent proprietary remedies against pain. Acet- 
phenetidin, efficient in 10-grain doses, for neuralgia, hemicrania; is largely 
used for the relief of pains of the character for which Antipyrine is employed 
(W) . Phenocoll Hydrochloride, in doses of 1 2 to 1 5 grains, is a good analgesic 
in the neuralgic pains of influenza, and in gouty and rheumatic pain. Chloro- 
form by inhalation as a general anesthetic; internally for the pain of colic, 
even that of lead colic, and externally as liniment with other substances for 
chronic neuralgic or rheumatic pains (W); the vapor to the raw surface 
of cancers, to the photophobic eye, etc. (R). Ether as spray for local anes- 
thesia, by inhalation for general anesthesia (R); anesthetics should be em- 
ployed only when pain is exceedingly severe and transient (W). Hydrated 
Chloral is analgesic only in large and dangerous doses (W); sometimes 
relieves neuralgia, chronic rheumatic pains, colic, gastralgia, etc. (R). 
Aconite was formerly much used for neuralgic pain (W) : Aconitine locally is 
one of the most certain and powerful palliatives in neuralgic, rheumatic and 
gouty pains (Wa); especially in trigeminal neuralgia (B). Veratrine as 
ointment locally for neuralgia, is readily absorbed through the skin and is 
more dangerous than useful (W). Guaiacol, locally or by hypodermic in- 
jection, 1 part in 10 of olive oil, or mixed with equal part of glycerin for paint- 
ing on the surface, is an efficient local anesthetic, and is used successfully in 
orchitis, in neuralgic pains of tuberculous subjects, also in sciatica and 
rheumatism (Moissy) ; a few drops rubbed in gently give immediate relief in 
many superficial pains, also in labor-pains (Brodnax). Phenol pure, is a 
local anesthetic (R); but has been supplanted by cocaine (W). Creosote 
locally is efficient for the pain of an exposed dental nerve. Ichthyol locally 
is analgesic against inflammatory pain; hypodermically is analgesic, less so 
than morphine and less dangerous (Damiens). Amyl Nitrite, also Nitroglyc- 
erin and other Nitrites, are effective usually against cardiac pain (Leech) ; 
especially when arterial spasm exists as in angina pectoris (B). Cannabis 



PARALYSIS. 



763 



is inferior to opium, but may be tried when the latter is contraindicated for 
any reason (W). Salicylates are efficient in rheumatic and gouty pain, also 
in rheumatic neuritis (W). Iodoform in suppository for painful disease of 
the rectum or bladder (R); as a local analgesic in painful ulcers, hemor- 
rhoids, and fissures, etc. (W). Iodides are magical for syphilitic nocturnal 
pains of the head (B); Ammonium Iodide, gr. iij ad §j Olei Olivae, with 
friction; causes the disappearance of nocturnal syphilitic pains (W). Cimi- 
cifuga, relieves many kinds of pain, as neuralgia of 5 th, rheumatic headaches, 
ovarian neuralgia, dysmenorrhea; inferior to Ergot in labor-pains or after- 
pains; 3j doses of the tincture (B). Conium, in cancer, rheumatism, neural- 
gia, ovarian pain (R) ; also for the fulgurant pains of locomotor ataxia, chronic 
alcoholism, sciatica, phthisis, doses of ITU of a fluidextract of the unripe fruit 
every \ hour, well watched (Madigan). Iron, with Belladonna, for the 
wandering pains of anemia, in which morphine is dangerous and bromides 
are useless (Waugh). Oil of Peppermint locally is sometimes very effective 
in relieving pain (W) ; has been long used in China for neuralgia and subacute 
rheumatism. Menthol freely rubbed on for superficial neuralgic pain of 
peripheral origin (W). Rhatany relieves the pain of ulcers, burns, and blisters 
(Tr). Methylene-blue, relieved neuralgic and rheumatic pains (Ehrlich); 
has some analgesic action, but is uncertain, and has no advantage over the 
newer aniline derivatives (W). Aquapuncture relieves pain in a superficial 
nerve (B). Electricity, the galvanic current for neuralgia, it is powerless 
against pain of phlegmonous inflammations (W) ; galvanism of the affected 
nerve gives certain relief; the positive pole on point of emergence, negative 
over superior ganglion of cervical sympathetic (B). Radium relieves pain 
almost immediately, whether of organic, nervous or neuralgic origin (Shober) . 
Heat, if pain is without fever or inflammation (B); warm injections soothe the 
pain of cystitis, prostatitis and abdominal pains generally (B). Hot Water, 
as bath, relieves pain most wonderfully; Napoleon, at St. Helena, suffering 
from cancer of the stomach, appreciated highly the pain-relieving power of 
the hot bath; often staying half and even whole days therein. Cold, when 
pain is inflammatory in origin (B). Phototherapy, the ultra-violet rays 
are very effective in relieving acute muscular pain, especially if obtained with 
iron-carbon electrodes (Rosenberg). [Compare After-pains, Anesthesia, 
Boils, Chest-pains, Colic, Gastralgia, Headache, Hepatalgia, In- 
flammation, Lumbago, Myalgia, Neuralgia, Neuritis, Odontalgia, 
Otalgia, Ovaralgia, Rheumatism.] 



1$. Antipyrinae, , gr. xv. 

Cocainse Hydrochlor., gr. ss. 

Aquae Destil., ttjjxv. 

M. Sig. — One-half as hypodermic injec- 
tion, or the whole when rapid action desired. 

(See.) 



1$. Liq. Morphinae Magendie,... 5j- 

Aquae, q. s. ad §ij. 

M. Sig. — A teasp. to a dessertsp. every 
six or eight hours, for pain. Each drachm 
contains § grain of Morphine Sulphate. 



Paralysis and Paresis. 

Nux Vomica, in hysterical paralysis and in that from lead-poisoning; only 
in chronic cases (P) ; in paraplegia due to softening and wasting of the cord 
(Brown-Sequard). Strychnine, hypodermically into the affected muscles, 
for hemiplegia, paraplegia, local, mercurial, paludal, rheumatismal, facial, 
infantile and diphtheritic paralyses; in that of the spinal, muscles, of the 



764 



PARALYSIS. 



bladder and all local forms (B); in hysterical paralyses (P); in all forms 
except cerebral and spinal paralyses (Barwell) ; internally in doses of gr. %\ 
to T V (R) ; is much abused, can be useful only when the paralysis is due to a 
depressed state of the spinal motor centres (W). Phosphorus, with Cod-liver 
Oil in the paralysis of white softening of the brain (B); in hysterical paralysis 
(R) ; in myelitic paraplegia from excessive venery; the only drug which really 
affects the nerve-centres (W). Belladonna, when depending on chronic 
inflammation of the cord (R) ; externally as ointment along spine, with Ergot 
internally (Brown-Sequard). Physostigmine, into the eye in ocular paraly- 
ses (B); Physostigma in general paralysis of the insane, also in progressive 
muscular atrophy without much mental disorder, long-standing hemiplegia, 
paraplegia, locomotor ataxia, (R). Ergot, in paralysis of bladder from over- 
distention (B) ; paralytic dysuria, sensation of but partial emptying of bladder 
(P) ; said to be useful in paraplegia (R) ; in paraplegia complicated with men- 
strual irregularity and forms of paralysis arising from spinal congestion (Wa) ; 
has cured cases of constipation of the paralytic when all the most powerful ca- 
thartics failed (Curran). Mercury Benzoate in daily doses of gr. ^ to ^ hypo- 
dermically, markedly ameliorated the symptoms in six cases of general paraly- 
sis (Lemoine). Picrotoxin has greatly benefited several forms, especially 
paralysis of the sphincters, hemiplegia from cold, and gloss-labio-laryngeal 
paralysis. Cannabis, for retention of urine in spinal paralysis (R). Ammo- 
nium Iodide and Carbonate, to aid in absorption of thrombi, thus promoting 
cerebral nutrition in cases of incipient hemiplegia, due to endarteritis defor- 
mans reducing the lumen of the vessels in the brain (B). [See formula 
below.] Colocynth, in cerebral paralyses, sometimes seems to act favorably 
upon principle of revulsion or counter-irritation (P). Mustard, as an 
emetic to stimulate failing heart in certain forms of paralysis (P). Nutmeg, 
the Oil as external stimulant (P). Oil of Bay, has been given; is obsolete 
(P). Capsicum as a general stimulant, in doses of gr. j-ij every 4 hours (P). 
Counter-irritation, by blistering fluid, in peripheral paralysis of the 7th nerve 
(R). Cod-liver Oil, when low nutrition and faulty assimilation (Anstie). 
Galvanism, in hemiplegia and many forms (B). Electricity, faradization of 
the muscles affected; localized electricity probably of more importance in con- 
firmed spinal paralysis than medicinal treatment. Galvanism should not be 
used on the muscles in an acute palsy connected with active irritation of the 
nerve-centres until the centric disturbance has subsided (W). Massage, in 
infantile paralysis, given with Calcium Lactophosphate and Cod-liver Oil, 
and Strychnine injected into the muscles (B). [Compare Hemiplegia, 
Locomotor Ataxia, Paralysis Agitans, Tongue.] 



1$. Strychninae Sulph., gr. iij. 

Aquae Destillatse (fervid.),. . . 3*. 
M. Sig. — For hypodermic administra- 
tion; Ti£x = gr. jfc of Strychnine Sulphate. 



1$. Ammonii Iodidi, 5 J- 

Ammonii Carbonatis, oij- 

Liq. Ammonii Acetatis, ovj. 

M. Sig. — A tablesp. thrice daily. (B.) 



Paralysis Agitans. 

Hyoscyamus, full doses of the tincture will palliate the trembling (B). 
Hyoscine temporarily but effectually controls the tremor, if used continually 
will lose its power (W). Duboisine acts similarly in most cases; gr. T ^ 7 by 
mouth thrice daily. Chloral depresses the motor tract of the spinal cord, and 
is of value in this affection. Sparteine, gr. i~| thrice daily, has proved use- 



PAROTITIS. 765 

ful (Potts). Conium has seemed to benefit in some instances (Harley). 
Gelsemium, in full doses, to quiet the nervous irritation (Lavers); a combina- 
tion of Conium, Hyoscyamus and Gelsemium. [See under Tremor.] Po- 
tassium Iodide, to promote absorption (Lavers). Cocaine, influences paraly- 
sis agitans more favorably than any other remedy, large doses and frequent 
administration are unnecessary (B). Cannabis, in large doses, lowers reflex 
activity. Picrotoxin, has greatly benefited some cases. Opium, Arsenic 
and Hyoscyamine may be tried, but the disease is incurable, and nothing can 
be done except to attend to the physical comfort of the patient; there is no 
treatment which can be recommended as satisfactory in any respect (O). 
Sodium Borate, gr. xv-xlv daily, in 3 or 4 doses, produced most striking im- 
provement in a case of paralysis agitans which developed after a fall upon the 
shoulder (Sacaze). Phosphorus, in small doses, with Cod-liver Oil, is very 
useful (R). Hypophosphites, the Syrup ought to be of service, if taken 
steadily for a long time. Cod-liver Oil, long continued is more constantly 
useful than any other medicine (Anstie). Orchitic Extract, has been used 
with apparent benefit. Parathyroid Gland gave very favorable results, not 
only in recent but in advanced cases (Berkeley). Sulphur Baths, are cer- 
tainly of great value in this disease (Lavers). Electricity, the constant cur- 
rent, anode over the spine, cathode drawn along the course of the nerves 
from where they leave the vertebral column to the periphery (Id). Cupping 
the skin of the spinal region with dry cups, to dilate the vessels of the cord 
improving its nutrition, also to improve the elasticity of the deep muscles and 
ligaments (Taylor). Exercises of the muscles are beneficial, whenever by 
exertion of the will-power a temporary intermission of the tremors and con- 
trol of the muscles are still possible (Friedlander) ; a series of directed move- 
ments, passive and active, to restore tissue elasticity and overcome contrac- 
tures, gives much relief in many severe cases if faithfully performed (Taylor) . 
Electric Baths caused recovery or lasting improvement in 44 out of 56 cases 
so treated (Schnee). [Compare Chorea, Tremor.] 

Parotitis. 

Aconite, in febrile conditions (R) ; no medicine is required unless the fever 
is high when Aconite may be given (O). Mercury, -| grain of Gray Powder, 
3 or 4 times a day is very useful, relieving pain and swelling (R). Ichthyol 
in 20 per cent, ointment with Lanolin, causes rapid removal of the pain and 
swelling (Stauffner). Sodium Salicylate with Sodium Bicarbonate is the 
most effective remedy for cases attended by rise of temperature and severe 
pain (Dixon). Guaiacol in 5 per cent, ointment spread over the gland, gives 
relief from pain on the first application, and cures after two or three (Grande). 
Cold compresses may be used, but children usually prefer hot applications 
(O). Ice-cap if delirium and other head symptoms (O). Cathartics, the 
bowels should be freely opened, and a light, liquid diet used. Leeching, 
often gives speedy relief, when pain is great and resists hot fomentations (Wa). 
Care to avoid chilling, important. Incision, when suppuration occurs. 
Stimulants and Tonics internally are very necessary in symptomatic paro- 
titis, occurring as a complication or sequel of other diseases, with adynamic 
symptoms. Rest, in bed is required during the height of the disease, and 
especially if orchitis, in which rest and support of the swollen testicle with 
cotton-wool, is usually sufficient. [Compare Orchitis.] 



766 PEDICULOSIS — PELLAGRA. 



Pediculosis. 



The disinfection of all wearing apparel in Pediculosis Vestimentorum is 
necessary, as the pediculi are much more commonly found in the clothing 
than on the body. In pediculosis of the scalp, cutting the hair is unneces- 
sary except in the most extreme cases. After soaking with Olive Oil, the 
hair can be combed carefully and gently and with patience, restored to its 
normal condition. The ovas are best removed with the use of one or more 
of the following preparations which can be poured into a saucer and a fine 
tooth comb dipped into it and drawn through the hair. If any difficulty is 
encountered in removing the ovae in this way, comb towards the scalp, not 
always away from it. Bichloride of Mercury, i to iooo, in the form of wet 
dressings is of value in the pyodermic infections which are prone to accom- 
pany this disease in the class of patients who are lodging-house habitues. 
Beta-napthol, J to i drachm to the ounce of petrolatum may be used with 
considerable success. Chloroform is of value, particularly in Pediculosis 
Pubis, where it can be poured on and the pediculi will immediately drop off. 
Care, however, should be taken to insert a pledget of cotton in the rectum. 
The Tincture of Cocculus Indicus is of value in the removal of the parasites. 
Hydrarg. Ammoniata, 20 grains to the ounce of petrolatum, is of value for 
the impetigo contagiosa which is so frequently associated with pediculosis 
capitis. Mercuric Chloride Lotion, § to 2 grains to the ounce of water, may 
be applied for two or three days twice daily, if there is no raw surface (Stel- 
wagon). Mercury in the form of Blue Ointment is mentioned only to be 
condemned, as the medicament in this preparation is absolutely of no value, 
it is the ointment which stops up the breathing pores and makes the para- 
site drop off. It is commonly prescribed by druggists and others but in a 
very large percentage of cases, produces a marked dermatitis. Olive Oil, if 
the hair is very much matted from an associated impetigo contagiosa is of 
great value and should be applied freely and the head bandaged for twenty- 
four hours and then thoroughly washed in soap and water. Crude Petroleum 
thoroughly rubbed into the hair will kill the lice. Tinctura Saponis Viridis 
has particular value in Pediculosis Capitis and during the course of treat- 
ment the hair should be washed frequently with it. Fluidextract of Staphi- 
sagria will kill the parasite and Dilute Acetic Acid will dissolve the gelatinous 
material holding the ovae to the hair. See the following prescription. Petro- 
latum is very extensively used for the destruction of the lice themselves, 
either alone or incorporated with equal parts of Balsam of Peru. 

1$. Fluidext. Staphisagriae, f 3iv. 

Acidi Acetici Dil., q. s. ad f Siv. 

Apply at night with fine tooth comb and wrap head in towel. 

Pellagra. 

Prophylaxis. — " There does not seem to be any satisfactory evidence as 
to the contagiousness of pellagra, so that any method involving isolation is 
not indicated. It is possibly advisable that the stools be disposed of as would 
be indicated in typhoid fever, there being some evidence that where proper 
disposal of feces is operative there is an absence of pellagra. Even if not 
productive of pellagra it is certainly advisable to prevent the use of spoiled 
corn by state regulation" (Stitt). Arsenic is antidotal to the toxin of spoiled 



PEMPHIGUS. 767 

maize; Fowler's solution gtt. v increased to tolerance and suspended from 
time to time (Lombroso). Quinine in full doses was given to severe cases 
with marked improvement in all, and entire absence of symptoms for 2 years 
in 2 cases (Dyer). Thymol, gr. j to §j of water with a little alcohol as a 
solvent will generally suffice for the sore mouth (Niles). Zinc Oxide, the 
ointment for the erythematous rashes, with avoidance of bright light (Id). 
Transfusion of blood from a pellagrin or normal blood, used as a last resort 
in 17 cases with 7 deaths (Cole). No specific is known (Bowen). Hydro- 
therapy, the use of water freely by mouth, by rectum, as cold abdominal 
compresses, hot packs and saline baths is recommended by Niles. Hygienic 
improvement and relief of poverty, with a liberal and varied diet, and the 
total prohibition of corn as food (Lavinder). Diet, Goldberger and his col- 
leagues of the Public Health Service, have observed striking influences of diet 
in causing and curing pellagra. In an orphan asylum with 211 orphans, 68 > 
or 32 per cent., had pellagra. These children were divided into three groups 
and given different rations, those under 6 years of age receiving milk and eggs, 
while those over 12 years were given meat, as they assisted in the work of 
the institution. The children between 6 and 1 2 lived practically on a vege- 
tarian diet in which corn products and syrup preponderated with deficiency 
of legumes. Of 25 young children only 2 snowed pellagra, with but 1 case 
in the 66 children over 12 years of age, while the 120 between 6 and 12 gave 
65 cases, or 52 per cent. Elsewhere these workers have shown that a generous 
diet with rest in bed has marked curative power which generally becomes 
manifest in about one month. Eggs, milk, fresh beef and fresh vegetables 
were conspicuous in the dietary. (Stitt, Diagnostics and Treatment of 
Tropical Diseases.) 

Pemphigus. 

In gravely acute cases of this disease or in the chronic type, the attention 
should be turned mainly towards supportive measures, with every effort 
being made to maintain the strength and to combat the toxemia. Ointments 
are usually borne better than the lotions as the caking of the latter produces 
much discomfort. The blebs should be evacuated as soon as they have 
formed. Arsenic is perhaps one of the best drugs which we have in the 
treatment of this disease and should be given in ascending doses of Fowler's 
Solution, rarely more than 10 drops t. i. d. being indicated. The Autogenous 
Serum Injections have proved of value in a few cases and as the chief symp- 
tom of which the patient complains is itching, extreme methods should be 
used in its alleviation. Boric Acid, \ to 1 drachm to the ounce of petrolatum 
is of some slight value, particularly if 5 minims of carbolic acid have been 
added. Lysol, \ to 1 ounce in a tub of water, has proved a great adjunct in 
controlling the pruritus which accompanies this disease. Menthol, 1 to 3 
grains, incorporated with other drugs, is extremely, cooling in its evaporation. 
Phenol, 5 minims in water or incorporated in an ointment base, is of value 
to relieve the intolerable itching. Quinine is borne very well by patients 
with this disease and as large doses as the individual can take, are of ad- 
vantage. Salvarsan has been given at times with some success. Scarlet 
Red, 1 per cent, in petrolatum, at times is of considerable value in healing 
the sores. Sodium Bicarbonate baths are of some value. Sodium Caco- 
dylate hypodermically administered, 1 to 3 grains every other day is of 
considerable importance. 



768 PERICARDITIS — PERIOSTITIS. 



Pericarditis. 



Aconite, when violent throbbing and extreme pain (R) ; of great value, if 
given early (P); proves in the highest degree serviceable, when object is to 
diminish vascular excitement or irritability (Wa); depressants are contrain- 
dicated, as the danger lies in failure of the heart (Bramwell); drugs, such as 
Aconite and Digitalis, to reduce the heart's action, are of doubtful utility (O). 
Veratrum Viride, extract gr. ij with gr. j of Calomel every two hours, is valu- 
able (Waring-Curran) ; is inadmissible, as it depresses the heart (Huchard). 
Digitalis when the heart is rapid and feeble, with cyanosis and dropsy (P) ; 
when there are marked nervous irritability, palpitation, and tachycardia 
(Huchard) ; in the second stage when the heart flags § ss of the infusion every 
4 hours. Opium regularly in grain does, every 3, 4, 6, or 8 hours, is very 
beneficial (Wa); invaluable in acute pericarditis, allaying the irritable, ex- 
cited action of the heart in a way no other drug does, Tfl.v of the tincture 
every 4 hours (West). Mercury when there is a tendency to fibrinous exu- 
dation (W). Quinine is a useful remedy in many cases (Bramwell); gr. xv- 
xx may suppress an acute attack if given at the critical moment (B). Iron, 
the tincture of the Chloride in full doses, may be required in the second stage. 
Potassium Iodide, to promote absorption in chronic pericarditis (W); may 
be of service when pulse is strong and constitutional disturbance not great 
(O) . Leeches to the precordium, or scarification and wet cups, are very use- 
ful (Huchard); local blood-letting by cupping or leeching is advantageous, 
especially in robust subjects (O). Counter-irritation, has been much abused; 
useful at commencement but not in acute inflammatory stage (B) ; by Iodine 
painted over the cardiac region, or flying blisters in the second stage. Heat 
by large hot poultices often renewed (R) ; is disadvantageous as it increases the 
rapidity of the heart's action (Huchard). Ice-bag over the heart may be 
useful (Id) ; especially in the early stage. Paracentesis by aspiration, if the 
fluid is not absorbed, after giving sufficient time (Id) ; aspiration is sufficient 
when exudate is sero-fibrinous, as usually occurs after rheumatism; but when 
purulent the pericardium should be incised and freely drained (O) ; is rarely 
necessary in pericardial effusions of rheumatic origin, which are always serous, 
and even the largest usually disappear spontaneously (West). Pericardot- 
omy when the effusion is purulent (Huchard) ; is best made in the apex region, 
avoiding excision of the ribs (West). Quiet, absolute, mentally and bodily, 
to reduce the heart's action to a minimum, is better than drugs for this pur- 
pose (O). [Compare Endocarditis.] ' 

Periostitis. 

Potassium Iodide, in syphilitic children, also in non-syphilitic periosteal 
thickening (R) ; holds the first place for syphilitic affections of the bones (Wa). 
Ammonium Iodide, cures periostitis most readily when syphilitic (Wa). Io- 
dine, the tincture, or blister locally, of great service 'in chronic form (R); 
under the external use of Iodine periostitis often rapidly improves (Wa). 
Poultices, after an early and free incision, when suppuration takes place (C). 
Incisions, carried deeply, should be made without waiting for fluctuation, 
when great tension exists and there is a tendency to suppuration; the sides 
of the abscess should then be brought together with compresses and a ban- 
dage (Gross). Tonics and Stimulants, as milk-punch, Quinine, Iron, and 



PERITONITIS — PERSPIRATION — PERTUSSIS . 769 

Opium, in full and sustained doses, are imperatively demanded in many cases 
(Gross). [Compare Nodes, Onychia.] 

Peritonitis. 

Operation is the only treatment for peritonitis. No known drug will 
cure peritonitis. 

Peritonitis, Tuberculous. 

Arsenic, children affected with tuberculosis involving the intestines and 
peritoneum have steadily and slowly improved and finally recovered under 
the Arsenic treatment (R). Iodoform locally, in tuberculous peritonitis, 
has performed many reported cures (W). Laparotomy, has been done with 
uniform success and with complete cure of the disease in 80 per cent, of all 
cases of tuberculous peritonitis in which the abdomen was opened, cleaned 
and drained (Tait); in 131 cases so treated 84 were cured and 23 greatly 
improved; only in 3 per cent, could death be ascribed to the operation 
(Konig); of 38 cases treated by simple laparotomy in 1896-97, 21 cases or 
55 per cent, were completely cured (Chrobak). Treatment by medicine is 
useless, tapping is at best only of temporary service, incision and evacuation 
of the abdominal contents afford by far the best chances of recovery (Id). 

Perspiration (See Hyperidrosis). 

Pertussis. 

Antipyrine is successfully employed, clinical experience shows that it has 
real power (W); as a preventive holds the first rank (Weill); TTLx-xx of a 2 
per cent, solution injected into the larynx by a glass instillation tube (Yank- 
auer); used with phenomenal success (Fondler). Bromoform, in daily dos- 
age of 5 to 20 minims, in glycerin and alcohol, very efficient for relief of par- 
oxysms, and to reduce their number, but has little other influence on the 
course of the disease; must be pure, hence colorless; increasing doses should 
not be pushed very far, for fear of toxic symptoms (Bedford); is almost a 
specific, acting as a local anesthetic on the mucous membrane of the pharynx 
and larynx, given in doses of 1 to 5 drops 3 or 4 times daily (Carpenter) ; it 
may be used by inhalation instead of chloroform or ether, to lessen severity of 
the paroxysm. Quinine by inhalation, employed with good results (Henke) ; 
in solution locally to the fauces (Dawson); the Tannate with Sodium 
Bicarbonate, of each 5 parts, and pulverized Acacia 100 parts, used by an 
insufflator (Pollack) ; is one of the best remedies, gr. J thrice daily for each 
month of age, and gr. jss for each year in children under 5 years (O) ; seems 
to act specifically (W). Belladonna in full doses, even gr. J of the extract 
thrice daily to a child of 6 to 8 months, is the most satisfactory remedy 
(Jacobi); is of value in the febrile stage and of special use when dentition 
is in progress; relieves the congestion of air -passages and also the determination 
of blood to the head (P); good when profuse bronchial secretion; best in 
spasmodic stage; children bear this drug well, TTU of tinct. may be given 
hourly to a child 3 years old (R); Atropine has been largely used (W). 
Ammonium Picrate is highly praised; doses of gr. J-gr. ss, up to gr. x per diem. 
Opium in the convulsive stage, enough to maintain slight heaviness (R); 
49 



77° PERTUSSIS. 

a dangerous drug for children. Heroin with Belladonna is palliative (Hyams) ; 
is more dangerous than morphine. Dionin is safer than heroin, and lessens 
the number and severity of the paroxysms. Acetphenetidin is praised by 
many physicians. Veronal, gr. j-jss once or twice daily gives good results 
as a sedative and antispasmodic. Aconite with Ipecac and cherry-laurel 
water, is very efficient as a preventive or abortive remedy (Dervieux); 
in all acute congestions of the respiratory passages (P). Lobelia in the spas- 
modic stage, is well tolerated by children, Tfl.x of the tincture every hour for a 
child 2 years old, and an additional dose when the cough is imminent (R, P). 
Amyl Nitrite, with Phenol, in a steam atomizer, has proved a very efficient 
inhalation (Bayliss). Ipecacuanha, useful in many cases (R); TTlj for 5 years 
of age, every hour or two, gives the greatest relief (P); when bronchitic or 
pneumonic complications, combined with Ammonium Bromide (Wa). 
Bromides, relieve spasmodic element (B) ; that of Ammonium will readily cure 
many cases; gr. ij or iij ter die for infants (Wa). Camphor Monobromide 
gr. v three or four times daily, is serviceable (B). Cannabis, the tincture 
TTlij-viij as per age every 3 or 4 hours, lessens the frequency and intensity of 
the attacks (Burton). Ichthyol internally Tflj-iij, increased to Tfl.x-xv daily, 
also a 3 per cent, glycerin solution by inhalation (Maestro); gr. j increased 
to gr. iij every 4 hours, gives good results (Souther). Phenol, pure, with 
steam atomizer 2 or 3 times a day, the spray delivered 4 to 5 feet away 
from the patient (Baumel). Resorcinol in 1 to 300 solution, applied to the 
glottis every 4 hours ( Wiltse) ; applied to the perilaryngeal mucous membrane, 
has aborted an attack at the outset in 24 hours, has cured well-marked cases 
in from 9 to 14 days, and is a perfect method of prophylaxis for children living 
with those suffering from the affection (Moncorvo). Naphthalene, burned 
in the patient's room, is of high value, as a palliative agent (Chavernac). 
Hydrogen Dioxide, the solution, in drachm doses diluted with 2 or 3 of water, 
internally, cuts short the paroxysms and lessens the duration of the disease. 
Benzol, is a reliable pulmonary antiseptic, and has been used for many years 
in this affection with unvarying success (Robertson); the vapor may be dif- 
fused throughout the room, carefully avoiding a light or fire. Ouabain, 
in doses of gr. T oW every three hours, is highly efficient in all stages of this 
affection (Gemmell). Alum, when acute stage is over and no complication 
exists, gr. ij— vj every three hours or less every hour, in glycerin or honey (R). 
Conium, or the Hydrobromide of Conime, in doses of gr. - s \ to gr. § according 
to age, an efficient remedy (W). Drosera, small doses are effective (Murrell) . 
Hydrocyanic Acid, is serviceable in cough from habit after cessation of 
whooping-cough proper, or in the nervous sympathetic cough of the mother 
(P). Formalin, as spray, is quite efficient. Cocaine, a 5 per cent, solution, 
painted on tonsils, fauces, back of tongue, and if possible on larynx, is very 
efficient (Labrie). Chloral, gr. v-x in spasmodic stage, relieves quickly (B); 
gr. iij-viij every 4 hours (Porter) ; to temporarily suppress the motor disturb- 
ance (W). Valerian, said to control the paroxysms (R). Nitric Acid, well 
diluted in sweetened water, after the subsidence of the catarrhal stage (B). 
Gelsemium, in spasmodic stage (B); its employment seems plausible in 
this spasmodic affection (W). Sodium Benzoate is said to be an efficient 
remedy. Zinc Sulphate in doses of gr. J-j with Extract of Belladonna, 
gr. J-J, has a varying degree of success (B). Lactucarium, the syrup as a 
vehicle for cough mixtures (B). Petroleum on rags around head of the bed, 
is highly efficient (Hildebrandt) . Manipulation of the lower jaw by pulling 



PHARYNGITIS. 



771 



it down and forward, checks paroxysm by controlling the glottis spasm (Sobel) ; 
is contraindicated only when food is in the mouth or esophagus. Vaccine, 
several investigators who have used a stock vaccine of the pertussis bacillus 
claim that, used in small and appropriate doses, the severity of the paroxysms 
of coughing is lessened, and the whole course of the infection shortened; be- 
sides this, they assert, it decreases the danger of a complicating bronchopneu- 
monia (K). When the disease is unusually severe and the prognosis is bad, 
a vaccine may be administered in doses of 25,000,000 if the patient is over 
4 years of age (K). The pneumococcus and bacillus influenzae are fre- 
quently associated, and a mixed vaccine of these micro-organisms may be 
of special aid in the later stages of the disease (K). Dr. E. E. Graham gives 
the following results and conclusions: Of the 24 reported cases, 7 were appar- 
ently not benefited by the treatment, the disease evidently pursuing its 
usual course in about 29 per cent. Seventeen patients, or about 71 per cent., 
were apparently benefited by the treatment. I believe the dose could and 
should be increased beyond 40 million, especially for severe cases; 60, 80 or 
100 million will probably be a more efficient dose. The results obtained in 
these 24 cases warrant, in my opinion, a more extensive trial of the vaccine. 
Fresh Air, day and night is most essential (O) ; except when grave compli- 
cations the child should be kept out of doors the most of the day in fine 
weather, and the room should be constantly aired at night. Abdominal 
Binder in over 500 cases 87 per cent, showed marked improvement in the 
checking of vomiting and gain of weight (Kilmer); is of very great help, 
especially for infants, in whom the results are wonderful (Cassidy). Diet 
should be bland and strengthening, the food given in small amounts, 
preferably after paroxysms. [Compare Cough.] 



fy Chlorali Hydrati, 5 j. 

Potassii Bromidi, 5ij. 

Syr. Pruni Virgin., 

Aquae, aa § j. 

M. Sig. — A teasp. thrice daily for infants 
in the convulsive stage. (Dessau.) 



1$. Bromoformi, TTJJxvj. 

Glycerini, 5jss. 

Tinct. Cardamom. Co., 

Alcoholis, aa 5ij- 

M. Sig. — A teaspoonful at commence- 
ment of the paroxysm. (Bedford.) 



Pharyngitis. 

Aconite and Belladonna, for acute attacks (B); when high temperature 
(R). Belladonna, is very useful, relaxes the pharyngeal muscles (W). 
Capsicum, 5 j of the tincture to O J of water, as gargle in the very early stage 
only (R). Salicylates when there is a rheumatic diathesis (W). Ammonium 
Chloride, gr. ij with Tfl,xv of Tinctura Cubeba?, every half hour, often con- 
trols acute pharyngitis; when a gouty diathesis exists add Tltx of the Am- 
moniated Tincture of Guaiac, and give every hour (Smith). Silver Nitrate, 
gr. v-xx to the §, on sponge probang, successful if systematically applied 
(B); in early stage of inflammation; also on brush, or as spray in the chronic 
form (R); the solid stick to each diseased follicle, after scraping (A). Pro- 
targol in 5 per cent, solution applied by a swab, proved very efficient in a 
severe case (Van Hoesen). Ichthyol is the best remedy for dry pharyngitis 
(Ertler); applied locally undiluted, followed by an ointment of 10 per cent, 
strength (Berens"). Potassium Chlorate has an almost specific effect in limit- 
ing the pharyngeal inflammations of children (Southworth) ; as lozenge to 
stimulate the follicular secretions and restore their healthy condition (A). 



77 2 PHIMOSIS — PHLEBITIS. 

Alum as gargle in chronic pharyngitis (R). Xanthoxylum, a decoction of the 
bark locally to throat, and TUx-xxx of the fluidextract thrice daily, a very 
successful remedy for chronic pharyngitis (B). Tannin, by insufflation 
to affected surface (B). Cubeb, powdered, locally, useful (B). Glycerin, 
pure, locally with Tannic Acid, very serviceable (B); in chronic inflammation 
of the throat (R). Hydrastis, the fluidextract locally, also TTtv-x internally 
(B). Alcohol, diluted, as gargle in relaxed throat (R). Cimicifuga, when 
pharynx dry and spotted over with inspissated mucus (R). Ipecacuanha, 
the wine as spray in non-inflammatory sore throat, with hoarseness from 
congestion of vocal cords (R). Pomegranate Bark, as a gargle (P). Re- 
sorcinol, in strong solution, a very efficient application (Tymowski). Zinc 
Sulphate, as gargle, occasionally employed in relaxed throat (R). In- 
halation of vapors, or of pulverized fluids, by the atomizer, found very 
beneficial (Wa) . Purgation, a Calomel or saline purge, and steam inhalations, 
meet the indications in most acute cases (O). Tobacco smoking must be 
stopped if a cure is to be effected in chronic pharyngitis (O). Food, of 
piquant kind, spices, pepper, mustard, etc., should be strictly prohibited; all 
fluids should be used as a moderate temperature (A). Water, by throat 
compress at night, relieves; also in daytime, in obstinate cases. Rest, to 
voice and cultivation of beard, are useful aids. [Compare Throat, Sore, 
Tonsillitis.] 

]$. Tinct. Aconiti, 1$. Aluminis, 5j~iv. 

Tinct. Belladonnae Fol.,. . . aa 5ss. Sodii Boratis, 3iij- 

Tinct. Guaiaci Ammon., .... Sss. Glycerini, 

Syr. Limonis, §ss. Tinct. Myrrhae, aa 5iv. 

Aquae Cinnamomi,.. .q. s. ad §iv. Aquae q. s. ad Sviij. 

M. Sig. — A teasp. every 3 hours for \ M. Sig. — Use as an astringent gargle, 4 

acute pharyngitis. j or 5 times a day. 

Phimosis. 

Belladonna, as ointment, the extract 7 to 20 parts of Lard, has proven 
effectual (Wa). Cocaine or Eucaine, in 1 or 2 per cent, solution, by injection 
at several points around the edge of prepuce, as local anesthetic during opera- 
tion. Chloroform or Ether, by inhalation, as a general anesthetic before 
attempting reduction of paraphimosis (Wa). Iodoform is the best of all 
dressings after division of the prepuce in specific or suspicious cases, where it 
is best to allow healing to take place by granulation (Hirsch). Iodomuth or 
Aristol, as dressing in place of Iodoform (Id). Reduction of paraphimosis by 
bimanual manipulation, may be facilitated by a dusting powder of Boric Acid 
and Lycopodium, which is better than a lubricant (Id). Operation is cir- 
cumcision for phimosis; division of the prepuce dorsally on the median line in 
paraphimosis (Id). 

Phlebitis. 

Mercury, in frequent and liberal doses, to early and decisive constitutional 
impression; the best form being Calomel or Blue Mass (Gross). Collargol 
by inunction cured a case of crural phlebitis following a protracted broncho- 
pneumonia (Van Zandt). Sodium Nucleinate, gr. v by injection into the 
muscles once or twice daily. Ichthyol in 25 per cent, glycerin solution ap- 
plied on lint, gave very good results in a severe and apparently hopeless case of 
lymphangio-phlebitis of the leg (Robinson). Rest, fomentations, poultices, 






PHLEGMASIA ALBA DOLENS — PHTHISIS. 773 

early incision of abscesses, aperients, Opium to relieve pain and insure quiet of 
mind and body (D). Blisters, over the course of an inflamed superficial 
vein (R). Diet, nutritious, also wine, especially if great loss of blood (D). 
Stimulants, as Quinine and Iron, especially the tincture of the Chloride, also 
milk-punch, are needed to combat the depression which is sure to arise; the 
disease is always dangerous and often fatal (Gross). Incisions, must be freely 
made if abscesses form, and the internal organs watched for multiple ab- 
scess. Ulceration, if it occur, must be watched for hemorrhage, which should 
be arrested by compression and styptics (Gross). [Compare Phlegmasia, 
Varicosis.] 

Phlegmasia Alba Dolens. 

Belladonna, and Mercury, equal parts, as ointment, often of much benefit 
(Wa). Blisters, in early stage; are extremely useful if judiciously employed 
(L). Ichthyol ointment may prove beneficial. Ammonium Carbonate, 
often valuable where great prostration; full doses (Wa). Hydrochloric 
Acid, 5 j of dilute acid in Oij of Barley-water, with 5ss of Potassium Chlorate, 
to be taken daily (Mackenzie). Opium, large doses internally, with leeches 
and anodyne ointments (Wa) ; Laudanum, sprinkled on hot fomentations, if 
pain severe ^L). Leeches, of great service during the acute inflammatory 
stage (Wa). Bandaging, when the more acute symptoms subside; at first 
with flannel, afterwards with ordinary roller bandage (L). Regimen, should 
be tonic (L). Water, by compresses in active stage; hot and cold douches, in 
chronic form. Rest, and elevation of the part, are necessary. Incision and 
drainage, if abscesses occur. 

Phlegmon. 

Aconite, or Belladonna are certainly efficacious; Aconite best (R). Phe- 
nol, injections; a 2 per cent, solution (B); are used with great success 
(W); deep injections in phlegmons of all grades and characters (Hueter). 
Iodine by injection after evacuation (B). Incisions, multiple incisions, and 
the old-fashioned flaxseed poultice to set up staphylococcic inflammation, 
and thereby shorten the course of the case in wooden phlegmon (J. C. Da 
Costa). [Compare Carbuncle, Erysipelas, Gangrene, Inflammation, 
Suppuration.] 

Phthisis. * 

Creosote acts only as a stimulant expectorant; is directly curative, at 
least in the initial stage of the disease (Frantzel), promotes the sclerotic 
change by means of which recovery is found to occur (Jaccoud); Morson's 
beechwood Creosote should be used, it gives the best clinical results of any 
one remedy (Burroughs). Guaiacol, the chief ingredient of creosote and 
equally efficient; the Carbonate in doses of gr. vj to viij, up to 3ss daily, is 
better borne and an efficient substitute; gr. iv four times a day increased to gr. 
vj six times a day, also inunctions of Europhen in Olive Oil, 3 j in §ijss, has 

* Although the literature of the past, and to a limited extent, of the present, contains 
numerous references to drugs which are alleged to be of near specific value, it is important 
to keep in mind that no positive proof has ever been adduced to warrant such a conclusion. 
Many of the statements contained in this paragraph are retained as a matter of reference. 
The cure or arrest of a given case of tuberculosis depends upon the early recognition 
of the disease and the prompt application of rest in the fresh air with an abundance of 
good food. These measures may be aided by the judicial use of drugs. (Elmer H. Funk.) 



774 PHTHISIS. 

given excellent results in many cases (Flick). Guaiacol as antipyretic, TUxx 
for an adult rubbed into the skin of the abdomen once daily (Cain) ; TTlv-x 
hypodermically with Liquor Strychninae to combat depression, once or twice 
daily preceding the rise of temperature, the most certain antipyretic (Coghill). 
Benzosol, contains 54 per cent, of Guaiacol, which it yields up in the intestines; 
in doses of 4 grains, gradually increased to 12 grains, thrice daily, it has given 
results in phthisis, equal if not superior to those from creosote (Walzer). 
Creosotal, the carbonate of creosote, is better than Creosote itself or the phos- 
phate (Bernheim). Thiocol contains 60 per cent, of guaiacol, is less disagree- 
able in taste than other preparations of creosote of guaiacol (Braun) ; in doses 
of gr. iij-v every 3 hours, does not irritate the stomach and stimulates 
appetite. Styracol (guaiacol cinnamic ester), liberates free guaiacol also the 
strongly antiseptic cinnamic acid; is the best agent for giving guaiacol, es- 
pecially for cases with intestinal ulceration (Raw). Iodine should be more 
used than it is (Da C) ; the Bromine-Iodine compound solution hypodermically, 
each dose of 5j has of Iodine gr. ss, Bromine, gr. T \, Phosphorus gr. T ^, 
Thymol and Menthol of each gr. § (Ingraham) ; is directed against the organ- 
isms of mixed infection (Clarke) ; Menthol Iodine radio-active, as used by Dr. 
Szendefly of Budapest, always acts well, and cures in a very great many cases 
(B ernheim) . Iodoform internally, has proved extremely effective in all forms, 
as witnessed by numerous observers in various countries (S. Smith); though 
not one of the most active germicides, it is very destructive to the bacillus 
tuberculosis (B). Iodol may be advantageously substituted for Iodoform 
(B). Iodipin, the 10 per cent, solution by injection into muscles of the back, 
ameliorates the symptoms (Croftan). Europhen by inunction, with Creosote 
internally, has given curative results even in the breaking-down stage, and 
almost always cures incipient cases (Flick). Ichthyol in capsules, gr. v-xxx 
daily, is superior to creosote or cod-liver oil (Cohn); used in 150 cases with 
great benefit on all the smyptoms, also on the pulmonary lesions (Scarpa) ; 
used in several hundred cases with good results in a large majority (Williams). 
Ichthoform internally for diarrhea and pain, gives satisfaction (Schaefer). 

Arsenic, there is no general tonic more satisfactory (O) ; valuable in chronic 
forms as no other remedy; but not in caseous phthisis or where much hectic; 
may be given by stomach or fumigation (B); as cigarettes, useful in the 
diarrhea, probably diminishes temperature, caution required! (R); of great 
value in early stage, in later stages it is of no use (Da C); is often of great 
service in chronic cases (W). Sodium Cacodylate is more toxic than ordinary 
preparations of arsenic (Murrell); used hypodermically in doses of 5 to 10 
centigrams daily, it is free from unpleasant results (Gautier); under it certain 
forms, with excavations or with softening of the tubercles, are greatly im- 
proved (Letulle). Sodium Cinnamate internally and by intravenous in- 
jection, is more effective than any other remedy (Heusser); increases the 
leucocytes to 20,000 and is very efficient (Guttmann). Sodium Silicate 
inhibits the progress by inducing firm scars and coarse capsules, also by chang- 
ing the disintegration process into a fibrous condition (Kobert). Camphor 
in oil, by hypodermic injection, gives better results in cases with large cavities 
than all other remedies combined, and though not a specific it gives a new 
lease of life, probably by setting up leucocytosis and inflammation at the site 
of infection (Alexander) ; renders the patient more comfortable and prolongs 
life (Koch). Camphoric Acid, gr. x-xx dry on the tongue, is very efficient 
against the night-sweats. Collargol by inunction, removed the fever and 



phthisis. 775 

rapidly improved the general condition, in case of acute ulcerative broncho- 
pneumonic tuberculosis (Netter). Formalin by spray in the early stage 
(Green); inhalation of the vapor from equal parts of Formalin and Alcohol in 
a special apparatus containing wire netting and gauze, as a pulmonary anti- 
septic and stimulant (Shallcross). Aurum, the Bromide of Gold and Arsenic 
internally, with inhalations of Papoid as glycerole by the atomizer, gave 
astonishing improvement in two cases of fibroid phthisis with cavities, due to 
neglected pneumonitis; also in a case of grinders' consumption (E. A. Wood). 
Tuberculin and its derivatives are fully described and discussed in Part I 
of this book. Streptococcus Antitoxin prepared by the Hubbert process, 
proved very efficient in cases of mixed infection (Foss). Nuclein has 
been used with good results (Vaughn). Cod-liver Oil, holds first rank as a 
remedy and food in the chronic forms; a teasp. after meals ter die is enough; 
when not well borne may be combined with Aqua Calcis, Comp. Tinct. of 
Gentian; or with Ether when not digested (B, R); is of great utility by im- 
proving nutrition, and by affecting the tubercle; give §ss thrice daily one 
hour after meals, with Tfl.v-xv of Ether, or an equal quantity of malt or 
whisky; do not give it in hot weather (Da C). Alcohol, an important remedy; 
may be given with Cod-liver Oil; or Spt. Frumenti, 5 j~5ij with some bitter, 
immediately after meals; if it disagrees, it harms: curiously, it induces an 
intractable form of phthisis (B). 

Aconite, in small doses for the irritative fever, is a remedy of much value 
(Da C). Antipyrine, in a 2§-grain dose hourly for 3 doses daily, for the hectic 
fever. Acetphenetidin, better borne and efficiently antipyretic; extensively 
employed in the hectic of phthisis. Cinchona, for the hectic and sweats, 
Quinine, gr. xv-xx (B); if small doses fail, a dose of 6 or 8 grains at once, or 
in portions repeated hourly (R). Ipecacuanha, the wine as spray to throat 
when bronchial asthma and emphysema combined with fibroid phthisis (R) . 
Oil of Cloves, TTliij-v in capsule or milk, is very efficient in advanced cases 
where cavity formation has occurred and severe paroxysms of coughing with 
excessive amount of sputum are prominent symtpoms (Landis). Opium, or 
Morphine, in a viscid vehicle for cough, or as lozenges when cough due to in- 
flamed throat (R) ; must in time be given for the cough, which is an irritative 
one. Codeine, gr. J to | in simple elixir, is useful and does not constipate (Da C) . 
Apomorphine, with Morphine, makes a good combination for many symp- 
toms, especially for dyspnea, continual cough and thick tenacious mucus (Br). 
Heroin is one of the best agents for the cough, dyspnea, and night-sweats 
(Hyams). Dionin is an efficient cough remedy. Orexin, the Tannate is 
highly efficient for the anorexia (Kolbl). Sodium Glycocholate to promote 
the digestion of fats (Keown). Hedonal is particularly efficient against the 
insomnia (Reisman). Pyramidon, the Camphorate, gr. xv daily, reduces 
the temperature and the night-sweats (Lyonnet). Cannabis in aqueous 
solution relieves cough and aids the patient in many respects (Lees). Fer- 
rum, often prescribed, has no especial influence on deposit (B); is prescribed 
in tuberculosis (Tr) ; the Liquor Ferri Perchloridi 3 j ad § j aquae, the most 
serviceable local application in laryngeal phthisis, diminishing irritability of 
the mucous membrane, and quieting cough (Mackenzie). Benzoin, as in- 
halation, to lessen cough and expectoration (R). Mineral Acids, for the 
indigestion; especially the dilute Hydrochloric (B). Prunus Virginiana, has 
a domestic reputation, probably due to its influence over cough; the syrup is 
much used as a vehicle for cough- mixtures (B). Hypophosphites, are very 



776 PHTHISIS. 

useful in chronic cases (B); have no special effect (Da C). Digitalis, as an 
antipyretic; deranges intestinal canal therefore injurious in phthisis (B). 
Copper Phosphate, in nascent form soluble in an alkaline body, is held to be 
specific by Prof. Luton of Rheims; his formula contains Neutral Acetate of 
Copper 0.15, Cryst. Phosphate of Sodium 0.75, Glycerin and Pulv. Licorice, 
aa q. s. for one pill. Copper Sulphate, gr. ^, or Silver Nitrate, gr. i, or 
Bismuth, gr. xx, for the diarrhea (Da C). Chloroform by inhalation in small 
quantities for the cough and dyspnea, gave extraordinary relief to a noble 
patient of mine during the last 8 months of his life (Spencer Wells) ; 3 Mj by 
inhalation twice daily, continued for a -long period of time, will give better 
results than any other known remedy (Flick); Creosote, with Chloroform as 
a vehicle, may be taken into the lungs from a globe nebulizer, producing the 
most happy results (Id). Chlorine gas, by inhalation, also the hypodermic 
use of Iodine and Chloride of Gold and Sodium, extensively employed in pul- 
monary consumption with good results (Gibbes and Shurly). Hydrogen 
Dioxide, the solution internally, in doses of 3 j to iij diluted with 3 parts of 
water, renders good service by promoting digestion, palliating cough, and 
increasing the activity of chalybeate remedies. Terebene, with Thymol 
and Phenol, equal parts of each, of which 3ss to a pint of hot water as an 
inhalation; is extremely useful for the dyspnea (Camman). Verbascum, the 
Mullein-plant, has long been a popular remedy in phthisis; it facilitates ex- 
pectoration, improves the general condition, and palliates the cough. Cal- 
cium Phosphate, in the diarrhea, and in chronic forms of phthisis with little 
or no fever (R). Calcium Iodide has been employed by me and is preferred 
to all the other iodides (Malem) ; dose gr. j-iv, largely diluted. Cimicifuga, 
useless in tuberculosis, but sometimes it relieves cough, improves appetite, 
lessens intercurrent bronchitis, and so improves the patient's general con- 
dition (Wa). Cocaine, locally for the throat symptoms, to be applied just 
before meals are eaten (Da C). Sanguinaria, helps expectoration, and re- 
vives the enfeebled stomach (P). Camphorated Naphthol, undiluted, or 
Tfl.ij in olive oil hypodermically, used with very good results in 15 out of 32 
cases so treated (Reboul). Menthol in 12 per cent, solution in pure olive oil, 
by intra-laryngeal injection daily, gives good results, and in some cases 
caused remarkable improvement (Brookhouse) . Eucalyptus leaves in powder 
burned, the fumes inhaled all night and for several hours during the day, 
has greatly relieved many cases (Schneider). Oxygen is contraindicated in 
febrile cases, in which it can only hasten death. Baths, sea-bathing, in 
chronic cases with little or no fever, without active deposition of tubercle, or 
scrofulous pneumonia; Turkish baths for the cough (R). 

Aliment, the cure is a question of nutrition; digestion and assimilation 
control the situation (O) ; food should be nutritious and digestible, malt liq- 
uors better than wine or spirits; extract of malt, cod-liver oil, plenty of meat, 
and alcohol in moderation (Da C); warm clothing, bathing and friction of 
skin, moderate exercise, and a suitable climate. Forced Alimentation, when 
anorexia appears, and superalimentation at all times, necessary to successful 
treatment; washing out the stomach daily by syphon- tube, with warm water 
alkalinized with Borax, and then feeding through the tube (Robinson). 
Kumyss is an especially useful food in the incipient cases, to promote nutri- 
tion (Brush). Climate, the best by far is that of Egypt or Algeria; next com- 
ing New Mexico, Southern California, especially in the desert along the 
Colorado River, North Carolina and portions of Georgia and Florida; the latter 



PITYRIASIS. 



777 



being especially suitable for cases having a co-existing bronchitis; for some 
cases Colorado is very good, and the Adirondack region for early cases in 
which there is no tendency to hemorrhage (Da C); the requirements are. a 
pure atmosphere, an equable temperature not subject to rapid variations, 
and a maximum of sunshine; given these three factors, it makes little differ- 
ence where a patient goes, so long as he lives an out-door life (O). Fresh Air 
and out-door life are most valuable, the patient should be freely exposed to 
fresh air night and day, also to all the sunshine possible. The purity of the 
atmosphere is the first consideration (O). Therapeutic Pneumothorax has 
been advocated by various authorities for the treatment of pulmonary tuber- 
culosis. It should be limited to those cases in which the tuberculosis is 
fairly well limited to one side, is active and progressing in spite of rest, fresh 
air and good food, and in those cases in which hemoptysis persists in spite of 
all treatment and threatens the life of the patient. [Compare Cough, Hectic 
Fever, Hemoptysis, Laryngitis Tuberculous, Meningitis tuberculous, 
Peritonitis tuberculous, Perspiration, Tuberculosis Acute, Tuber- 
culous Affections. I 



1$. Quininae Sulphatis, gr. xviij. 

Digitalis, gr. vj. 

Opii Pulveris, gr. iij. 

M. ft. pil. no. xij. Sig. — One pill thrice 
daily, for the irritative fever. (Niemeyer.) 



. Iodoformi, 

Creosoti, 

Benzoini, 

Bals. Tolu, aa gr. j. 

In pill, of such 2 to 4 daily. (Huchard.) 



]$. Europhen, 3 j- 

01. Rosae, Try. 

01. Anisi, 5j- 

01. Olivae., gijss. 

M. Sig. — gss by inunction at bed- time; 
wash off with bay rum or whisky in the 
morning. (Flick.) 



fy. Arseni Iodidi, 

Strychninae Sulph., 

Hydrarg. Chlor. Corr.,...aa gr, j. 

Quininae Sulph., 

Iodoformi, aa 5ij. 

M. ft. pil. no. xl. Sig. — One thrice daily 
as a tonic in tuberculous cases. (Mann.) 



1$. Creosoti (beech- wood),. . . . Trjrvi. 

Glycerini, § j. 

Spt. Frumenti, §ij. 

M. Sig. — For one day's use, as directed 
in §ss doses. (Robinson.) 



I*. 



Codeinae, gr. xv-xx. 

Alcoholis, q. s. ad solv. 

Potassii Cyanidi, gr. xij. 

Syr. Pruni Virgin., §iv. 

Aquae, q. s. ad 5 vj. 

M. Sig. — A teasp. 4 to 6 times daily, for 
the cough. (Potter.) 



Pityriasis Maculata et Circinata. Pityriasis Rosea. 

As some observers are inclined to look upon this disease as of gastro- 
intestinal origin, it is well to direct the attention, especially in severe cases, 
to such gastro-intestinal correctives as are indicated. Other dermatologists 
are strongly inclined to look upon this disease as of parasitic origin and 
to direct treatment along that line entirely. Personally, I believe a combi- 
nation of both methods the preferable way. As the disease usually 'runs 
a limited course of from three to six weeks, the principal object is to allevi- 
ate subjective symptoms. Boric Acid in saturated solution, or 1 drachm 
to the ounce of petrolatum is valuable in the treatment of this disease. 
Phenol, 5 minims to the ounce should be used if there is any itching. Salicin 
in 15-grain doses 3 times a day is advocated by Crocker. Salicylic Acid, 
2 to 5 per cent, in an ointment base is at times of service. Sodium 
Bicarbonate Baths, 2 to 4 ounces to the tub of water, is of considerable 
value in loosening the scales. There is no objection to daily bathing. Sul- 



778 PLAGUE. 

phur is one of the best drugs in the treatment of this disease, from J to i 
drachm to the ounce of petrolatum or lanolin. 

Plague. 

Prophylaxis. — It is highly important to exterminate rats by trapping, by 
a careful disposal of the garbage and other particles of food for the rat, which 
if available will prevent the inducement of the rat to eat poisoned bait or 
bait in traps. Where rats are on shipboard fumigations of sulphur dioxide 
are usually employed. In pneumonic plague the infection is contained in 
the droplets of sputum projected into the air when the patient coughs. The 
attendant should be protected by a gauze mask and goggles for the eyes. 
Immunization. — "The best-known bacterial prophylactic is that of Haffkine. 
Stalactite bouillon cultures are grown in flasks for 5 to 6 weeks. The organ- 
isms are then killed by heat at 65 C. for 1 hour. Phenol (J per cent.) is then 
added and from 0.5 to 4 mils injected according to the age and size of the in- 
dividual. Ten days later a still larger amount is injected. The reaction 
following these injections is apt to be quite severe" (Stitt). Recent reports 
show that of 118,148 inoculated persons the plague incidence was approxi- 
mately 8 per 1000, while among 321,621 non-inoculated the incidence was 
34 per 1000 (Stitt). Strychnine, should be used as a routine treatment and 
commenced early in the disease; also with or without Ammonium Carbonate 
in the later stages when the pulse begins to fail (Lowson). Phenol pure, 
TTliv of the melted crystals with gr. iv of Quinine Sulphate internally every 
4 hours, also a phenolized oil, 1 in 30, externally to the glands, gave a recovery 
rate of 75 per cent. (Seymour); gr. xij every 2 hours in mixture of orange 
syrup and chloroform water, used in 143 cases in 1903, with a mortality of 
only 36.4 pfer cent. (Thomson). Mercuric Chloride and Phenol solutions, 
were injected into the glands with temporary benefit, during the Hong-Kong 
epidemic (Payne); good results followed the injection of Mercuric Chloride 
and Potassium Iodide (Cantlie). Iodine, as liniment for indolent bubonic 
swellings (Mn). Calomel in full dose, followed by a saline, usually relieves 
the vomiting (Lowson) ; a purgative dose followed by a saline in 6 hours at 
beginning of treatment (Jackson). Camphor, or Ammonia, Amyl Nitrite, 
Nitroglycerin, should be kept ready for use to combat sudden cardiac failure 
(Id); cardiac stimulants are still the mainstay (Elliot). Adrenalin Chloride, 
TTlxxx by mouth every 4 hours, or TTlxx in the vicinity of the buboes, of the 
1 in 1000 solution, used in 50 cases with a mortality of 26 per cent. (Thornton). 
Morphine, is by far the best hypnotic if given with judgment, gr. f-J hypo- 
dermically at the onset to relieve suffering and induce sleep, later on gr. f 
suffices (Id). Hyoscine, gr. ^io'^hi or Chloral, gr. xx with Potassium Bro- 
mide gr. xxx, are of service for the same purpose (Id). Salol, gr. x every 4 
hours, as an intestinal antiseptic for the diarrhea, if urgent (Mn). Bella- 
donna with glycerin, applied to the buboes in their early stage; if red and 
inflamed they must be poulticed and when softening occurs they should be 
incised and treated with Iodoform (Mn). Cold, by ice-bags to the head and 
neck, when headache and high fever (Mn) . Water, sponging the body with 
warm water every hour to reduce hyperpyrexia, is safer than antipyretic drugs 
(Id). Serum Treatment, "The only treatment which has any curative 
value is that with antiplague serum. This would appear to be of consider- 
able value in bubonic plague provided it is administered in the first day or 



PLETHORA — PLEURITIS. 779 

two of the disease. It must be given in large amounts, from 50 to 100 mils 
or even to the extent of 250 mils. Intravenous administration gives a better 
chance for success in desperate cases. In septicemic and pneumonic plague 
the use of serum has been without results" (Stitt). Diet would seem to be 
of minor importance in a malady of such short duration. Incision of buboes 
and carbuncles when suppuration occurs, also drainage and antiseptic dress- 
ings (Jackson). Extirpation of the bubo will not remove the source of 
infection; and may be dangerous. 

Plethora. 

Aconite, is useful for affections of plethoric subjects, and is decidedly the 
best remedy for apoplexy in the plethoric (P). Arsenic, is used with advan- 
tage when there is determination of blood to the head (Wa). Sulphur, as a 
mild purgative for plethora from cessation of the menses (Wa). 

Pleuritis. 

Veratrum Viride, gtt. viij of tincture every 3 hours, with a drop added to 
each dose until the pulse is reduced or nausea occurs ( Wa) ; opinions differ as to 
whether it should be used in sthenic or asthenic forms (R). Tartar Emetic, 
in early stages and young plethoric subjects, when much febrile action, 
small doses, gr. T V to f , may be useful (Wa). Opium, cannot be too highly 
extolled (P); is especially beneficial; gr. ss of Morphine hypodermically at 
the beginning will often cut short an attack; during the disease its effects are 
very beneficial; a slight physiological effect should be maintained (B); Mor- 
phine for severe pain (R). Atropine as a stimulant to the circulation when 
sudden collapse occurs in young children (W). Aspirin gives excellent results 
in both the dry and exudative forms (Merkel). Gelsemium is highly 
serviceable (B); the dangers attending the large doses required counter- 
balance its advantages (W). Potassium Iodide to promote absorption of 
effusion, given steadily for a long time (R); is of value (W). Iodine painted 
over the chest daily on each wall alternately (B); in chronic pleurisy with 
large effusion (W) ; as injections with great benefit and without risk, in empy- 
ema and hydrothorax (P). Burgundy Pitch, the plaster externally as a 
mechanical support (P). Pilocarpus, in subacute cases to remove fluids 
(Caro); or Pilocarpine Nitrate, gr. \ bis die, for children (Vigier); is too 
depressing and therefore unsafe (Smith). Sodium Chloride, 5ss in §j of 
water, flavored with Licorice, in tablesp. doses every 3 hours, often very useful 
in causing absorption of pleuritic serous exudations; but is contraindicated when 
exudation is purulent (B) . Theocine gr. iv thrice daily, as a powerful diuretic, 
efficient in pleuritic effusion (Meinertz) . Diuretin has removed a large effusion 
by its diuretic action. Antipyrine promotes the absorption of pleuritic effusions. 
Guaiacol painted on the chest, remarkably promotes absorption. Blood- 
letting, by cups or leeches, useful by reason of counter-irritation produced, 
and to relieve pain, only in robust sthenic cases (B). Blisters, often greatly 
abused; are harmful during inflammatory stage (B); their counter-irritant 
effect is often of service by affecting favorably the disease process, and by 
hastening the removal of the effusion (W) ; are of no special service in the 
acute stages, though they relieve the pain (O). Poultices, large, hot, and 
frequently renewed (R) ; the whole chest may be enveloped (W). Water, the 



780 



PLEURODYNIA — PNEUMONIA. 



cold wet-pack to the chest is probably better than a hot one, pinned tightly 
to limit movement of the chest- walls (B) ; the ice-bag may be used as in pneu- 
monia (O). Strapping the side gives great relief (O). Aspiration, to be done 
as soon as the presence of fluid is made out, is the only treatment needed for 
pleurisy with effusion; in fortunate cases there is no more pleurisy or effusion 
within 24 hours after aspiration, in a large number the disease is cured within 
a week, and none should be sick longer than 2 weeks if so treated (Delafield); 
the results obtained by Delafield in 200 cases treated by early aspiration have 
never been equalled by any other method (O). Diet in the early stage should 
be liquid, with rest in bed; dry diet with frequent saline purges, given in con- 
centrated form before breakfast (Hay) ; recently it has been advised to use a 
salt-free diet (O). Antituberculosis measures should be instituted in a large 
majority of cases of so-called simple pleurisy, as experience teaches that many 
of these are evidences of tuberculous infection, even in the absence of definite 
signs of pulmonary involvement. [For Chronic Pleurisy see Empyema; and 
also compare Hydrothorax, Pneumonia, Pneumothorax.] 



fy Potassii Acetat., 5j- 

Infusi Digitalis, q. s. ad §iv. 

M. Sig. — Teasp. every 3 hours to a child 
of 4 to 6 years, in the second stage. 



]$. Morph. Sulph., gr. j. 

Tinct. Aconiti, ngxxiv. 

Liq. Potassii Citratis, §ij. 

M. Sig. — A teasp. every 3 hours. 



Pleurodynia. 

Cimicifuga, curative when rheumatic, and valuable in sympathetic cases 
from irritability of uterus (P); or uterine derangements (R, Wa). Croton 
Oil, in obstinate pleurodynia especially when blackened feces (R). Bella- 
donna, the plaster or liniment; the latter generally best (R). Chloral, made 
liquid with an equal weight of Camphor and rubbed in gently, often 
affords instant relief (R). Ichthyol as a liniment, also internally in doses of 
ttlij twice or thrice daily, gives good results (Schmitz). Sodium Salicylate, 
gr. xv-xx, every 2 or 3 hours, useful in most cases (Hughes). Ether, as 
spray, sometimes immediately and permanently removes the pain (R). 
Opium, as liniment rubbed in after warm fomentations (Wa) ; or a hypodermic 
injection of Morphine (R). Iodine, as liniment painted on the chest, often 
relieves where mustard fails (R). Blistering, often successful when other 
means fail; sometimes strong vesication is necessary (R). Rest, is important 
and may be obtained by strapping the affected side with strips of adhesive 
plaster. Poultices, very hot, followed by application of lint and oilskin; 
Belladonna Liniment generally better (R). Mustard, as a poultice, is gen- 
erally efficient, and can be renewed when the pain returns (R). Photo- 
therapy, the ultra-violet rays are specific for relief of the pain (Rosenberg). 
[Compare Myalgia, Neuralgia, Pleuritis.] 



Pneumonia. 

Creosote gtt. j every 3 hours gives good results (Van Zandt). Creosotal 
TTlxvj every 3 hours has given satisfaction (Philips) ; gives remarkably good 
and uniform results (Weber) ; in acute pulmonary inflammations its use is one 
of the great life-saving discoveries of the century (Van Zandt). Guaiacol, 
rubbed into the cleansed skin of chest or abdomen, in average doses of Tfl.xx 
for adults, Tflx for a child of one year, repeated once or twice, but only after 12 



PNEUMONIA. 781 

hours, used in 50 consecutive cases without a death (Cain) ; may cause dan- 
gerous collapse (W) ; the Carbonate (Duotal), gr. xx in emulsion every 2 hours, 
gave excellent results in a case of double pneumonia (Thomson); in 13 cases 
successfully treated it was practically the only remedy used (Cassonte) ; is 
almost specific in this disease (A. H. Smith); preferred to the salicylates 
after the stage of congestion, in feeble cases and when cardiac lesions exist 
(Bridges). Quinine or Salicylic Acid, to reduce temperature (R) ; Quinine as 
a tonic in cases which are asthenic from the first (P); in conjunction with 
Aconite and Veratrum, gr. viij-xij daily at start, is beneficial (Da C). Qui- 
nine Salicylate is most useful as a tonic and general alterative (Sir J. Moore). 
Sodium Salicylate, in large doses, not less than gij daily, proved curative in 
72 consecutive cases (Liegel); has antibacterial power in pneumonia (A. H. 
Smith). Strychnine Sulphate, in addition to guaiacol or the salicylate, to 
obviate cardiac depression, also for its action on the nervous system 
(Bridges) ; in a full dose hypodermically, repeated if necessary, for impending 
cardiac failure; is more useful in 1 or 2 full doses than in smaller doses more 
frequently (Pye-Smith). Camphor, in dose of gr. vijss in sterilized olive oil 
hypodermically, is the best stimulant for heart failure (Thomson). 

Veratrum Viride, valuable (P); in the very incipiency (B); opinions differ 
as to whether it should be used in sthenic or asthenic cases (R) ; is largely used 
with the fallacious idea that it relieves congestion by dilating the vessels, 
which it does not do in therapeutic dosage, hence this use of the drug does not 
find a scientific justification (W) ; still holds a place to reduce the intensity and 
shorten duration of the attack, TTUj-v of the tincture every 2 hours (O). Digi- 
talis is credited of late with great power in controlling the course of the dis- 
ease (O) ; useful in late stage and in adynamic cases by sustaining the cardiac 
action (W); is of doubtful value; may be useful for high temperature, ische- 
mia, and low tension of vessels (B); as case goes on and circulation is to be 
further controlled, Digitalis is indicated (Da C); the best agent to slow the 
heart in infantile pneumonia, with Belladonna as an adjuvant (Brown). 
Phosphorus, especially when typhoid symptoms; approved by Fleischmann 
(R). Belladonna is useful in the first stage (P); Harley esteemed it highly 
in pneumonia (Wa); as an adjuvant to Digitalis in infantile pneumonia, to 
soothe the irritable nervous system and curtail superabundant secretion 
(Brown). Atropine as a stimulant to the circulation for cases of sudden col- 
lapse as seen in the pneumonia of young children (W). Tartar Emetic in full 
doses, formerly used as part of the so-called contrastimulant treatment, now 
abandoned (W); gr. § every 3 hours, also Calomel purgation and venesection, 
with blisters, gave a mortality of almost nothing in former times (Sheets). 

Antipyrine, all coal-tar antipyretics are dangerous to the heart and should 
never be used (Fussell); may be employed as an antipyretic (W); is more 
serviceable than quinine (Wa); with Camphor successful in all of 22 cases of 
croupous pneumonia so treated at the Lorn Hospital, Antipyrine gr. viij, 
Camphor gr. ij, Morphine Hydrochloride gr. T ^- in powder every one or two 
hours (Ivanoff). Camphor, in olive oil, in doses of from gr. j to gr. ij three 
or four times a day, hypodermically, in adynamic cases, used simultaneously 
with the above antipyrine and camphor powder (Id) ; in fibrinous pneumonia 
these injections lower the temperature about a degree and ameliorate the 
general condition; hypodermically a useful cardiac stimulant in emergencies 
(W). Opium, or Morphine by injection, sometimes needed for severe pain 
(R) ; Opium is very desirable in many cases, relieves the symptoms and ar- 



7§2 PNEUMONIA 

rests delirium (Wa) ; is often dangerous, as it reduces the cough, which is a 
necessary evil (Burt); narcotics are dangerous if much secretion in the air- 
passages (West). Ammonium Carbonate, at crisis for depression; in infusion 
of Senega (B); is useful late in disease when lung tissue breaks down (Da C). 
Ammonia, the Aromatic Spirit as a substitute for the Carbonate, in doses of 
5ss in simple elixir (Da C). Turpentine, as stimulant at crisis (B); 5j to 
5 iv of boiling water, the vapor to be inhaled as an irritant to provoke cough 
and expulsion of the products, in cases so exhausted that expectorants fail 
(Murray). Serpentaria with Ammonium Carbonate in low types of pneu- 
monia, as a stimulant for the crisis. Potassium Iodide gr. x-xv every 2 hours 
in milk night and day throughout the disease, has remarkably beneficial 
effect (Altshul); with the Citrates, and a fluid non-nitrogenous diet, to de- 
fibrinate the blood, thus discouraging hyperinosis and coagulation (Ewart). 
Ammonium Iodide with Arsenic to prevent the caseation of inflammatory 
products (R). Ethyl Iodide gtt. v-xx thrice daily by inhalation, is valuable 
in the catarrhal form (B). Sodium Iodide is useful in catarrhal pneumonia 
(Da C). Ipecacuanha, the wine in infantile pneumonia, should never be dis- 
pensed with, as it promotes expectoration, controls hemorrhage and regulates 
secretion (Brown). Senega, in advanced stages as expectorant, when cough 
is dry, irritating and painful, tightness and oppression of chest (P). San- 
guinaria as a contra-stimulant when the fever has abated and the graver 
symptoms have amended (P). Adrenal Extract gr. j-iij every 2 or 3 hours, 
as a powerful cardiac tonic (Gray). Serum. Recently as a result of the 
experimental and clinical studies made at the Rockefeller Institute, the spe- 
cific treatment of acute lobar pneumonia with anti-pneumococcic serum has 
been recommended. An essential to the successful use of anti-pneumococcic 
serum is the recognition of the fact that pneumococci morphologically and 
culturally alike, differ vastly in their immunological reactions. According to 
their immunological reactions they have been divided into four groups. The 
antipneumococcic serum used is derived from animals immunized against the 
specific type. In this way a serum of high potency has been obtained against 
organisms of Type 1, serum of less potency against organisms of Type 2, a 
serum of very slight potency against organisms of Type 3, and a serum of no 
potency against organisms of Type 4. Clinically the application of the 
serum, therefore, is of practical value only in cases due to pneumococci of 
Types 1 and 2. Sixty per cent, of the cases of pneumonia belong to this 
type (Cole). Fortunately there are few cases of Type 3, although the mor- 
tality is high and of the remaining number belonging to Type 4, the mortality 
is relatively low. Cole reports that " cases of Type 1 infection so far treated 
with serum is not large, but the results have been very encouraging. Sev- 
enty-two cases have now been treated by this method. Before beginning 
serum about one- third of the patients died. Of the 72 since serum treatment 
was commenced, 6 have died, a mortality of only a little over 8 per cent. 
Moreover, of these 6 fatal cases, one patient died late in convalescence from 
a pulmonary embolism, one died on the fifty-fourth day of the disease from 
a complicating general streptococcus infection, and two received serum treat- 
ment only when they were in extremis." (Pennsylvania Medical Journal, 
February, 191 7.) Cole states further that in regard to the administration 
of the serum " the amount required has differed in the different cases, depend- 
ing on the severity. Our plan is to give 80 c.c. and repeat this dose every 
twelve hours until the temperature and pulse rate fall. Some cases have 



PNEUMONIA. 783 

received 500 mils or even more; in other cases one to two doses have been suffi- 
cient. To guard against the administration of serum to patients who are 
sensitive to such injections, it is our custom to give to all pneumonia patients 
on admission to the hospital 0.5 mil of horse serum subcutaneously in order 
to desensitize them. By the time the type of organism is determined, in 
six to eight hours, we have considered it safe to go ahead with the treatment. 
So far in over 100 cases receiving serum of the various types there have been 
no alarming or unfavorable results. A large number of the patients receiving 
the large doses of serum suffer from serum sickness after a week or ten days. 
The symptoms, while sometimes distressing, are never serious, and if the 
serum is efficacious, this disturbance is of course negligible." 

Alcohol is adding poison to that already present (Anders) ; is dangerous, 
and with other anesthetic drugs is responsible for the increased mortality in 
this disease of late years (Davis); for alcoholic subjects, in asthenic cases, 
those of malignant type, and those of aged persons ( Wa) ; should be withheld 
during the early stage, and when there is a full, bounding pulse, any acute 
inflammation of the heart, embarrassment of the pulmonary circulation, 
much pulmonary edema or bronchial catarrh, or profound toxemia (Suther- 
land); give it when pulse becomes small or irregular, or compressible, and 
runs up to no or more, and for collapse due to failure of the cardiac centre, 
not for that caused by general toxic infection (Id). Oxygen is of doubtful 
benefit, and may be irritant, actually producing inflammation of the lungs, as 
shown by Lorrain-Smith; when used it should be allowed to flow from a 
nozzle held at a little distance, so as to be freely diluted with air (O) ; to do 
good must be employed early, and allowed to bubble through equal parts of 
alcohol and water, for when dry it is irritant to the lungs (West). Venesec- 
tion at the very onset in robust, healthy individuals in whom the disease 
sets in with great intensity and high fever, is good practice (O); in the 
first stage followed by sedatives and alteratives (Davis); is of very great 
value if a pint or more be taken (Rochester) ; replaced by the same quan- 
tity of normal saline solution by hypodermoclysis, a valuable procedure 
in cyanosed cases (Reyburn). Hypodermoclysis by 600 to 1000 mils of hot 
normal saline solution, when respiration is shallow, intermittent and irregu- 
lar, extreme cyanosis, almost imperceptible pulse, and coma with profound 
asthenia (Thompson); Saline infusions promote elimination and may help 
in tiding over a period of vascular depression (O) ; a liter may be allowed to 
run by gravity beneath the skin, and may be repeated 2 or 3 times in the 
24 hours, if necessary (O). Hydrotherapy for hyperpyrexia, is the most 
trusty weapon; the ice-bag to the affected side, cold sponging, a cold bath for 
10 minutes; stimulates the vaso-motor centres (O). Cupping vigorously over 
the lungs for pain, relieves better than morphine (Rochester). Blisters, use- 
ful at very beginning only, or at crisis of disease, harmful in inflammatory 
stage (B); to lessen the pain, but should be used in moderation (R). Wet- 
pack, hot, tightly pinned to limit motion of chest- walls (B). Poultices, en- 
circling the whole chest in children (R); the poultice-jacket belongs to the 
dark ages of medicine (Rochester) ; local applications to the chest have no 
influence whatever upon the course or outcome of the disease (Thompson). 
Fresh Air is very important, the windows should be open day and night 
(Fussell) ; the open-air treatment is valuable in all cases which are not com- 
plicated with bronchitis (Northrup) ; is not likely to be ever given up when 
once introduced into practice (Ewart). Diet should be farinaceous, with 



7 84 PNEUMOTHORAX — POISONING. 

mucilaginous drinks and rest in bed in a warm room (R); should be liquid, 
chiefly milk and cereal foods and eggs, water or lemonade freely (O). Rest 
is fully as important after the crisis as during the fever, the heart being en- 
dangered by any effort made too soon. 

1$. Tinct. Veratri Viridis, ttjxI. j 1$. Sodii Iodidi, 5iij- 

Spt. .Etheris Nitrosi, 5vj. Morphinae Sulph., gr. j. 

Liq. Potassii Citratis, 3ivss. Elixir Simplicis, giv. 

Syr. Zingiberis, q. s. ad Syj. M. Sig. — A teasp. ter die, also blisters 

M. Sig. — A tablesp. every 3 hours, in the over the apex. In catarrhal pneumonia. 

early stage. {Da Costa.) {Da C.) 



1$. Ammonii Iodidi, gr. xl. 

1$. Ammonii Carbonat., gr. xl. Spt. Ammoniae Aromat.,.. . 5ij- 

Infusi Serpentariae, §iv. Elix. Simp, et Aquas, . . . .ad 5 viij. 

M. Sig. — A teasp. every 3 hours, as a M. Sig. — Two tablesp. thrice daily. In 

stimulant about the crisis. (B). syphilitic lobar pneumonia. {Da C.) 

Pneumothorax. 

Stimulants freely, if symptoms indicate them. Treatment is the same 
as that for pleurisy with effusion in most non- trauma tic cases (O). Para- 
centesis, immediate aspiration with a trocar has saved life in the acute form, 
when urgent dyspnea, cyanosis, low blood pressure, and great displacement 
of the heart (O). Incision early is dangerous (West) ; has dangers of its own, 
injury of diaphragm, etc. (Fowler). Pleurectomy, when there is pus (pyo- 
pneumothorax) and the case is not doing well, or in the tuberculous cases if 
the other lung is not involved (O). Irrigation after incision is unjustifiable, 
the fluid may enter a bronchus and produce suffocation (Fowler). Trau- 
matic variety and spontaneous cases usually do well without interference, as 
the air is quickly absorbed (O). [Compare Empyema, Pleuritis.] 

Poisoning. 

A Poison, in the medical and toxicological sense, is any substance of in- 
herent deleterious character and incapable of self-reproduction, which, acting 
chemically or physiologically upon the tissues or fluids of the body, will 
seriously injure the health or destroy life. 

Energetic poisons are Hydrocyanic Acid, Potassium Cyanide, Nicotine, 
Strychnine, Phenol, and some reptile venoms. The poisons usually selected 
by poisoners for criminal purposes on others are those which produce effects 
resembling the symptoms of natural disease, as Arsenic, Colchicine, Tartar 
Emetic, Strychnine, Morphine and Aconite. Those generally chosen for 
suicidal purposes are such as may be most readily obtained by the laity, 
namely — Phenol, Morphine, Illuminating gas, Charcoal gas and Potassium 
Cyanide, the first being easily purchased for disinfecting purposes, while the 
last is commonly used in the arts. . 

General Principles of Treatment. In the treatment of poisoning, whether 
by mineral or vegetable substances, if the poison is known the first indication 
is to administer the proper chemical Antidote, so as to render it harmless or 
comparatively so. Next, the stomach should be emptied and washed out, 
lest the newly-formed compound be absorbed after a time, also to remove any 
poison which may have escaped the action of the antidote. Next, the ap- 



POISONING. 785 

propriate Antagonist should be administered, to counteract the effects of such 
portion of the poison as may have been absorbed. Lastly, such Antagonistic 
Measures should be employed as may sustain the action of any organic func- 
tion showing signs of failure. In most cases of alkaloidal poisoning ab- 
sorption has proceeded so far before professional assistance is obtained that 
antidotes are of no value, hence reliance can be placed only upon gastric 
and intestinal irrigation, upon the physiological antagonist and such sup- 
porting measures as will tend to maintain vitality until the poison can be 
eliminated. 

Antagonists and Antidotes. 

These are discussed on pages 17 and 20 ante. The antidotes include 
Emetics, Cathartics, Washes, Injections, the use of Ligatures, the Stomach- 
tube, Tourniquets, etc., which are termed Mechanical Antidotes; and the 
Chemical or True Antidotes, which include Albumin, Milk, Charcoal, Soap, 
Starch, Oils, Tannin, Turpentine, Acids, Alkalies, Potassium Permanganate, 
Carbonates, Hydrates, Sulphates, Sodium Chloride, Iodine, Iron prepara- 
tions, etc. 

The following list includes the principal Antidotes which are in general 
use. For the Antagonists see ante, page 17, and the article following this, 
entitled Poisoning by. 

Acids. Vegetable acids, as Acetic (or vinegar), Citric (or lemon-juice), 
and Tartaric, are employed as antidotes against the poisonous alkalies and 
alkaline carbonates. Sulphuric Acid, well diluted with water, is antidotal 
to the soluble salts of Barium and Lead, with which it forms insoluble sul- 
phates; also as a prophylactic against lead poisoning. 

Albumin is an ideal chemical antidote, being harmless, easily procured, 
and forming compounds (which are more or less insoluble) with most of the 
metallic salts, corrosive alkalies and mineral acids, as also with Iodine, Bro- 
mine, Chlorine, Creosote, Aniline, and alcoholic solutions of most of the Alka- 
loids. It is especially suitable against inorganic poisons, and was recom- 
mended by Orfila for invariable use, even on the mere suspicion of poisoning. 
It should be well diluted, the whites of four eggs to a quart of lukewarm 
water; and should be followed by emetics and cathartics, as many of its 
compounds are slowly soluble. 

Ammonia, diluted, used by inhalation, is an efficient antidote against the 
vapors of corrosive acids and Nitrobenzol, also against Chlorine, Bromine 
and Hydrocyanic Acid. 

Calcium Hydroxide and Carbonate, in the form of lime-water, chalk, 
eggshells or powdered oyster-shells, are used against Acids, both mineral and 
organic, and especially against Oxalic Acid and the acid oxalates, which they 
neutralize and convert into the insoluble calcium oxalate. 

Carbonates and Bicarbonate s of Sodium and Potassium are employed 
against most of the poisonous metallic salts, especially those of Zinc, which 
they immediately decompose, forming insoluble basic compounds; also 
against Iodine, Bromine, and Potassium Dichromate, forming the neutral 
chromate with the latter and harmless salts with the former. They are use- 
ful in dilute solution against Acids, but are less easily tolerated than magnes- 
ium sulphate. They are contraindicated in posioning by Oxalic Acid, with 
which they form dangerous compounds. 
So 



786 POISONING. 

Cathartics are generally employed after the use of a chemical antidote, to 
remove the compounds formed thereby from the intestinal canal. The best 
are Castor Oil, Croton Oil, Senna, and Magnesium Sulphate (Epsom salt). 
Castor Oil protects the mucous membrane, and obstructs absorption, but 
is contraindicated in poisoning by phosphorus, phenol, copper salts, or can- 
tharis, the absorption of which is aided by oils and fats. Croton Oil is rapid 
and powerful in the dose of from i to 5 minims, in a bread pill. Magnesium 
Sulphate, in the dose of 1 to 4 oz., well diluted, is of special service in chronic 
lead poisoning and to remove antidotal compounds from the intestines. 
Senna, Gamboge, and other drastics are the best cathartics in narcotic 
poisoning. 

Charcoal has some antidotal value against many alkaloids, the metallic 
salts, and Phosphorus, slowing their toxic action and postponing their effects, 
probably by a protective action upon the gastric walls. It has the valuable 
property of absorbing gases, but enters into no fixed compound with any 
mineral or vegetable poison. Fresh animal charcoal is the best, though 
wood charcoal is efficient, but in less degree. 

Copper Carbonate, in dose of 3 to 6 .grains, in water, preceded and fol- 
lowed by an emetic, is recommended in phosphorus poisoning, being 
supposed to coat the particles of Phosphorus first with a layer of copper 
phosphide and then with one of copper itself, thus preventing their solution 
in the fluids of the stomach. 

Emetics, when employed, should be used without delay. They are often 
rendered needless by vomiting induced by the poison itself, or by the free 
use of diluent drinks; and are contraindicated when there is severe corrosion 
of the alimentary canal or when abdominal inflammation exists. The best 
emetics are: Zinc Sulphate, for administration by mouth, being non-nauseat- 
ing, 20 to 30 grains in water, 5 grains for children. Apomorphine, gr. -j^g— §, 
hypodermically, when narcosis prevents the use of emetics by the mouth. 
It should be administered hypodermically, as it is very uncertain in action 
when given otherwise. The following may be used: Copper Sulphate, 1 
to 5 grains in water; Ipecac, in powder, syrup or wine; Emetine, gr. ^ to J; 
Tartar Emetic, ij grain, acts slowly and is depressant; Turpeth Mineral; 
Cadmium Sulphate; Sodium Chloride (common salt), 2 teaspoonfuls in a 
pint of water; Mustard 2 teaspoonfuls in a cup of warm water; also Olive Oil, 
Soap-Suds, and tickling the fauces with the finger or a feather. Sodium 
Chloride, as an emetic is contraindicated in poisoning by tartar emetic or 
corrosive sublimate, and so also are Oils and Fats and substances containing 
them, in poisoning by phosphorus, cantharis, phenol or copper salts. 

Gelatin is of especial value against Iodine, Bromine and the Alums, but 
requires too much time for its preparation, as it should be broken up , soaked 
in water for half an hour and reduced to the consistency of honey. 

Gluten is of value aginst Corrosive Sublimate, but is less so than albumin 
and is not easily obtained. 

Gum Arabic, in the form of mucilage, is chiefly Used as a protective against 
corrosive poisons, and has been recommended in copious draughts against 
poisoning with the Bismuth salts. 

Iodine, in very dilute solution, is used as an antidote against alkaloids and 
their salts, other vegetable poisons and snake-venom. All its compounds are 



POISONING. • 787 

more or less soluble and toxic, and must therefore be removed from the sys- 
tem as soon as possible. Bouchardat's Antidote for vegetable poisons consists 
of 3 grains of Iodine, 30 grains of Potassium Iodide, and n oz. of distilled 
water. The dose, which is from ij to 3 oz., should be repeated frequently. 

Iron. The Hydroxide, Fe(OH) 3 , is by far the best antidote to Arsenic in 
solution or in a soluble form, as it combines with the latter to form a ferrous 
arsenate, and also protects the gastro-intestinal mucous membrane against 
the local action of the poison. In the proportion of 10 parts to one of arsenic 
the union is very complete, but its union with the salts of arsenic is limited 
even when it is in great excess, though much more effectual if there is added 
to it a small amount of ammonia or other caustic alkali, or if the basic ferric 
acetate is mixed with it. For the preparation of the official arsenic antidote 
see Ferri Hydroxidum cum Magnesii Oxido, under the title Ferrum in Part I. 
Dialyzed Iron, Saccharated Iron, and the basic Ferric Acetate have all been 
used with more or less success in arsenic poisoning. 

Magnesia (MgO), is obtained by heating Magnesium Carbonate, which 
is a compound of the Hydroxide and Carbonate of Magnesium with water. 
When the Carbonate is heated at a low temperature it becomes calcined, 
losing CO2 and H 2 0; then mixed with 25 times its weight of warm water it 
becomes gelatinized, in which condition it is best for antidotal purposes, 
in doses of from \\ to 2 oz., at short intervals for a few doses then at longer 
intervals. An excess does no harm, but rather benefits the patient by its 
cathartic action. Magnesia is the most efficient antidote against Acids and 
the acid salts, also against Oxalic Acid and the acid oxalates, in the absence of 
the calcium antidotes therefor. It is also valuable against Arsenic, Phos- 
phorus, Mercury, Corrosive Sublimate and other metallic salts in solution, 
precipitating the corresponding oxides or basic salts. 

Milk is a good substitute for Albumin, its antidotal action being nearly 
the same in range and due to its casein, albumin and free alkali. It is par- 
ticularly valuable against metallic salts, corrosive acids and alkalies (es- 
pecially Ammonia) and the alkaline earths, but it is contraindicated when 
fatty antidotes are to be avoided, by reason of its richness in fat. 

Oils and Fats are efficient against the corrosive acids and alkalies, the 
metallic oxides and salts; but are contraindicated in poisoning by Phos- 
phorus, Cantharis, Phenol, or Copper salts, the absorption of which they 
promote. With the caustic alkalies they unite to form soaps, liberating 
glycerin; they are inferior to albumin against the metallic salts, and as their 
action is slow they are less efficient than acids against alkalies. Those 
used are olive, cotton-seed, linseed and almond oils, also melted butter and 
lard. 

Potassium Ferrocyanide, given in doses of 30 to 60 grains in water, is of 
special value against the Copper salts, but albumin is equally efficient and 
more easily obtained. 

Potassium Permanganate, is the best antidote against organic poisons, 
if used promptly, before absorption has taken place, as it rapidly destroys 
them by oxidation. It has been used successfully against Morphine and 
Strychnine salts and Phosphorus in the stomach, and locally for snake- 
poison. 

Soap, as Castile Soap, dissolved in 4 times its bulk of hot water, to make 
"suds," and given by the cupful, is one of the most efficient antidotes against 



7§8 • POISONING. 

corrosive acids and metallic salts, especially Corrosive Sublimate, Potassium 
Dichromate, and Salts of Tin and Zinc. It is inferior to albumin against these, 
but is preferred to caustic alkalies against acids, as of itself it has no corrosive 
action. It should not be used against alkalies. 

Sodium Chloride (Common Salt), in dilute solution, is the best antidote 
against the Silver salts, converting them into the insoluble chloride of silver. 
It may be given with albumin, which is also a very efficient antidote in this 
form of poisoning. 

Sodium Thiosulphate in doses of 15 grains, in very dilute solution and 
frequently repeated, is a valuable antidote against Bleaching Powder (Cal- 
cium Hypochlorite), Labarraque's solution (Sodium Hypochlorite), and 
Javelle Water (Potassium Hypochlorite), which it reduces to chlorides, 
itself undergoing oxidation to the sulphate. 

Starch, in paste, 1 to 15 of water, is the antidote for Iodine and Bromine, 
with which it forms compounds which are almost harmless. It has some 
value against Corrosive Acids, Corrosive Sublimate, and Zinc and Copper 
Sulphates, but it is not so efficient as Albumin, which is preferred for these 
poisons as well as for Iodine, since it has a greater affinity than starch has 
therefor. 

Stomach Pump and Stomach Siphon are efficient, and do not weaken the 
patient as emetics do, but they are not always available, and cannot be used 
when there is corrosion of the stomach or esophagus, for fear of perforation. 
Washing of the stomach at regular intervals is a measure of great importance 
in the case of soluble poisons, some of which are excreted into the stomach 
[see infra under Opium]. These appliances are almost useless when the 
poison is in solid form and in large pieces (as meat, sausage, fish, cheese). 

Sulphates of Magnesium and Sodium (Epsom and Glauber's salts), 
the soluble sulphates, are particularly efficient against Phenol and the salts 
of Barium and Lead. 

Tannin (Tannic Acid), precipitates the Alkaloids and their salts, with 
which it forms compounds (tannates), which, though comparatively insoluble 
are not entirely inactive, and should be removed at once from the alimentary 
canal by emetics and drastic purgatives. It acts well against many metallic 
salts, though inferior to albumin for these, except against Tartar Emetic, 
which albumin does not affect, but tannin renders harmless. It is given in 
doses of gr. xv. to xlv, in a 2 per cent, solution, every | hour; and if combined 
with about 10 per cent, of its weight of Iodine its antidotal effect on vege- 
table poisons is greatly increased. If not itself obtainable, decoctions or 
infusions of substances containing it may be used, as tea and coffee, nut- 
galls, kino, rhatany, catechu, and the barks of oak, willow and cinchona. 

Turpentine, after long exposure to the air, therefore containing much 
oxygen, is one of the antidotes against Phosphorus. It should be adminis- 
tered immediately after the ingestion of that poison, alone or in hot water, 
and in quantity 100 times that of the phosphorus supposed to be present. 

Antidote Bag, designed by Martindale, of London, contains the following- 
named articles, labeled with directions for use, viz. — 

Dialyzed Iron. Spt. Ammoniae Aromat. Amyl Nitrite. 

Syrup of Chloral. Oil of Turpentine. Zinc Sulphate. 

Chloroform. Acetic Acid. Ipecacuanha. 

Spt. Chloroformi. Tincture of Digitalis. Potassium Bromide. 

Magnesia. Tannic Acid. Potassium Permanganate. 



POISONING. 789 

Solution of Ferric Sulphate, 40 mils in 125 mils of water. Magnesia, in solution, 10 
grammes in 750 mils of water, in a bottle of 1000 mils capacity. These two, mixed 
together, make the official antidote against Arsenic. 

Also a Hypodermic Syringe and Solutions or Pellets therefor of — 
Morphine Sulphate. Apomorphine Hydro- Pilocarpine Nitrate. 

Atropine Sulphate. chloride. Strychnine Nitrate. 

General Antidotes have been devised for use when the nature of a poison 
is unknown, with the object of a "shot-gun prescription," intended to hit 
something. One of the best is JeauneVs, composed as follows, — Liquor Ferri 
Sulphatis (sp. gr. 1.45) §ijss, Magnesium Oxide gij, Carbo Animalis §j, 
Aqua 5 xx. These ingredients should be kept separate — the solution of the 
sulphate in one vessel, the others together. When needed, the former should 
be added to the latter and violently agitated. Dose, 5jssto giij. This is 
a perfect antidote for Arsenic, Zinc, and Digitalin. It delays the action of 
the salts of Copper, Morphine and Strychnine, and slightly influences com- 
pounds of Mercury. It is valueless for Cyanide of Mercury, Tartar Emetic, 
Hydrocyanic Acid, Phosphorus, or the caustic Alkalies. Bouchardafs An- 
tidote is described on a previous page, under Iodine. Bellini considers the 
Iodide of Starch a valuable antidote to alkaline Sulphides, earthy Sulphides, 
vegetable and caustic Alkalies, and Ammonia. In the first two cases he con- 
siders it superior to all other antidotes. 

A fresh mixture of the Sulphides of Iron and Sodium with Magnesia, 
is said to be a perfect antidote for Copper salts, Corrosive Sublimate and 
Mercuric Cyanide. If the nature of the poison is entirely unknown, a harm- 
less yet effectual antidote in most cases is one composed of equal parts of 
Magnesia, Wood Charcoal, and the Ferric Hydroxide, given freely in plenty 
of water. 

Borax mixed with Milk is a good general antidote against the metallic 
salts and the salts of the alkaloids. 

Poisoning by 

Acetanilid. Antagonists, — Belladonna or Atropine, to maintain the 
blood pressure; Strychnine, for the respiration; Oxygen inhalations, to over- 
come cyanosis; Heat, externally applied. Stimulants and supporting meas- 
ures. Death has occurred from a dose of 5 grains. 

Acid, Acetic. Antidotes, — Magnesia or Magnesium Carbonate, freely; 
Soap and water, Lime-water, Chalk, White- wash; also milk, oils and thick 
gruel may be given. General measures for inflammation of the gastrointes- 
tinal tract. 

Acid, Carbolic. — See under Phenol. 

Acid, Carbonic (Carbon Dioxide). See under Illuminating Gas, below, 
for the treatment of poisoning by Carbonic Acid and Carbonic Oxide gases. 

Acid, Hydrocyanic (Prussic). Forty minims of the official diluted acid 
have proved a fatal dose. Antidotes, — if time to do anything, Cobaltous 
Nitrate has proved a perfect antidote in over 40 cases (Antal). Ammonia, 
diluted, by inhalation, or Chlorine Water by spray, for the vapor. Per-salt 
of Iron with Magnesia (see under Cyanide of Potassium for formula). Cal- 
cium or Sodium Chloride, gr. xxx-xl, in water. Sodium Thiosulphate is said 
to be an efficient antidote. Emetics or the stomach-pump. Antagonists, — ■ 
Stimulants, as Brandy, Chloric Ether, Ammonia, ad libitum. Alternate hot 



79° POISONING 

and cold Douche, from a height. Artificial Respiration, the faradic current 
(mild) to chest walls and over cardiac region. Atropine, has antagonistic 
action, but is too slowly diffused to be of any value. Ammonia by inhalation, 
and by the stomach, with cold affusion to the spine, and artificial respiration, 
are the measures most likely to avail in cases where there is time to do 
anything. 

Acid, Oxalic, also the Acid Oxalates, as Potassium Oxalate, known as 
" Salts of Lemon," or of " Sorrel," used for removing ink-stains. Antidotes, 
— Calcium Carbonate or Hydroxide (as lime-water, chalk, writing, wall-plaster, 
in water), or Magnesia. Avoid Potassium and Sodium Carbonates and 
Bicarbonates; they form salts with oxalic acid, which are as poisonous as the 
acid itself. Bland mucilaginous drinks. Poultices to the abdomen. 

Acids. Antidotes, — Alkalies for the least irritant acids, Magnesia, 
Magnesium Oxide, slaked Lime, Chalk; plaster from wall with water, milk, 
oil, white of egg, bland mucilaginous drinks and poultices (R) . Antagonists , 
— See next paragraph. 

Acids, Mineral. Antidotes, — Alkalies, as Sodium Carbonate or Bi- 
carbonate, Magnesia, or Chalk, Soap, Whiting, Wall-plaster, in water. 
Albumin, Flour, Milk, Starch, Olive Oil, to protect the mucous membrane. 
Avoid water in Sulphuric Acid cases. Antagonists, — Opium, Alcohol, as 
stimulants, to combat the depression of the vital powers. Avoid the Stomach 
pump, which is liable to cause perforation of the softened stomach and 
esophagus. 

Aconite. Antidotes, — Tannic Acid, or Animal Charcoal, powdered, in 
water. Emetics or the stomach-pump are to be avoided if the symptoms are 
severe, as vomiting may cause cardiac failure. Castor Oil, or other purga- 
tives. Bland fluids, and poultices for abdominal irritation. Antago- 
nists, — Atropine, Caffeine, Ether, Ammonia, antagonize its effects on the 
heart and respiration. Atropine seems to be the antagonist from which most 
good is to be expected (Cushny). Digitalis antagonizes its action on the 
heart and its relaxation of cardiac inhibition (Fothergill). In Aconite- 
poisoning the stomach should be evacuated, warmth applied to the ex- 
tremities, stimulants administered, artificial respiration if necessary, and 
the recumbent posture strictly maintained. Caffeine may be administered 
hypodermicaiiy and strong Coffee by the mouth. 

Alcohol. Antidotes, — Emetics, or the stomach-pump, if much alcohol 
recently swallowed. Antagonists, — Caffeine is powerfully antagonistic in 
doses of gr. j-ij every hour to 3 hours (Hall). Hydrated Chloral in dose of 30 
grains repeated in 2 hours if necessary, is very efficient to secure sleep, or 30 
grains each of Chloral and Potassium Bromide for the same purpose. Chloral 
is said to be dangerous to the heart in old alcoholics, but the experience of 
physicians of inebriate asylums does not corroborate this statement. Nutri- 
tious, digestible diet in liquid form and small quantity frequently repeated, is 
an essential feature of the treatment. Ammonium Chloride, 3s.s in J pint of 
water at one draught, or the Liquor Ammonii Acetatis, in doses of 5 j> are said 
to have marvellous power in straightening up a drunken subject, restoring the 
faculties, and antagonizing stupor. Ammonia by inhalation cautiously. 
Cold affusion to the head. Warmth to the extremities. Faradism of the 
muscles of respiration. Artificial Respiration. [Compare the article on 
Alcoholism and Delirium Tremens.] 



POISONING. 791 

Alkalies. Antidotes, — Acids, diluted, especially the vegetable acids, as 
Vinegar, Lemon-juice, etc. Albumin, Milk, Gelatin. Oils to protect the 
mucous surfaces. [Compare Ammonia below.] Antagonists, — Atropine 
for the shock and vital depression; also Caffeine, Alcohol, and other stimu- 
lants. Never use the stomach-pump, which may cause perforation of the 
injured esophagus and stomach. 

Alkaloids. Antidotes, — Tannin holds high rank, forming tannates, 
which are comparatively insoluble. Potassium Permanganate is capable of 
destroying many and probably all alkaloids, acting rapidly on morphine and 
cocaine, slowly on strychnine (W). Albumin to form albuminates. Iodine. 
Charcoal. Emetics and cathartics afterwards. Antagonists, — differ for 
each. [See their several titles in this section.] 

Alum. Antidotes, — Carbonates of Ammonium, Potassium, etc. Other 
treatment as for corrosive salts. [See Metallic Salts in this section.] 

Ammonia. Sources of Danger, the use of Smelling Salts or Spirit of Harts- 
horn in excess, and the strong solution of Ammonia kept by housekeepers for 
laundry purposes. Antidotes, — Vinegar, Lemon- or Orange-juice, any 
Vegetable Acid, followed by demulcents to protect the mucous surfaces. 
When inhaled, give vapor of Acetic or Hydrochloric Acid or Chlorine- water 
by inhalation, the two latter forming the chloride. Edema of the glottis is 
to be carefully prepared for by having measures convenient to perform 
tracheotomy if conditions demand. Antagonists, — Aconite, Veratrum, 
Digitalis, as cardiac sedatives. [See Alkalies.] 

Amyl Nitrite. Antagonists, — Ergotin, Atropine, Strychnine, also Bru- 
cine, Digitalis, are antagonistic, though not always available by reason of their 
slower rate of diffusion. Stimulants, artificial respiration, the alternate cold 
and hot douche, with cold to the head, and Ergotin or Atropine hypoder- 
mically, are the best measures to be used in cases of poisoning by the Nitrites 
and Nitrates, the latter passing into the blood as nitrites. 

Anesthetics (Ether, Chloroform, etc., by inhalation). Antagonists, — 
Atropine, hypodermically, is of great value in combating the cardiac and 
respiratory failure of ether (Amidon) ; and is equally efficient in chloroform 
poisoning, as I have found by experience (Potter). Strychnine, hypoder- 
mically, has done good service in chloroform narcosis and has many advo- 
cates; it is a most valuable antagonist in chloroform poisoning. Oxygen by 
inhalation is the best antagonist to chloroform (Sayre). In danger from 
Chloroform inhalation prompt measures must be taken. The tongue should 
be pulled out with forceps and kept out. The face and chest should be 
slapped with a wet towel, and Artificial Respiration should be commenced at 
once and kept up for some time, not faster than 20 to the minute. A suc- 
cession of quick, sharp blows on the chest, over the cardiac region, will some- 
times provoke the heart to renewed action after it has apparently failed. 
Sudden cardiac failure especially during surgical operations has been success- 
fully treated by direct massage of the heart. Venesection is wrongly neglected 
in such cases; it relieves the right cardiac engorgement; supplemented by 
Galvanism of the phrenic to stimulate the heart into action (Spooner). Amyl 
Nitrite by inhalation, has been used, but is dangerous as it lowers the blood 
pressure and depresses the heart and respiration (Vance). Adrenalin hypo- 
dermically for the vaso-motor paralysis (Takamine). Faradism of the mus- 
cles of respiration. Heat to the body and limbs, Ice in the rectum. Invert 



79 2 POISONING. 

the patient, draw the tongue well forward with forceps, compress and relax the 
chest, maintain the inverted position until the pulse and respiration are good 
(Nelaton). Alcohol should not be used (Riley). [Compare the article on 
Anesthesia.] 

Antimony (Tartar Emetic, etc). Antidotes, — Tannin, or any substance 
containing it, is the antidote, forming the insoluble tannate. Albumin or 
Milk. Carbonates of Magnesium and Sodium. Magnesia, in milk, es- 
pecially for the chloride of antimony. Alkalies and Salts of Lead decompose 
tartar emetic. Emesis by tickling the fauces. Demulcent drinks freely, to 
protect the mucous membranes. Water, warm, in large draughts; or lavage 
of the stomach with water first, then with a solution of Tannin. 

Antipyrine. See under Acetanilid, for the treatment of poisoning by 
Antipyrine, Acetphenetidin, Kairine, and similar compounds. It is impor- 
tant to have patient in recumbent position, head lower than heels. For the 
pain opium can be used but strychnine should be combined with the opium 
to prevent the depression. 

Arsenic (Arsenic Trioxide). Two grains have been fatal. Common 
Sources of Danger: arsenical wall-papers, Arsenic mistaken for " salts" or for 
" magnesia," adulterated confectionery, also Paris Green (Cupric Aceto- 
Arsenite) taken with suicidal intent. Antidotes, — Ferric Hydroxide, 
freshly prepared by precipitating a solution of Ferric Chloride with Sodium 
Carbonate or Ammonia, or by the action of calcined Magnesia on the solution 
of Ferric Tersulphate, or by treating a solution of any Ferric salt with any of 
the alkalies or their carbonates. The official antidote is the second named 
above, Ferri Hydroxidum cum Magnesii Oxido (see page 268), in the propor- 
tion of gr. viij for each grain of arsenic. Dialyzed Iron, is quite efficient as an 
antidote, is more easily obtained than the hydrated oxide, and has rendered 
good service in many cases of poisoning from inhaling arsenical fumes. Ferri 
Subcarbonas is equally good, 5 ij followed by Castor Oil (Leale) ; or Magnesium 
Hydroxide freshly precipitated, or Magnesia and Sugar (Carl). Magnesium 
Bicarbonate or other alkalies (R). Charcoal, 5ss or more (R). Saccharated 
Ferric Oxide. Basic Ferric Acetate. Apo-morphine, hypodermically, or 
Zinc Sulphate, as an emetic (but avoid tartar emetic). Emesis by feather- 
tickling. Oil and Lime-water mixed before and after emesis (Taylor). 
Milk or other bland fluids to wash stomach. Raw eggs beaten up with milk, 
are particularly useful. Castor Oil after emesis. Magnesia and Linseed 
tea. Poultices and fomentations over abdomen. Potassium Iodide after- 
wards to promote elimination. Antagonists, — None, but hot baths and 
diuretics may be given to favor elimination of the absorbed arsenic, and the 
general after-treatment should be as for gastro-enteritis from any other cause. 

Barium Salts. Antidotes, — Sulphate of Magnesium or Sodium (Epsom 
and Glauber's salts), of Calcium or Potassium. Diluted Sulphuric Acid. 

Bee and Insect Venom. Antidotes, — Aqua Ammonia, Sodium Bicar- 
bonate or Chloride, or pure Phenol, applied to the wound; or Tflxv of a 2 per 
cent, solution of the first hypodermically, with Liquor Ammonii Acetatis 
internally. [Compare the article on Stings.] 

Belladonna and Atropine. Antidotes, — Tannin, Zinc Sulphate or Apo- 
morphine, as emetics, or the Stomach-pump. Purgation. Magnesium 
Bicarbonate, and other alkalies (R). Charcoal, §ss or more is necessary (R). 
Borax in milk solution to precipitate any remaining alkaloid, or Potassium 



poisoning. 793 

Permanganate to oxidize it (Riley). Antagonists, — Morphine is the physio- 
logical antagonist to the effects of Atropine on the cerebrum, pupils, heart, 
respiration, arterial tension and kidneys; Aconite, Physostigmine, Pilocarpine 
and Quinine are each antagonistic to some of its effects, Muscarine to most of 
them. Pilocarpine in full doses hypodermically is probably the best antag- 
onist (Riley). Artificial Respiration is very important. Brandy or strong 
coffee. Faradism of respiratory muscles. Flagellation. Cold to the head. 
Frequent catheterization is most important (Kemp). Hypodermoclysis to 
promote elimination (Id). 

Bromides. Antidotes, — Nitrous Ether is incompatible with Ammonium 
Bromide, Acids and Metallic Salts are so with all the bromides. Poisoning 
thereby is always chronic, never acute, hence antidotes can not be employed. 
Antagonists, — Digitalis, Ergot, Belladonna, antagonize many of the effects 
of the bromides. The acne seen in bromide administration may be prevented 
to some extent by the concomitant use of Fowler's solution in physiological 
dosage. 

Bromine. Antidotes, — Albumin, Starch, Gelatin, Sodium and Potas- 
sium Carbonates and Bicarbonates. Against the irritant vapor, Ammonia 
vapor by inhalation, or steam inhalations. Antagonists, — Alcohol as a 
stimulant, if much depression ensues. 

Calcium Chloride. Antidotes, — Albumin, Mucilaginous drinks, or Oils, 
Milk, Flour and water. Avoid acids. Antagonists, —Alcohol, for severe 
depression. 

Camphor. Antidotes, — Water to precipitate it from the alcoholic solu- 
tion. Alkalies and earthy salts precipitate even the small quantity which is 
soluble in water. Emetics to remove as much as possible. Antagonists, — 
Aconite and other arterial sedatives. Amyl Nitrite or Nitroglycerin. Alco- 
hol. Coffee. Cold. Opium and Bromides for the convulsions. 

Cannabis. Antidotes, — Emetics to remove as much as possible. 
Antagonists, — Strychnine as respiratory stimulant. Faradism of muscles of 
respiration. Lemon-juice is said to antagonize its effects, which last over 24 
hours from a large dose. 

Cantharis. Avoid Oils, fats and milk, which promote its absorption. 
Antidotes, — Emetics. Demulcents, as linseed tea, gruel, barley-water, 
freely. Water in large quantities, to flush the kidneys. Oleaginous injec- 
tions into the bladder to allay irritation. There is no chemical antidote. 
Antagonists, — None, but Opium may be given for the gastro-enteritis. 

Carbon Monoxide. See under Illuminating-gas, for the treatment of 
poisoning by Carbon Monoxide and Carbonic Acid gases. 

Chloral, Hydrated. Antidotes, — Liquor Potassii Hydroxidi, in hourly 
doses of 59 we ll diluted, which will decompose 20 grains of chloral each time 
in the blood (Dougall). Evacuate the stomach at once if the patient is seen 
soon after ingestion; emetics are not reliable, the pump or syphon should be 
used. Reliance must be placed on antagonists rather than on antidotes. 
Antagonists, — Strychnine is the most efficient; in a case in which Sj^cf 
hydrated chloral was taken, recovery occurred after the use of nearly a grain 
of Strychnine hypodermically in broken doses (Colenso). Heat to the body 
and limbs is a most efficient antagonist. Atropine antagonizes its cardiac and 
spinal depression, but synergizes its paralyzant action on the motor nerves, 
and should not be used as a respiratory stimulant. Picrotoxin has been found 



794 POISONING. 

to be of much value. Morphine administered with chloral antagonizes its 
tendency to produce cardiac failure, while synergistic to the hypnotic action 
of the drug. Strychnine is of value for the cardiac and respiratory depres- 
sion. Alcoholic stimulation. Frictions. Coffee, black, a pint injected into 
the rectum," as for narcotic poisoning. Artificial respiration. 

Chlorine. Antidotes, — Albumin for chlorine preparations in the stom- 
ach, also Aqua Ammonia in small quantity, well diluted. Ammonia vapor, 
cautiously inhaled against chlorine inhalations, forming ammonium chloride. 
Ammonium Sulphide has similar reaction, but should be used in great modera- 
tion. Fresh air. Steam inhalations. Emesis with warm water, then white 
of egg or milk, flour, or lime-water. Antagonists, — Chloroform by inhala- 
tion, to ease the irritant cough. 

Chloroform (swallowed). Recovery has occurred after the ingestion of 
one, two and even three ounces of chloroform (H. C. Wood). Antidotes, — 
Sodium Carbonate in plenty of water. Emetics will not act if narcosis present, 
the pump or syphon must be used to evacuate the stomach. The after- 
treatment as for irritant poisoning. Antagonists, — Atropine or Strychnine, 
hypodermically. Adrenalin hypodermically for the vasomotor paralysis, 
Artificial Respiration as soon as possible. Oxygen, by inhalation. Coffee, 
black, a pint into the rectum. Heat to the body and especially to the cardiac 
region. Rouse by slapping with wet cloth. Mustard over the heart. Re- 
lapse may occur, hence the patient should not be left for some time after 
apparent restoration. [Compare Anesthetics in this section.] 

Coal-oil, (Kerosene), Gasoline, (Petroleum Benzene). Wash out the 
stomach with warm milk, and treat the case symptomatically, and for gastro- 
enteritis. Strychnine and Coffee, if supporting remedies are indicated. The 
case should be watched for twelve hours at least. 

Cocaine. Antidotes, — There is no direct chemical antidote, and if there 
were it would not be available, as this agent is usually administered hypo- 
dermically. If swallowed give Potassium Permanganate to oxidize it (see 
under Alkaloids), after evacuating the stomach. Chloral is the most direct 
antagonist, so also are Chloroform and Ether. Morphine is directly antago- 
nistic at almost all points of action. Amyl Nitrite combats the earliest 
symptoms of cardiac depression, then Alcohol and Opium as cardiac stimu- 
lants. Digitalin, and Eserine antagonize some of the effects; Strychnine, 
Caffeine, and Ammonium Carbonate, have given good results. Chloroform 
or Ether subcutaneously in case of collapse. Artificial Respiration, may be 
required. Adrenalin hypodermically, for the vaso-motor paralysis. Strych- 
nine for collapse occurring after withdrawal. Baths for the insomnia. 

Colchicum. Antidotes, — Tannic or Gallic Acid, followed by emetics and 
cathartics. Demulcent drinks, warm. Antagonists, — Alcoholic stimulants. 
Morphine, hypodermically for the cardiac depression. Treatment is the same 
as that for Aconite poisoning. 

Conium. Antidotes, — Tannic or Gallic Acid, followed by emetics and 
cathartics. Antagonists, — Nux Vomica and its alkaloids, also Picrotoxin 
and other tetanizers. Alcohol. Muscular Movement. Heat applied exter- 
nally, as soon as the stomach has been evacuated. Atropine for respiratory 
failure. Artificial respiration. Strong Coffee has been used with benefit. 

Copper Salts. Antidotes, — Albumin, Soap, Gluten, Milk, Sugar, Mag- 
nesia. Potassium Ferrocyanide, is the most efficient antidote, but Magnesia 



poisoning. 795 

or Albumin may be used. In the absence of eggs, give a paste of flour and 
water. Any antidote should be followed by prompt evacuation of the 
stomach, and Potassium Iodide to saturation of the system. Antagonists, 
—Opium and Demulcents for the gastro-enteritis. Pilocarpine in small doses 
to favor elimination, also Turkish baths, in chronic copper poisoning. 

Corrosive Sublimate (Corrosive Mercuric Chloride). Antidotes, — 
Albumin, Gluten, Magnesia, Milk, Lime-water. Albumin, in some form, 
the most efficient; the white of an egg to each 4 grains of the poison, forms the 
albuminate, which must be at once evacuated by emesis or the stomach- 
pump, it being soluble in an excess of albumin, also in the alkaline contents of 
the intestines. Potassium Iodide for after-treatment, converts the poison into 
soluble combinations and promotes their elimination. Hydrated Proto- 
sulphide of Iron, if given within 20 minutes, is said to be an efficient antidote. 
Immediate administration of a tablet composed of sodium phosphite 0.36 
gramme and sodium acetate 0.24 gramme. If this is not available give the 
following: sodium hypophosphite 1 gramme, water 10 mils and hydrogen 
peroxide 5 mils. If the amount of the poison taken be known 10 times as 
much of the hypophosphite should be given as poison was taken. As this 
might require a large and possibly harmful amount of hypophosphite, it 
should be immediately followed by a copious lavage with a very dilute 
solution of the antidote. This may be followed by a safe dose of the antidote 
which is to be retained and which might be repeated every eight hours for 
several days (Fautus — Journal Lab. & Clin. Med., 1916, i, 879). Wilms 
(Journ. Lab. and Clin. Med., 1917, ii, 445) concludes in advanced cases of 
mercuric chloride poisoning the intravenous method of injecting calcium 
sulphide, grain for grain of bichloride of mercury taken, is the safest and most 
rapid. An advantage of the intravenous method lies in the assurance that 
the patient receives the required amount of the antidote and that it is more 
direct. 

Calcium sulphide may also be administered by mouth (when the in- 
travenous method is not a practical one) in 2 to 5-grain doses every hour until 
all symptoms of mercurialism have disappeared, since it is nontoxic. For 
intravenous administration the solution must be freshly prepared or it loses 
its sulphur and becomes ineffective. It should not be used stronger than 1 
gr. to the ounce of water; boiled, then filtered through cotton. 

Lambert and Patterson (Arch. Int. Med., Nov., 1915, p. 865) report a 
series of sixteen cases of mercurial poisoning with but two deaths under the 
following treatment. Wash the stomach out twice daily and give colonic 
irrigation night and morning. Give by mouth 8§ of milk every 2 hours, 
alternated every 2 hours with 8§ of the following mixture: potassium 
bitartrate i3; sugar i5; lactose §ss; lemon juice ig; boiled water, 16 §. 
In addition, give by rectum a solution of 1 § of potassium acetate to a pint 
of water more or less continuously. The patient is hot packed daily. Check 
the results of the treatment by daily determination of urinary constituents. 
It is important to keep the urine alkaline in reaction. 

Creosote. [See Phenol.] 

Cyanide of Potassium. Antidote, — Ferrous Sulphate to form Prussian 
Blue (Ferric Ferrocyanide), followed by evacuation of the stomach. Where 
special liabilty to poisoning by a Cyanide or Hydrocyanic Acid exists, a stock 
antidote should be kept on hand; thus — solution (3 per cent.) of Ferrous Sul- 
phate, 30 mils, and Solution of Potassium Hydroxide (5 per cent.), kept 



796 POISONING. 

separate and protected from air. For use the two solutions are mixed, 2 or 
3 grams of powdered Calcined Magnesia and half a liter of water are added, 
the whole is shaken together, and administered; followed after a short inter- 
val by washing out the stomach (Riley). Cobaltous Nitrate is a perfect chem- 
ical antidote (Antal). Sodium Thiosulphate. Hypochlorite of Calcium or 
Sodium, much diluted. Whatever is done must be done quickly. Antag- 
onists, — Atropine, Digitalin, Strychnine, Alcohol. Artificial Respiration, 
general friction and galvanism. [Compare Acid, Hydrocyanic] 

Digitalis. Antidote, — Tannic Acid, to form the tannate, which, how- 
ever, is not inert, so that the stomach should be immediately washed out. 
Emetics should not be used, being too depressing. Antagonists, — Aconite 
for the effects of large doses, External heat, Galvanism, Horizontal posture 
for several days after active symptoms of poisoning have subsided. 

Ergot. Antidote, — Tannic Acid, followed by an emetic. Antago- 
nists, — Amyl Nitrite, Aconite, Veratrum Viride, Tobacco and Lobelia, 
antagonize its action on the circulation. 

Fish-poison. Antidotes, — Emetics and Cathartics. Antagonists, — ■ 
Potassium Chlorate freely, Liquor Ammonii Acetatis, Opium, Capsicum, 
Chloroform. 

Formaldehyde or Formalin. Antidote, — Ammonia immediately de- 
stroys the gas. When the gas has been inhaled cautiously administer the 
vapor produced by heating a 25 per cent, aqueous solution of Ammonia. 
When Formalin has been swallowed Ammonium Acetate or Aqua Ammonia 
diluted and cautiously given. 

Fungi, Poisonous. Antagonist, — Atropine, is practically specific as 
an antagonist in many cases of fungi poisoning. [Compare Muscarine.] 

Gamboge. Antidotes, — Potassium or Sodium Carbonates. Magnesia 
in milk. Emetics, — Mucilaginous drinks. Antagonists, — Alcoholic stimu- 
lants. 

Gases and Vapors. See Ammonia, Acid Hydrocyanic, Chlorine, Illu- 
minating-gas, Nitrous Oxide Gas, Sulphur. 

Gelsemium. Antidote,' — Tannic Acid, followed by an emetic or the 
stomach-pump, if recent. Antagonists,' — Digitalis, Amomonia, Alcohol, 
Atropine, and to some extent of the tincture of Xanthoxylum, are also 
antagonistic. Heat externally. Faradization of the respiratory muscles, 
and Artificial Respiration are measures of prime importance. Brandy and 
Capsicum are useful. 

Glass (coarse or powdered). Antidotes, — Bread-crumbs, mashed po- 
tatoes and thick meals freely to envelop it, then emetics. 

Gold Salts. Antidotes, — Ferrous Sulphate. Albumin, as eggs or 
flour. Mucilage. Emetics. Antagonists, — Belladonna for the salivation, 
Hyoscine for the tremor. 

Hyoscyamus. [See Belladonna.] 

Hypochlorites, as Javelle Water (Potassium Hypochlorite), Labarraque's 
Solution (Sodium Hypochlorite), and Bleaching Powder (Calcium Hypo- 
chlorite). Antidote, — Sodium Thiosulphate, in dose of gr. xv, well diluted 
and frequently repeated, reducing them to chlorides, itself undergoing oxida- 
tion to the sulphate. 

IUuminating-gas. — This has been described in full under Carbon 
Monoxide. 



poisoning. 797 

Iodine. Antidotes, — Starch, Albumin, Flour, Gelatin, Sodium and 
Potassium Carbonates and Bicarbonates. Sodium Thiosulphate. Starch 
is the antidote to free Iodine, but the stomach must be evacuated, as the 
Iodide of Starch is not inactive. In chronic poisoning by the Iodides, a 
free salivary flow induced by chewing Pyrethrum-root will hasten elimination 
of the drug. 

Ipecacuanha. Antidotes,- — Vegetable Acids and Astringents are in- 
compatible with Ipecac, and may be used as antidotes. Antagonists, — 
Bismuth, Phenol, and Hydrocyanic Acid, also Narcotics, antagonize the 
emetic, action. 

Iron Compounds act as simple irritants. Antidotes, — Magnesia, 
Carbonates of Ammonium or of Sodium. Mucilaginous drinks. Antago- 
nists, — Opium. Ice. [See also Metallic Salts.] 

Lead Salts. — Antidotes, — Sodium or Magnesium Sulphate, or Alum, 
dissolved in water, to convert the lead salt into the insoluble sulphate. 
Sodium Phosphate, Diluted Sulphuric Acid, Magnesium Bicarbonate, 
Ferrous Sulphate, freshly precipitated. Albumin, Milk. Emetics or the 
stomach-pump. Potassium Iodide, gr. xv-xxx, 3 to 4 times daily, in cases 
of chronic poisoning as eliminative (R). The cachexia is much relieved by a 
combination of Quinine Sulphate, Ferrous Sulphate and Diluted Sulphuric 
Acid (B). Baths of Potass a Sulphur ata (§ j or mere in the necessary water), 
are also very useful in chronic poisoning by lead (R). Antagonists, — 
Opium, to allay irritation. Belladonna, the extract, gr. ■§-, with Pulv. Rhei., 
gr., ij, in pill twice daily, for the great pain at defecation (Da C). Alum, is 
the most efficient remedy for the colic; to a pint of boiling milk add 90 
grains of powdered Alum, separate the curd and sweeten with sugar; give a 
wineglassful every hour or two (B). Tetranitrin in f-grain doses, to reduce 
high arterial tension. Strychnine, for the paralysis, gives good results; also 
Atropine, gr. y-J-g-, with Potassium Iodide, gr. v. Electricity, a slowly interrupted 
current until it causes reaction, for the paralysis of extensors (dropped wrist) ; 
cure to be completed by the faradic current (B). Marked Diagnostic 
Signs of chronic poisoning by Lead are — the dropped wrist, due to par- 
alysis of extensor muscles and a dark, blue line around the margin of gums. 
[Compare the article on Colic, Lead.] 

Lime. [See Alkalies.] 

Lobelia. Antidotes,' — Tannic Acid, to form the insoluble tannate. 
Strychnine, atropine, ammonia are useful to support the cardio-vascular 
system. The use of external heat is also required. Opium is used to treat 
the vomiting and relieve pain and irritation. 

Lysol. [See Phenol.] 

Mercury. [See Corrosive Sublimate, also Metallic Salts.] Anti- 
dotes, — Albumin, Gluten, Flour, Milk. Vegetable astringents. Hydrated 
Protosulphide of Iron. Charcoal. Alkalies, especially Magnesium Bicarbon- 
ate (R). Potassium Iodide, to saturation of the system, as after-treatment; 
converts the metal into soluble combinations (B). Baths, simple or sulphur- 
ous (R). Antagonists, — Bismuth, Tannin, Sodium Sulphite, Diluted 
Nitric Acid in water, as gargles and mouth-washes for salivation. Bella- 
donna, TTlv-x of tincture every 4 to 6 hours, to lessen secretion in ptyalism 
(B). Hyoscy amine, for the tremor, gr. j-$ gradually increased to gr. y 1 ^ 
(Oulmont). 



79S POISONING. 

Metallic Salts. Antidotes, — Albumin, Milk, Magnesia, Starch, Soap. 
Oils and other demulcents. Sodium or Potassium Carbonate or Bicarbonate. 
Lavage of stomach. Emetics and cathartics. 

Morphine. [See Opium.] 

Muscarine. Antidotes, — see Alkaloids. Antagonists, — Atropine ex- 
actly opposes Muscarine, and vice versa; it is the best antagonist and fre- 
quently gives prompt relief. Digitalis is antagonistic to some extent, so 
also is Physostigmine. There is no example of physiological antagonism so 
complete in all particulars as that between Atropine and Muscarine. 

Mushrooms. Antidotes,— Emetics, if poisoning very recent; Cathartics, 
especially Castor Oil, if some time has elapsed. Tannic Acid, has been 
recommended. Antagonists, — Atropine. Alcoholic Stimulants. Poul- 
tices, warm, to the abdomen. [Compare Muscarine, above.] 

Nitrates and Nitrites. [See Amyl Nitrite.] 

Nitrobenzol (Oil of Mirbane). Antagonists, — Aq. Ammonise (3ss in 
water), or Chloric Ether (5j in water), frequently repeated, as stimulants, 
given internally, by enema or hypodermically (brandy). Alcoholic liquors 
seem to hasten and intensify its toxic action (Riley). Atropine, Strychnine, 
or Digitalin, to stimulate the respiration and circulation. Normal Salt Solu- 
tion intravenously. Artificial respiration is important. Camphor has been 
given with much apparent benefit (Riley). Empty the stomach. External 
heat. Galvanic current, interrupted, to chest walls, and over cardiac region. 
Fatal Dose, — Death has resulted from merely tasting it. 

Nitroglycerin. [See Amyl Nitrite.] 

Nitrous Oxide Gas. Antagonists, — Artificial Respiration, to be com- 
menced at once and kept up for two hours if necessary, not faster than 18 
per minute. Fresh air, open all doors and windows, and fan the patient. 
Oxygen by inhalation, 3 or 4 pints. Douche to chest, alternately hot and 
cold. The tongue should be pulled well forward and the mouth cleared of 
any obstruction to respiration, as artificial teeth. In apparently hopeless 
cases, two or three violent blows on the chest, delivered in quick succession, 
may restore the cardiac action (Murrell). 

Nux Vomica and Strychnine. Antidotes, — Tannic Acid, forms the very 
insoluble tannate. Iodine in dilute solution, or a soluble salt thereof. Ani- 
mal Charcoal, largely. Potassium Permanganate, has been taken in large 
doses by Dr. Fahr, of Milford, N. J., after having ingested gr. f of Strychnine, 
resulting in the entire absence of any symptoms of strychnine poisoning. 
Wash out the stomach with a 1 per cent, solution. Lard, is antidotal as 
shown by numerous experiments on dogs and other animals (Turner). Euca- 
lyptus, a decoction as a wash for the stomach; has a true antidotal action in 
frogs (Masmeci). Emetics or the stomach-pump should follow the adminis- 
tration of any antidote. The bladder must be frequently evacuated to pre- 
vent reabsorption. Antagonists, — Quiet, as perfect as possible, is very im- 
portant. Chloral is the antagonist, gr. xxx as soon as possible, repeated in 
20-grain doses at hourly intervals, as long as reflex exaltation continues. 
Butyl-chloral Hydrate, is a very energetic antagonist (Grigorescu). Potassium 
Bromide, is almost too slow of action to be of much practical service. Chloro- 
form or Ether inhalation, to procure muscular relaxation; Ether controls the 
convulsions, and is better than chloroform (Shakier). Physostigma, is antago- 
nistic (R). Amyl Nitrite, by inhalation when collapse seems imminent (R). 



poisoning. 799 

Veratrum Viride, cured a bad case; 5j was given at once, then gtt. ij every 
ten minutes (R). Curare, gr. J hypodermically; is warmly recommended, 
but its claims are doubtful (P). Apomorphine, hypodermically, to relax the 
spasm (Howard); is very effective in dogs (Wills). Nicotine, many cases 
prove its antagonistic and curative power (P). Artificial Respiration, if pos- 
sible; especially with Oxygen, has given excellent results (Riley). 

Opium and Morphine. Antidotes, — Tannic Acid, or vegetable astrin- 
gents, followed by evacuation of the stomach, if the poison has been taken by 
the mouth. Charcoal, gss or more (R). Emetics must be administered 
before narcosis sets in (B). Stomach-pump better than emetics, which by 
the mouth are generally useless in these cases. Potassium Permanganate, an 
efficient antidote if given soon after ingestion of the poison; the stomach 
should be washed out with a i per cent, solution in acute cases, and some of the 
solution allowed to remain in the stomach, to combat any of the morphine 
which may be excreted thereby, and prevent its reabsorption. Compound 
Tincture of Iodine. Antagonists, — Cocaine is the most rational antagonist 
against Morphine, in doses of gr. \ every half hour until consciousness re- 
turns and the respiratory and cardiac functions are sufficiently aroused 
(Barnes) ; is effective as to the respiration, arterial tension, body temperature, 
and psychic functions, and should be given in small doses cautiously repeated 
(Reichert). Caffeine acts similarly to cocaine but with less marked effect 
(Id). Atropine is antagonistic but if given too freely may deepen the nar- 
cosis, no one is warranted in omitting it (P) ; is synergistic in many important 
actions, and may prove dangerous, even fatal (Reichert). Picrotoxin seems 
to be a more reliable antagonist (Riley). Strychnine has found favor with 
some, especially for the respiratory paralysis, but must be pushed to a danger- 
ous physiological effect (Reichert) . Co fee strong and black, frequently given 
by the mouth or per rectum, or caffeine hypodermically (see above). Adren- 
alin is useful in the collapse (Takamine). Serum of animals immunized 
against morphine, was successfully used in a case of acute opium poisoning 
(Hirschlaff). Amyl Nitrite, by inhalation, the former proved eminently 
successful in a case wherein Atropine proved useless to restore the patient. 
Capsicum, the tincture, §ss-j by rectal injection, is said to antagonize the 
stupor almost instantaneously. Vegetable Acids, as Vinegar and water, 
Lemon-juice, Cream of Tartar in water, etc., every 10 minutes (R) ; to antago- 
nize the narcotism. Alcohol is to be avoided (Riley). Douche, alternately 
cold and hot, or hot water and ice alternately to nape of neck, for the narcosis. 
Artificial Respiration, should be kept up for at least two hours (Murrell). 
Oxygen, by inhalation, is of great value (Macalister) . Venesection, has proved 
effective after all other measures failed; is especially beneficial when death 
is impending from failure of respiratory action due to distention of the right 
heart with backward pressure (Marshall). Potassium Bromide removes 
some of the cerebral effects of Opium, as the vertigo and mental confusion. 
The Important Measures indicated in Opium or Morphine poisoning are — 
(i) the removal of the poison, (2) the maintenance of respiration, (3) the 
keeping up of the circulation. The stomach should be evacuated at once, 
and then washed out repeatedly at short intervals, in order to recover the 
morphine which is constantly excreted into that viscus. Faradization of 
the chest muscles, cold affusion and artificial respiration are of great value, 
and evacuation of the bladder frequently is important, to prevent reabsorp- 
tion. Flagellation is a very dangerous procedure, from the exhaustion which 



SOO POISONING. 

may be thereby induced, — strong faradic currents are much more efficient. 
The anode should be placed over the lowest conjoined root of the phrenic 
nerve, the cathode three inches below the ensiform cartilage and a little to 
the left of the median line. 

Phenacetin (Acetphenetidin). See under Acetanilid for the treatment of 
poisoning by Phenacetin, Antipyrine and similar compounds. 

Phenol (Carbolic Acid), Lysol, etc. If the case is seen shortly after the 
ingestion of the poison Apomorphine may be administered hypodermically 
as an emetic; in any case if possible the stomach should be washed out freely 
with alcohol and water. Antidotes, — Alcohol, is a perfect antidote to the 
corrosive effects of phenol (Phelps) . The routine practice in one emergency 
hospital is to wash out the stomach with alcohol and water, equal parts of 
each, and then to leave in the stomach about § viij or § x of the same mix- 
ture for a short time, then washing out with warm water. This treatment has 
proved efficient in numerous cases. Next in value is any soluble Sulphate to 
form the harmless phenolsulphonates ; as Magnesium Sulphate § j, or Sodium 
Sulphate § ss, dissolved in half a pint of water. Even if several hours have 
elapsed since the ingestion of the poison this treatment should be employed, 
as the antidotal action of the sulphates proceeds in the blood. In one case 
§ss of the 95 per cent, phenol was taken, and nearly 5iij of Magnesium Sul- 
phate was used, resulting in complete recovery from an apparently hopeless 
condition. Liquor Calcis Saccharatus is antidotal in the stomach, but is 
much less efficient than the sulphates. Vinegar, especially that made from 
cider, is antidotal, both locally and internally (Ames). Soap in strong watery 
mixture (suds) is said to have acted perfectly as an antidote in the stomach. 
Oils are contraindicated, as they promote the absorption of the poison. 
Vegetable Demulcents (but no oils or glycerin), to protect the mucous surface. 
Sodium Carbonate, in strong solution locally, for the effects of its local use in 
excess; this also as a wash for the mouth, if necessary. Antagonists, — 
Atropine is a very complete antagonist to the systemic symptoms, maintain- 
ing the heart and respiration until elimination occurs ; gr. -^\ hypodermically. 
Alcoholic stimulants freely. Heat to the extremities, also Faradism and fric- 
tion thereof. Venesection in desperate cases (Murrell) . Morphine to relieve 
pain. 

Phosphorus. Antidotes, — Potassium Permanganate is the most reliable; 
wash out the stomach with a J to i per cent, solution, leaving a small quan- 
tity in the stomach to oxidize any of the poison which may remain (Riley). 
Hydrogen Dioxide is less desirable, as it acts more slowly and is more irritant 
(Id). Copper Sulphate, as an emetic and a chemical antidote, doses of 3 
grains in dilute solution every 5 minutes, until emesis occurs; is recommended 
by authority, but is not to be used because it is dangerous. Turpentine, old 
and acid, containing oxygen, given rapidly in a gum emulsion, is said by some 
to be the best antidote ; it is generally unattainable and has proved useless in 
many cases. Lime-water or Charcoal, to prevent action on the tissues. 
Hydrated Magnesia, as a quickly acting purgative ; may be given in Linseed 
tea. Copper Carbonate, with sugar and water. Avoid Oils, Fats and Milk, 
as they dissolve the poison and promote its absorption. Transfusion, to 
repair the blood, or normal salt solution. 

Physostigma. Antidotes, — Emetics or the stomach-pump. Tannic 
Acid or vegetable astringents. Antagonists, — Atropine, as to the effects 



POISONING. 801 

on the respiration, heart and pupil; gr. -%\ to -gV hypodermically, repeated 
until effects are evident. The one nine-thousandth of a grain of Atropine 
injected 5 minutes before giving a minimum fatal dose of Physostigma, pre- 
vents its fatal result (R). Strychnine hypodermically; or the tincture of 
Nux Vomica, TTlxx by mouth or rectum, in very bad cases (Murrell). Stimu- 
lants, freely. Artificial Respiration. 

Picrotoxin. Antidotes, — Emetics or the stomach-pump. Acetic Acid 
gives relief in overdosing, and may have some antidotal power. Antago- 
nists, — Chloral, is antagonistic to its cerebral and spinal action, but synergistic 
to its depressant power over the heart and respiration. Anesthetics, against 
its spasm-producing action. Potassium Bromide, in addition to Chloral, if 
tetanus (Murrell). The treatment is identical with that for Strychnine. 
[See Nux Vomica.] 

Pilocarpine and Jaborandi. Antidotes , — Persalts of Iron and salts of the 
metals generally, are chemically incompatible. Antagonists, — Atropine, 
gr. T ^Q- for gr. J of the poison, is a complete antagonist, the most so known to 
physiological experimentation. Conversely, Pilocarpine is exactly antago- 
nistic to Atropine, but Jaborine acts similarly to the latter. Alcohol and 
Strychnine are used to combat cardiac depression. 

Potash. [See Alkalies.] 

Potassium Dichromate. Antidotes, — Magnesia. Chalk. Lime-water 
and milk. Emetics. Sodium and Potassium Carbonates and Bicarbonates. 
Soap. Antagonists, — Strychnine or Alcohol for the nervous and muscular 
depression. Demulcent drinks. After-treatment as for gastro-enteritis. 

Potassium Cyanide. [See Cyanide or Potassium.] 

Potassium Nitrate (Saltpetre). Antidotes, — No chemical antidote. 
Emetics or stomach-pump. Demulcent drinks and emollient enemata. 
Milk. Antagonists. Aromatics. Brandy. Cardiac stimulants. [Com- 
pare Amyl Nitrite.] 

Ptomaines in meat, fish, etc. See Fish-poison. They cause symptoms of 
gastroenteritis and great prostration. The stomach should be evacuated and 
irrigated, sedatives administered, supporting measures when required, and 
Opium for pain. 

Pulsatilla. Antidotes, — Tannic Acid, followed by emetics. Antago- 
nists, — Alcohol, Opium, Digitalis. 

Quinine. Antidotes, — Emetics and cathartics, also diuretics and sudori- 
fics to promote elimination. Antagonists, — Alcohol, Opium, Coffee. Mor- 
phine antagonizes its cerebral action; Atropine that on the nervous system 
and heart, also its antipyretic power. 

Rat -pastes, — contain Phosphorus or Arsenic. Ratsbane is Arsenic Tri- 
oxide (Arsenic). Rough-on-Rats contains Arsenic (which see). 

Resorcinol. Antidotes, — Albumin. Soda or Saccharated Lime, in 
plenty of tepid water, as wash for stomach. Emetics or the stomach-pump. 
Antagonists, — Stimulants freely. H eat to the extremities. Atropine and 
other cardiac and respiratory stimulants, cerebral excitants, and agents which 
raise the arterial tension, are physiologically antagonistic. Friction with 
warm hand. Galvanism, the interrupted current. Fatal Dose, — 3ij 
nearly proved fatal (Murrell) . 

Rhus (Poison Oak or Ivy). Antagonists, — Cocaine, a 5 per cent, 
aqueous solution, or a 10 per cent, oleate, locally, is one of the most efficient 
51 



S02 POISONING. 

applications, promptly relieving the burning and itching. Sodium Sulphite, 
a hypersaturated solution in water is practically a specific application, for 
even the worst cases (Briggs); 1$ Sodii Sulphitis, granulat., 5ij> Glycerini §j, 
Aquae Camphorae, q. s. ad 5 viij, as a local application (Behringer). Grin- 
delta, the fluidextract, undiluted; or i to 10 of water, with 2 per cent, of 
Phenol; is a very serviceable application. Ichthyol is one of the most effective 
local remedies (Klotz). Other applications found useful are: — Phenol, in a 
1 to 2 per cent, solution; Lobelia, as infusion, §j to the pint; solutions of 
Corrosive Sublimate, Lead Acetate, Chlorinated Soda, Lime-water with 
Linseed Oil, Alum-curd. 1$. Plumbi Acetatis, 5ijj Ammonii Chloridi 
(crude), §ss; Aquae, § viij; as lotion on cloths constantly wetted therewith, 
is used with uniform success (Burns). Soap-suds and Hot Water, frequently 
washing therewith the surest, speediest and best treatment (Couch). Thymol 
Iodide, dusted over the part, gives magical relief (Levick) . Hydrogen Dioxide, 
a solution washed over the face and hands, as a preventive (Behringer). 
Sassafras, an infusion of the bark, taken internally and applied locally, is 
almost specific for the rash (Hinton). Opium may be necessary to relieve 
the nervous irritability. Rest, low diet, and laxatives are appropriate 
measures. 

Savin. Antidotes, — Epsom salt. Demulcents. Emetics and purga- 
tives, especially Castor Oil. Antagonists, — Morphine, gr. \ hypodermically. 
Poultices of linseed meal to abdomen. After-treatment as for gastro- 
enteritis. 

Serpent-venom. Antidotes, — Potassium Permanganate, a strong solu- 
tion hypodermically into the vicinity of the wound, after ligating the part 
above it (Weir Mitchell). Chloride of Lime (Chlorinated Lime) in solution, 
1 in 60; injected in doses of 20 minims, produced recovery (Hodgson); after 
ligature applied above the wound, a solution, 1 to 1 2, was injected in doses of 30 
minims, 25 injections in all in different parts of the body, brought about re- 
covery after severe symptoms from the bite of a tiger snake (Mackenzie). 
Hypochlorites of Lime or Sodium, Chloride of Lime, and Gold Chloride, are 
absolute antidotes against serpent-venom (Calmette). Phenol, strong, or a 
Mineral Acid, as caustic, after forcible sucking of wound by a person with 
perfect mucous surface of lips and mouth, and thorough cleansing. Bile of 
the biter snake is an active antidote to the poison (Fraser); should be in- 
jected into the immediate neighborhood of the wound when possible (W). 
Antagonists, — Strychnine, hypodermically, has proved eminently efficient 
in numerous cases (Baron von Miiller). Arsenic, for the rapid prostration 
(B). Bromine, 1$. Potassii Iodidi, gr. iv; Hydrarg. Chlor. Corr., gr. ij; Bromi, 
5v; Aquae, 5j; of which gtt. x (or TTliij) in 5ij of Brandy, repeated if neces- 
sary (Hammond). Viola Cucullata, the common Violet, has been used in 
Pennsylvania against the rattlesnake venom. Agave Virginica, is known in 
South Carolina by the name of "rattlesnake's master." Echinacea (Black 
Sampson), a strong tincture both locally and internally, is used with invari- 
able success (Ellingwood). Antivenene has antagonistic and immunizing 
power against the effects of the venom of poisonous serpents (Calmette); 
is the recognized serum remedy for serpent bites, and has been success- 
ful in many cases. Ammonia is not antidotal (Brunton); may be useful as 
a stimulant to the heart (W). Alcohol, 5j-iv of Whisky every 15 minutes 
as a stimulant in acute depression threatening a fatal issue, but is not 
antidotal as generally believed (W); is inferior to other stimulants (Riley). 



POISONING. 803 

Pilocarpine in full doses hypodermically until sweating or salivation occurs, 
to favor elimination (Id). Transfusion of healthy blood, or the intravenous 
injection of normal salt solution, may be required (Id). 

Silver Salts. Antidotes, — Sodium Chloride (common salt), dissolved in 
water, largely diluted and freely used; precipitates the silver as the insoluble 
and harmless chloride, and acts as an emetic (R) ; vomiting should be induced 
at once, as silver chloride is soluble in a solution of sodium chloride and in the 
digestive fluids. Large draughts of salt and water should be taken and vom- 
ited, this being repeated until no silver remains. The stomach should then 
be filled with milk and the bowels moved by castor oil. Alkalies, especially 
Magnesium Bicarbonate (R). Albumin. Antagonists, — Milk, to allay 
the resulting irritation; it may serve as food until the stomach is restored. 
Opium, against results of irritation. [See Metallic Salts.] 

Soda and Sodium Salts. [See Alkalies, Potassium, Nitrate, Metallic 
Salts.] 

Stramonium. [See Belladonna.] 

Strychnine. [See Nux Vomica.] 

Sulphonal and Trional. Antidotes, — Sodium Bicarbonate in solution 
freely, by the mouth and by hypodermoclysis (W). Water in large quanti- 
ties freely to wash the poison out of the system (W). Saline cathartics and 
diuretics. Antagonists, — Strychnine gr. ^ every 4 hours, used in a case in 
which § j of Trional was taken, the patient having then slept 4 days, but after 
six injections he was awake (Alksue). Alcoholic stimulants may be required. 

Sulphur and Sulphides. Antidotes, — Chlorine-water. Sodium Chloride 
(common salt). Potassium Chloride. Ferrous Sulphate. Chlorine Gas or 
Calcium Hypochlorite, for Sulphuretted Hydrogen; the former should be well 
diluted with common air. Antagonists, — Artificial Respiration is the best 
treatment for poisoning by Sulphuretted Hydrogen. 

Tartar Emetic. [See Antimony.] 

Tin. Antidotes, — Albumin, Ammonium and Sodium Carbonates, Milk. 
[See also Metallic Salts.] 

Tobacco. Antidotes, — Tannin, followed by emetics, or the stomach- 
pump. Iodides. Antagonists, — Strychnine is the true physiological an- 
tagonist to Nicotine (or Tobacco) and vice versa. Alcohol, Ammonia, 
Ergot, Digitalis, Belladonna, antagonize its action on the circulation; Brandy 
is efficient, also strong Coffee. Warmth applied to the surface, also friction. 
Artificial Respiration. Recumbent position should be strictly maintained. 
Atropine if much depression of respiration. The juice of Nasturtium 
officinale has recently been credited with excellent results as an antagonist 
to nicotine (Riley). 

Trional. [See Sulphonal.] 

Turpentine. Antidotes, — Magnesium Sulphate (Epsom salt), §j in 
water. Emetics or the stomach-pump. Demulcent drinks, as milk, 
barley-water, etc. Antagonists, — Opium or Morphine, if much pain and 
for shock. 

Tyrotoxicon (in milk, cheese, ice-cream, etc). Antidotes, — Emetics, if 
vomiting is not free; also the stomach-pump or siphon to rinse out the stom- 
ach with water. Thymol, Salol, Naphthalene, or other antiseptics. Antag- 



So4 POLYPUS — PREGNANCY. 

onists, — Opium, or other sedatives, to allay irritation. Stimulants, when 
prostration. 

Veratrum and Veratrine. Antidotes, — Emetics or the stomach-tube. 
Antagonists, — Alcohol, Ammonia, Digitalis, and Belladonna counteract the 
cardiac depression. Morphine with Atropine hypodermically, or Laudanum 
internally, with alcoholic stimulants. Heat, dry, applied to the body. t Re- 
cumbent posture strictly maintained. Coffee, strong, as enema. [See also 
Aconite.] 

Veronal. Antidotes, — Tannic Acid in solution as wash for the stomach- 
Castor Oil or Saline Cathartics to clear the bowels. Diuretics and diapho- 
retics to further elimination. Antagonists, — Camphor and Caffeine hypo- 
dermically when pulse is weak, in stage of excitement during recovery. 

Wounds, Poisoned. Antidotes, — Ammonium Carbonate, gr. v hypo- 
dermically in the vicinity of wounds caused by poisoned arrows, was repeat- 
edly used with entire success by Parke, the surgeon to Stanley's last African 
expedition. [Compare Serpent-venom above, also the article on Wounds.] 

Zinc Salts. Antidotes, — Sodium or Potassium Carbonate, dissolved in 
warm water, largely diluted, used freely. Albumin as eggs and milk, with 
tepid water, freely. Tannic Acid, or vegetable astringents, or strong tea. 
Borax in milk. Lime-water. Soap-suds freely. Mucilaginous drinks. 
Antagonists, — Opium, or Morphine hypodermically. Linseed-meal as poul- 
tices to abdomen. Enemata of gruel or starch-and-water, if much abdominal 
pain. 

Polypus. 

Sanguinaria, has been employed as snuff for nasal polypi (P); with 
doubtful benefit (W). Iron, a solution of the Chloride is advised as an inter- 
stitial application (Auger). Acetic Acid, glacial, injection into the body of the 
tumor, will cause it to shrink up and to drop off in a few days. Alum, in pow- 
der, applied to point of origin to prevent recurrence (D). Surgical, — a nasal 
polypus should be seized with polypus forceps and twisted off at the neck; it 
may be removed through the mouth or the nostril; in a few cases the nostril 
must be dilated with a speculum, or the ala slit to give access to the root of the 
tumor (D). 

Pregnancy, Disorders of. 

Mercury, a few grains of blue pill to correct clay-colored stools (L). 
Iodine, the tincture internally for cardialgia (Wa). Aloes, has cured piles in 
pregnancy, by removing constipation; cautiously (P). Alum, Tannin or 
Catechu, in medicated pessaries for vaginal leucorrhea (L). Castor Oil, an 
excellent laxative (P); to clear out the bowels in diarrhea (L). Cocculus 
Indicus, when intestines much distended with flatus, and frequent desire to 
urinate from flatulent pressure on bladder (P). Bismuth, Calumba and 
Antispasmodics, with minute doses of Opium, for gastrodynia and pyrosis 
(L). Potassium Bromide, with Chloroform, as an antispasmodic in dyspnea 
(L). Galla, Unguentum Gallae cum Opio, the best local application to 
hemorrhoids, also fomentations with sponges wrung out in very hot water, to 
relieve pain (L). Digitalis, in infusion, very beneficial in the albuminuria 



PROLAPSUS ANI — PROLAPSUS UTERI. 80 5 

(L). Potassium Acetate, with Basham's mixture (Liq. Ferri et Ammonii 
Acetatis), when albuminuria with anemia. Calcium Phosphate, believed to 
exert an influence on the fetus if administered during pregnancy, so that 
mothers who have born only rachitic or scrofulous children will bear healthy 
ones (Beneke). Berberine, found very useful in the periodical neuralgiae 
of pregnancy, even in cases in which Quinine had previously failed (Maclagan) . 
Camphor Liniment, for lumbar pains ( Wa) . Senna, the confection proves a 
mild and efficient purgative in the constipation of pregnancy (Wa). Milk- 
diet, the best remedy for albuminuria of pregnancy, if strictly carried out 
(Parvin). Injections, must be used carefully, even tepid water often in- 
duces uterine contractions (L). Optic Neuritis may occur and progress to 
complete blindness, without any other cause than pregnancy (Holzbach). 
[Compare Albuminuria, Bright's Disease, Nervousness, Ptyalism, 
Vomiting of Pregnancy.] 

Prolapsus Ani. 

Treatment, palliative treatment forbids straining at stool and amends an 
improper diet; phimosis must be corrected; stone in the bladder must be 
crushed or cut for and removed; stricture must be dilated; hemorrhoids and 
polypi are to be removed (Da Costa). Give an Enema of Cold Water just 
before going to stool in order to hurry the emptying of the rectum (Id). 
Nux Vomica, or Strychnine, especially when in children, with constipation; in 
the latter event add Nux Vomica to a purgative, as tincture of Rhubarb (R, P) ; 
Strychnine hypodermically, gr. T \ f or an adult every 48 hours, f inch from anus 
and parallel to rectum into the cellular tissue; generally requires 4 to 8 injections 
(Weber). Piper, the Confectio Piperis in doses of gr. lx to cxx, persevered in 
for 3 or 4 months, in chronic weak subjects (Wa). Sulphur, has a beneficial 
effect in addition to its laxative value (R). Alum, in solution, gr. vj to the 
5 (R). Ice, locally, whein parts inflamed (R). Ergot, the fluidextract in- 
jected into the perineum, is followed by immediate relief (Vidal). Ferrous 
Sulphate, 3j to Sviij aquae, of which one- third by enema, twice daily. 
Podophyllin, in small doses for rectal prolapse in children (P). Tannin, by 
injection to restrain the prolapsus (R). Hydrastis, by enema, or as a lo- 
tion (P). Taxis, if a prolapse is caught firmly, paint it with cocain and 
adrenalin, place the patient in the knee-chest position, apply hot com- 
presses, grease it with cosmolin, insert a finger into the rectum, and apply 
taxis around the finger (Mathews). 

Prolapsus Uteri. 

Cimicifuga, to prevent miscarriage in prolapsus uteri (R) ; has a remark- 
able effect upon the uterus (P). Astaringents, as Decoctum Quercus, Decoc- 
tum Gallae (Wa); or Pomegranate bark (P). Tannin, as Catechu, Kino, 
Rhatany. Alum, a solution, gr. vj to the 5 (R) ; lb. j and C j acquae, as hip- 
bath; should also be passed well up vagina (Wa). Ice, locally, when parts 
inflamed (R); applied to the spine (Wa). Pessaries, in any form, are of but 
temporary benefit, and in the end positively detrimental (E) ; they insure us 
better position than any operation (Kustner) . Operation by ventral fixation, 
or by shortening the uterine ligaments, pemanently relieves the majority of 
cases. 



806 PROSTATE, HYPERTROPHIED PROSTATITIS. 

Prostate, Hypertrophied. 

Alkalies, for the cystic irritation with acid urine; great benefit from Liq. 
Potass. Hydroxidi or the Citrate of Potassium (B). Triticum Repens, bene- 
fit follows its use in the prostatic enlargement of old men (Sir H. Thompson). 
Ammonium Benzoate, for the cystitis, urine alkaline (B). Ammonium 
Chloride, is occasionally useful, gr. xv-xxx, 3 or 4 times daily (Wa). Iodine 
Injections, a weak ointment applied by rectum (Wa) . Iodine has been tried in 
all forms, but is of no value (Thompson). Iodoform, as suppository in the 
rectum, has proven of great value (B). Colchicum, in persons of gouty dia- 
thesis (Wa) . Medicines are not likely to have any control over this condition, 
which is a simple hypertrophy; castration was suggested by J. Wm. White, 
and has been performed with successful results in 3 cases by Haynes, also by 
the other operators. Catheterization, many cases of enlargement are treated 
by regular catheterization, and this is conducted with careful cleanliness, and 
if the patient rigidly adheres to hygienic rules, he may be kept comfortable 
in this way for a considerable time (Da Costa). Tell the patient to avoid vio- 
lent exercise, cold damp, sexual excitement, and the use of acoholic liquors; 
prevent constipation and indigestion, and direct him to drink milk and 
plenty of water (I). Operation, unfortunately, sooner or later a man who 
regularly relies upon the catheter will develop cystitis. A poor man cannot 
give the necessary time and attention to make catheter life safe and operation 
must be thought of in him sooner than in others. If the symptoms grow con- 
stantly worse, if the suffering becomes severe, if the patient cannot urinate 
without the use of an instrument, if catheterization is painful or impossible, 
if the patient is too careless or ignorant to trust with a catheter, if only a 
catheter of very small size can be introduced, if attacks of obstinate reten- 
tion occur, if there is persistent or recurring cystitis or hematuria, if there 
are signs of beginning infection of the kidney, if the residual urine gradually 
increases in amount, operation is called for (Da Costa) . [Compare Cystitis.] 

Prostatitis. 

Cantharides, a drop of the tincture, 5 may be required, 3 or 4 times a day 
(R). Triticum Repens, is found to be of benefit (Sir H. Thompson). Urino- 
Genitals, especially Turpentine, Cubeb, Juniper, Cantharis (B); Cubeb, in 
doses of gr. xx daily, is found of much benefit (Wa); Buchu relieves (P). 
Silver Nitrate, a solution, gr. v-x to the § , applied to the prostatic urethra 
may be useful in chronic prostatitis (Wa). Ichthyol in 10 per cent, aqueous 
solution injected 3 or 4 times daily per annum, was used in 40 cases with most 
gratifying results, a small syringeful each time, without abscess in any 
instance (ScharfT). Helmitol as a urinary disinfectant, is valuable in cases 
having a tendency towards alkaline decomposition of the urine (Gold- 
schmidt). Uriform acts beneficially by rendering the urine unirritating, also 
by its sedative and anti-catarrhal action on the inflamed urethral mucosa. 
Blisters, in chronic prostatitis, a small blister on each side of the raphe of the 
perineum, kept open 4 to 6 weeks, has given the best results (Wa). Tonic 
medicines and regimen should be prescribed (Wa). Hot Injections, to 
relieve pain (R). Cold by rectal injections or rectal ice-bags, is most efficient 
in promoting resolution of the inflammation. Incision, perineal, if abscess 
forms. [Compare Prostatorrhea.] 



PROSTATORRHEA — PRURITUS. 807 

Prostatorrhea. 

Iron, the Tincture of the Chloride, when there is much debility (B) ; chaly- 
beate tonics with Quinine and Strychnine (Gross). Atropine, indicated in all 
cases, with Potassium Bromide (Gross). Potassium Bromide, when irri- 
tability and excitement (B); indicated in all cases (Gross). Lead, injections 
of Goulard's Extract, 5 j to § x of water, night and morning, for 10 minutes at 
a time (Gross). Ergot, when relaxation exists (B). Bougie, methodically 
introduced, is one of the best local measures (Gross). Hydrastis, locally 
applied, a useful medicine (B). Cantharis, the tincture in drop doses is often 
an efficient remedy. [Compare Prostatitis.] 

Prurigo. 

It is extremely difficult to effect a permanent cure in severe cases of this 
disease and it is liable to recur year after year. The treatment should be 
directed towards the relief of the associated itching. Mild cases may be 
temporarily improved but are very apt to be recurrent. As it is necessary 
to keep up the patient's strength as much as possible, systematic exercise 
is advisable and a full diet is advocated. Iron, Quinine and Strychnine 
are of value at times as tonics. Arsenic is indicated as a tonic though 
it has very little direct influence on the lesions themselves. Beta Naphthol, 
2 to 5 per cent., has been recommended by some observers. Baths of 
Bicarbonate of Soda, 2 to 4 drachms to the tub, may be soothing. Carbolic 
Acid, 1 per cent., should be incorporated in all external applications. Lysol, 
I to 1 ounce to a half tub of water will help allay the itching. Tinctura 
Saponis Viridis should be used freely in the baths. Sulphur in the form of the 
official ointment with carbolic acid may be tried. If an associated eczema- 
tous condition exists, the treatment should be followed out in this direction. 
[See Eczema.] 

Pruritus. 

In all patients who present themselves for the treatment of this disease, 
it is of the utmost importance that the urine be examined carefully for 
sugar as pruritus is frequently a symptom of diabetes. It is also at times 
associated with lymphatic disturbances and many other internal derange- 
ments. In many cases, it is absolutely impossible to attribute it to any 
known cause and certain symptoms make it seem as though it were the 
result of some mental disturbance. A very thorough examination of all the 
organs may elicit the cause of this troublesome condition and the treat- 
ment should be along this line, and internal medication and diet governed 
entirely by such findings. Alcohol in any form is usually contraindicated. 
Autoserum treatment in a few selected cases has proved of great value 
with various dermatologists as well as myself. Some of the good re- 
sults are derived from the complete rest and relaxation which are part of 
the treatment; I always insist that these patients have three weeks abso- 
lutely confined to their beds. Full details for this form of treatment 
may be found in any recent book on dermatology. Boric Acid, a sat- 
urated solution in water, may be used combined with Carbolic Acid, 5 
grains to the ounce. Camphor with its cooling effect may be incorporated 
with other drugs. The Galvanic Current applied to different parts of the 



SoS PRURITUS ANi; PRURITUS VULVAE; PURITUS SCROTI. 

body has been reported of value as has also the High Frequency Current. 
Glycerin or Olive Oil should be added to the majority of lotions prescribed, as 
the skin is usually very dry. Ichthyol in 5 to 10 per cent, aqueous solution 
has been recommended but it is such a dirty preparation that it is rarely used. 
Dilute Lead Water is of great value if there is an associated inflammation of 
the skin. Liquor Carbonis Detergens or the Tinctura Picis Mineralis 
Comp., 5 to 20 per cent, in water, is of value in this as in other markedly 
pruritic diseases. Lysol, \ to 1 ounce to half a tub of water will help allay 
the itching. Menthol is also very cooling and should be prescribed in two 
to 5 grains to the ounce. Opium and its derivatives are not well borne 
as they tend to increase the itching; this applies particularly to Codeine. 
Phenol should be incorporated in all ointments and all lotions which are pre- 
scribed as it will aid materially in the alleviation of the itching. Potassium 
Bromide or the other Bromides may be used as the case requires and it 
may be necessary to resort to Chloral or some other sedatives. Resorcin, 2 
to 5 per cent., in either water or alcohol acts well, particularly if a small quan- 
tity of Glycerin is added. Sodium Bicarbonate Baths, 2 to 4 ounces 
to the tub of water, may be of value. Starch, one teacupful in a basin of 
tepid water may be applied freely to the body at frequent intervals as it will 
allay the itching temporarily but is of no permanent value. Tar is also of 
value and may be used where the odor will not be an objectionable feature. 
Thymol may be used in ointment, 5 to 20 grains to the ounce or the same 
quantity in a lotion. 

Pruritus Ani; Pruritus Vulvae; Pruritus Scroti. 

An examination of every organ of the body, to discover any underlying 
factor, should be made as pruritus is very frequently associated with dia- 
betes, etc., etc. For pruritus ani, a careful examination must be made for 
fissures and hemorrhoids. The fact that so many drugs are recommended 
for the external treatment of this disease, demonstrates how difficult it is to 
cure. There is one remedy in the hands of the writer and others which proves 
of such value that it is now used to the exclusion of all other methods of 
treatment, and that is the High Frequency Current. The percentage of cures 
has been so high under this treatment that I should not feel justified in pre- 
scribing anything else and can heartily endorse it to those who have the 
apparatus. In pruritus ani, cleanliness is of the utmost importance and the 
toilet paper should invariably be wet before using so that it may not irritate 
the inflamed parts. Dilute Lead Water is of great value in this disease, either 
alone or in the following prescription. Phenol should invariably be incor- 
porated in every prescription for the relief of itching. Menthol is of value on 
account of its evaporation, with resulting coolness. In addition to the drugs 
recommended for a general pruritus, some of the remedies prescribed under 
an acute eczema are of value for pruritus vulvae. Astringent applications in 
pruritus of this region may be used with considerable success. The best of 
these are Alum and Tannic Acid. Hot Water Injections or Hot Water 
Douches repeated once or twice daily will prove useful in some instances. 
(Stelwagon.) Alcohol Injections have been used recently for the treatment 
of pruritus ani. Care must be taken, however, that it be injected directly 
under the skin and not deeply, in order to avoid producing deep sloughing or 
impairing the action of the sphincter muscle. 



PSORIASIS. 809 

Bismuthi Subnitratis, 3iv. I 1$. Spts. /Etheris Nitrosi, 3iv. 



Liq. Plumbi Subacetatis dil., 5iss. 

Phenolis, ttj?xx. 

Aquae, q. s. giv. 

M. — Sig. Apply freely. 



Phenolis, ttjjx. 

Argent. Nitras, gr. xl. 

Aquae, q. s. 3ii- 

M. Sig. — Apply twice daily for three 
days with applicator. 



Psoriasis. 

A certain number of cases seem to do well on a meat free diet. Others 
in whom it has been found that there is an increased nitrogen output are im- 
proved by a diet consisting of a very low percentage of nitrogenous foods; 
and still with others, the diet apparently has no influence on the erup- 
tion. Alcohol as a beverage is contraindicated in this, as in the majority of 
skin diseases. Arsenic is the drug which is most commonly used in the 
treatment of this disease and in a very large percentage of cases exerts 
almost a specific influence on the eruption. It may be given in the form of 
Fowler's Solution, starting with 3 minims, increasing 1 minim a day until 
the point of tolerance is reached, care being taken to be on guard for the early 
symptoms of poisoning. It may also be given in the form of Arsenous Acid 
from -fo to 2V of a grain t.i.d. The Asiatic Pill is sometimes used. Other 
forms of Arsenic which are at times employed are Sodium Arsenite, Potassium 
Arsenite, but the one that has proved of the greatest assistance in the hands 
of many is Sodium Cacodylate. Given hypodermically, the initial dose is 
1 J grains increasing § grain every time until 3 grains are reached and that 
dose maintained. Injections should be given from 2 to 5 days. It is impos- 
sible to give this drug by the mouth on account of the odor of garlic which it 
produces. Salvarsan has been used by a few but with no better success than 
with less drastic measures. Liquor Potassae is of some little use at times, 
the dose being 10 minims at the onset and increased slowly to 20, well diluted in 
water. " Potassium Acetate is another alkali as well as a diuretic that has 
gained some reputation in doses from 10 to 30 grains three times daily" 
(Stelwagon). Sodium Salicylate, 5 to 20 grain doses, is of value at times. 
Salicin was used at one time quite extensively. Thyroid Extract has been 
employed in this, as in many other skin diseases with varying results, in 
doses from ^ to 5 grains. Carbolic Acid, once extensively used for the treat- 
ment of this disease has been found not to be of as much value as other 
drugs. Autoserum Treatment has many advocates and may well be tried 
in extremely obstinate cases. I have treated several patients by this method 
with marked success but the treatment has no influence in preventing further 
attacks. External Treatment of psoriasis is of as much, if not more impor- 
tance, than the internal. Daily warm baths in which has been incorporated 
some alkali, are indicated; perhaps the best of this class being the Sodium 
Bicarbonate, 2 to 4 ounces to the bath. Some method must be employed 
to remove the scales as it is obviously impossible for any medicament which 
may be used to have any influence on the disease if a thick laminated scale, 
intervenes. ' After the bath, and if the scales still adhere, the body may be 
rubbed with plain petrolatum or lard or olive oil. Turkish or Russian 
Baths are of importance in that they produce excessive sweating and loosen 
the scales. Cabinet Baths at home may be employed for the same purpose. 
Aristol, the strength of 5 to 1 o per cent, ointment may be used. Beta-Naphthol , 
15 to 60 grains to the ounce of ointment, petrolatum or lanolin, is at times 



Sio 



PTERYGIUM — PTYALISM. 



useful. Oil of Cade has its uses but is objectionable on account of the odor. 
Liquor Calcis Sulphuratae is used at times diluted, one to four parts with 
water. Chrysarobin is perhaps our most valuable drug in the treatment of 
this disease. If there are a few lesions, it may be painted on 20 to 40 grains 
to the ounce of Chloroform, allowed to dry and covered with Collodion. 
Two or three applications are frequently sufficient to cause a disappearance 
of the lesions. In certain susceptible individuals, it will produce a marked 
dermatitis, in which case the treatment should be withheld. A mild derma- 
titis is not an objectionable feature. If the eruption covers the greater part 
of the body, an ointment consisting of 10 to 40 grains of this drug to the ounce 
of petrolatum rubbed in night and morning is of the greatest advantage. It 
may be used directly following the daily bath. Flexible Collodion should 
be put over all lesions which have been painted with a drying lotion. It 
not only prevents the rubbing off of the drug, but protects the clothing. 
The various Intensive Light treatments may also be used for scattered 
lesions and some good results are being obtained from this line of treat- 
ment. The Tinctura Picis Mineralis Comp. or Liquor Carbqnis Deter- 
gens is a very valuable remedy. This may be incorporated 10 to 30 per 
cent, in petrolatum or 25 to 50 per cent, in water. Pyrogallic Acid has been 
advocated by some practitioners in the strength of 20 to 60 grains to the ounce 
of petrolatum but it has several objectionable features. Resorcin may also 
be used in from 2 to 1 2 per cent, strength in petrolatum. Salicylic Acid, 
5 to 10 per cent., incorporated in ointment base is of considerable value. 
While Sulphur was once very extensively used, both as a dusting powder 
and incorporated in ointments, it is little employed at the present time. 
Tar is of value in the treatment of this disease and were it not for its objec- 
tionable odor would be much more extensively used. The X-ray may be 
used where there are a few scattered lesions but it is of no permanent value. 



. Chrysarobini, 5j- 

Acidi Salicylici, gr. x-xx. 

Athens, 5j- 

Olei Recini, TTgv. 

Collodii, q. s. ad gj. 

M. Sig. — Apply twice daily. 



1$. Chrysarobini, 5 J- 

Acidi Salicylici, gt. x-xx. 

Liquor gutta perchas, 5j- 

M. Sig. — Apply twice daily. 

(Stelwagon.) 



Pterygium. 

If the growth is small and causes no disfigurement or impairment of 
vision, no treatment is necessary. Boric Acid, or a bland collyrium may be 
used to allay any conjunctival irritation. Operation is the only satisfactory 
treatment. The head of the growth should be removed from the cornea and 
stitched beneath the detached conjunctiva. This method usually results in 
permanent cure. 

Ptyalism. 

Acids, as astringents, small medicinal doses (R). Sulphuric Acid, in- 
ternally and with Decoctum Cinchonae as a gargle, of great benefit in mercurial 
ptyalism (Wa). Potassium Chlorate, in simple or mercurial ptyalism (R), 
in the latter form 5 j ad § vj aquae as mouth- wash, and internally in teasp. 
doses, 4 or 5 times daily (St). Belladonna, very effective in mercurial ptya- 
lism, and that of pregnancy; gtt. v-x, or Atropine, gr. ^0 t0 Tiro every 4 to 



PUERPERAL CONVULSIONS. 



8ll 



6 hours (B); is good treatment when ptyalism is the result of some reflex 
action, but not so when it is an effort of nature to eliminate some drug-poison, 
as mercury, iodine, etc., from the system (Whitla). Pilocarpine, in small 
doses, gr. -^, will stop mercurial salivation more effectually than anything 
else (Robinson) ; in small doses will relieve both ptyalism and profuse sweat- 
ing. Pellitory to stimulate the salivary flow when ptyalism is due to mercury, 
iodine, etc., unless the gums are swollen and ulcerated (Whitla). Hyoscine 
or Opium, may be used instead of Atropine (Id). Astringents, in ptyalism 
from excessive mercurialism when the gums are swollen and ulcerated; 
Alum i in 40, Zinc Chloride 2 grains to the § , Tannic Acid 1 in 40, or other 
vegetable astringents (Id). Tannic Acid, in mercurial ptyalism is an excel- 
lent gargle, 3 j of Tannin to 5 ij of Mel Rosae, and § vj of water (B). Alcohol, 
diluted, as a gargle (R). Potassium Iodide, is sometimes beneficial in mer- 
curial ptyalism, but often aggravates it (R). Iodine, the tincture 5ij in 
5 viij of water, as a gargle (R); is worthy of trial (jWa). Borax, the glycerite 
is an efficient local application, but must be used almost continuously 
(Whitla). Potassium Bromide, has proved useful in the salivation of 
pregnancy; it may be combined with small doses of Belladonna or Hyoscya- 
mus (Id). Chlorinated Lime or Soda, in weak solution, for the fetor (Id). 
Stimulants, may be needed in severe cases. Diet, liquid food when swallow- 
ing is difficult. 



]$. Acidi Sulphurici, 3ss. 

Tinct. Myrrhae, § j- 

Aquae, q. s. ad §vj. 

M. Sig. — Mouth-wash. 



1$. Sodii Boratis, 3ij- 

Tinct. Myrrhse, 3 j. 

Aquae, 5 vj. 

M. Sig. — Mouth-wash or gargle. 



Puerperal Convulsions. 

Chloroform, by inhalation to narcosis (R) ; its utility unquestionable when 
convulsions are not due to cerebral hemorrhage (B); the combined chloro- 
form and chloral treatment results in a death-rate of only 7.6 per cent. 
(Winckel). Chloral, after the chloroform, given with Bromides by the rec- 
tum to keep up the effect; full doses, 20 to 30 grains every 2 hours (B); a 
remedy of the greatest value, in full dose before proceeding to one of the 
bromides (Playfair, Barnes); is one of the most powerful anti-convulsants 
known, 3 SS m ay be given at once, and gr. xv every hour or two as required 
(W). Bromides, in large doses by enema, are distinctly indicated (P); 
Potassium Bromide, 3j~ij by the rectum, after venesection if convulsions 
return (Whitla). Veratrum Viride, in 5 s s doses of fluidextract every 15 
minutes, to nausea, invaluable (R); the fluidextr., in doses of Tflviij-x hypo- 
dermically, may be repeated in half -hour with Morphine, or Tfl,x by enema, 
promptly efficient in the worst cases (Elmer) ; a very bad case cured by 20- 
minim doses every hour for 5 days (Dunn); the worst case seen in my 30 
years' experience, after 14 seizures was promptly cured by a hypodermic in- 
jection of TTliv of Norwood's tincture in a little water (Etheridge) ; Tfl.xx-xxx 
of the fl. extr. hypodermically, have given unparalleled results, under it the 
mortality is only 20 per cent. (Archambault). Aconite, one of the best 
agents (P); gtt. j-ij of tinct. every 10 or 15 minutes for the first hour, then 
at longer intervals (B). Belladonna, the tinct. internally with Atropine 
hypodermically, of verified utility (P). Potassium Bitartrate, administered 
for a month prior to confinement, in quantity sufficient to bring about free 



8l2 PUERPERAL DISORDERS. 

action of kidneys and bowels, will certainly prevent puerperal convulsions 
(Anderson). Opium is apt to induce eclampsia, unless its use be preceded 
by free purgation or venesection (Id). Morphine used in 60 cases with but 
two deaths (Veit); in the intervals to prevent recurrence, is efficient and of 
rapid action (Krusen); most cases are due to parenchymatous nephritis, in 
which morphine is used with comparative safety and with brilliant results, 
but a few are due to interstitial nephritis and in them it is a dangerous agent 
(Ty). Apomorphine gr. J hypodermically, an excellent sedative and hyp- 
notic (Kitchen). Pilocarpine, the Nitrate gr. J hypodermically every 2 
hours, successfully used in several cases (Finniss) ; dangerous, being liable to 
cause edema of the lungs (P). Amyl Nitrite by inhalation (B); may cause 
alarming hemorrhage (W). Tropacocaine by spinal subarachnoid injection, 
gave prompt relief in eclampsia (Kamann). Urethane, may be used as an 
anti-convulsant (W). Thyroid Extract in full doses, fulfills all indications 
for treatment in threatening eclampsia (Nicholson); the chief symptoms of 
eclampsia are those of hypothyroidea, and a certain number of cases are prob- 
ably due to thyroid insufficiency (Richardson). Ice-bags to the back of the 
neck and head, have decided efficacy in warding off and controlling the 
convulsions (Id). Hot Pack is of considerable value in most cases (Davis). 
Venesection during the intervals, is superior to veratrum viride to reduce the 
pulse and prevent recurrence (Krusen) ; is by far the most efficient measure 
(Wallace) ; when great cerebral congestion and vascular tension, shown by a 
livid face, a full and bounding pulse, and strong pulsation in the carotids 
(Playfair) ; remove 15-20 ounces of blood, and follow by enemata of Potassium 
Bromide, 3 j~ij\ if convulsions return; Chloroform should be very cautiously 
used, if at all, after blood-letting (Whitla). Compression of the Carotids, 
Trousseau's method, often stops or materially modifies the attack, and may be 
used in most cases to gain time until chloroform narcosis is established (Id). 
Saline Purgatives, the best being Magnesium Sulphate, or the compound 
Jalap powder, with free use of the wet pack to act upon the skin, for the rapid 
elimination of the retained excrementitious products, urea, leucin, tyrosin, 
etc. (Id). Salt Solution copiously by hypodermoclysis or enteroclysis, to 
dilute the toxins and counteract the depressant effects of phlebotomy 
(Krusen). Delivery of the child as soon as possible, is indicated in all cases 
(Id); promises better results than any other treatment (Ballantyne). [Com- 
pare Convulsions.] 

Puerperal Disorders. 

Cimicifuga, in puerperal hypochondriasis, and depression ( Wa, P) . Opium, 
either alone or with alteratives, highly serviceable in puerperal intestinal irri- 
tation; a few drops of the tincture effectually arrests the diarrhea (Wa); when 
shock and marked exhaustion, a moderate dose is of benefit (L). Castor Oil, 
undoubtedly the best laxative (L); purgatives generally are not required, 
castor oil the very worst (Fordyce Barker); action uncertain (Parry). Rhu- 
barb, or enemata, best means of stimulating bowels after fourth day (L); 
gr. xx-xxx in some aromatic water a good aperient (Wa). Aliment, in 
puerperal state should be easy of digestion and sustaining (L). Catheter, 
necessary often for several days when bladder paralyzed, if warm water lave- 
ments fail (L). Water, tepid sponging of external parts, vaginal washings 
daily with warm water, with T ^ 7 part of Phenol (L). [See After-pains, 



puerperal fever — puerperal mania and melancholia. 813 

Hemorrhage, Labor, Lactation, Mastitis, Nipples, Phlegmasia Alba 
Dolens, also the previous and following articles.] 

Puerperal Fever. 

Aconite, drop doses every i or 2 hours steadily, with an occasional dose 
of Castor Oil, but useless if not promptly efficient (P). Veratrum Viride, 
is used with great benefit in most cases (Barker). Quinine, only large doses 
are useful; gr. v-xx every 4 hours (B); reduces the temperature (P). Resor- 
cinol, doses of gr. xl repeated when required, as an antipyretic (Braun) ; is less 
efficient and more dangerous than other members of its class (W). Anti- 
pyretics are dangerous and should not be used (Davis). Opium, for wakeful- 
ness and delirium (B); a very valuable remedy, tending to allay pain, and 
reduce excitement of the nervous and vascular systems (Wa). Sodium 
Salicylate, was used in 6 cases of mild form with most successful results 
(Dixon). Alcohol, freely used, until all evidence of sepsis subsided, caused 
recovery in one of the most desperate cases of puerperal septicemia of 3 
weeks' standing, with temp, falling to 93 and rising to 107 (Hilles). Tur- 
pentine for depression of the vaso-motor system, cardiac weakness and tym- 
panites (P); in the low form, large doses, Tfl,x-xv every 2 hours, also externally 
to the abdomen, paying regard to the skin (W). Iodine, Churchill's tincture 
the ideal antiseptic for puerperal sepsis, freely by swabbing the uterus after 
curetting with a dull curette (Robins). Collargol by intravenous injection in 
puerperal infections, is very efficient (Cohn); doses of 10 mils of a 1 per cent, 
solution (Bonnaire) ; by inunction and intravenous injection, is efficient in all 
forms of puerperal infection (Netter). Digitalis does good by its action on 
the heart, by contracting the uterine arterioles and lowering the temperature 
(Winkel). Ergotin contracts the uterine lymph channels and thereby forms 
a barrier against infection (Solt). Streptococcus Antitoxin was used in 14 
cases of puerperal septicemia with only two deaths (Williams); successfully 
employed in cases due to streptococcus infection (Marmorek) ; results have not 
proved encouraging (W). In puerperal sepsis of streptococcal origin the 
results of serum treatment have not been uniform, but are generally unfavor- 
able; if the serum is administered at all, it should be given early, in large doses, 
and intravenously (Kolmer). Nuclein is claimed to be a powerful germicide 
and but slightly toxic, has been especially recommended (W). Irrigation by 
Lysol or Creolin in 1 per cent, solution, or by the normal salt solution, after 
the uterus has been emptied; not with Mercuric Chloride which is very 
dangerous in the uterus (Davis). Curettage may be done once with extreme 
care lest the uterus be perforated or injured, may be of value in removing con- 
taminated decidual and placental debris (Bacon) ; is wrong in puerperal sepsis, 
on the manifestation of symptoms the infection has passed beyond reach of 
any form of curettage (Ruth). Rest in bed, quiet but attentive nursing, 
liquid food frequently. Prophylaxis, the use of rubber gloves in midwifery, 
also sterilization of the external organs and adjacent cutaneous area (White- 
house). [Compare Puerperal Peritonitis, Septicemia.] 

Puerperal Mania and Melancholia. 

Stramonium, will allay cerebral excitement and soothe the nervous sys- 
tem; when delirium wild and furious, but intermittent; tendency to suicide or 



1 

< 



8l4 PULSE PURPURA. 

to destroy the child; TTlx-xx of tinct. every 3-4 hours (P). Atropine, when 
mania is due to exhaustion, as in the puerperal form ( W) . Hyoscyamus, in the 
milder cases; when nervous system is greatly excited (P). Duboisine, as 
calmative and hypnotic, acts efficiently for a time in puerperal mania. Aco- 
nite, in puerperal mania with high fever and restlessness; speedy and marked 
success follows if given soon after the chill (P). Cimicifuga, has cured (B); 
its effects are truly remarkable in the mania and hypochondriasis of the puer- 
peral state (P). Chloral, often alleviates symptoms (B); to produce sleep 
(Wa); there is abundant testimony to its value in puerperal mania (W). 
Potassium Bromide, in sthenic cases (R); its effects are very variable (Wa). 
Anesthetics, Chloroform or Ether inhaled in violent paroxysms of mania (B). 
Tartar Emetic, in frequently repeated doses (Wa). Quinine, when much 
weakness; skin cold and sweating (B). Chalybeates, Tinct. Ferri Chloridi, 
TTiv-xx, in the anemic form (B). Opium, cautiously (B); gives the best 
results in such doses as may be necessary to allay irritation and procure 
sleep (Wa). Enemata, or gentle laxatives, nutritious and stimulating diet.. 
Lochia, should be watched (P). Weaning, imperative in melancholia; not so 
in acute mania. [Compare Mania, Melancholia.] 

Pulse. 

Aconite, for a quick, resisting pulse (P); a moderate dose, while it slows 
the pulse, renders it fuller, stronger and less compressible (R). Veratrum 
Viride, reduces febrile heat with abnormal rapidity of pulse (P). Veratrine, 
pulse at first quick and strong, then slowed; afterward quick, weak and irregu- 
lar (R). Digitalis, for weak, quick pulse; a large dose, § ss of the tincture, is 
credited with excellent results for the soft and feeble pulse of delirium tremens 
(W). Strychnine for weak pulse, when Digitalis disagrees (W). Camphor 
in oil or ether hypodermically, when the pulse fails suddenly (W). Nitrites 
are the most certain, in fact almost the only sure remedies to dilate the arte- 
ries ( W) . Alcohol as Brandy, when pulse is suddenly enfeebled from fright or 
loss of blood (R). Ether, TTtxx hypodermically, repeated soon, a prompt 
stimulant in sudden failure of the pulse; the compound Spirit in drachm doses 
internally, for less urgent cases. Strophanthin intravenously for sudden dis- 
appearance of the pulse due to acute cardiac failure. [Compare Cardiac 
Sedatives, etc.; Vascular Contractors, etc.; also the articles on Arteri- 
osclerosis, Heart Diseases, Fever.] 

Purpura. 

Rest is of the greatest importance in the treatment of this disease and in 
many cases better results are obtained if the feet are higher than the pelvis. 
In severe cases, gauze or elastic bandages are of considerable benefit and 
relief. Treatment of this disease should be largely systematic and sympto- 
matic. Calcium Chloride, 15 to 30 grains t. i. d., has been used by several 
to aid in the coagulation of the blood but its use should not be kept up for 
many days at a time, as it loses its effect. Ergot has been advocated by 
many as having great influence on this condition. Iron has from time imme- 
morial been considered almost a specific and usually in the form of the tinc- 
ture of the chloride, in 2 to 20 drop doses. Quinine is a very valuable 



PYELITIS — PYROSIS AND CARDIALGIA. 815 

remedy in the treatment of this disease. Silver Nitrate, one-sixth of a grain 
3 times daily (Poulet). Oil of Turpentine is of special value in the Purpura 
Hemorrhagic type, 10 to 15 minims t. i. d. 

Pyelitis. 

Buchu, as a mild stimulant to the urinary mucous membrane, in chronic 
cases (W). Cantharis, the tincture in drop doses, may be used in the chronic 
form. Copaiba is used with benefit. Ichthyol internally in the tuberculous 
form, has given excellent results (Richter). Juniper as a stimulant to the 
mucous membrane. Methylthionine is a mild genito-urinary antiseptic of 
some value (Christian). Pareira relieves chronic inflammation of the urinary 
tract. Salicylates as urinary antiseptics, are now rarely employed (W). 
Salol to keep the urine aseptic (Hirsch). Turpentine may benefit in chronic 
cases (W). Urotropin, as an alterative, diuretic and urinary antiseptic is 
especially useful in lithemic cases (W) ; of value in acute cases (O) ; valuable 
even in children (Langstein); to keep the urine aseptic (Hirsch). Uriform is 
a favorite remedy in acute or chronic cases. Uva Ursi, in chronic cases when 
a slightly stimulant and astringent action is desired (W). Baths, hot, to 
keep the skin active (Hirsch). Tonics should be given, nourishing diet, milk 
and buttermilk freely (O); mineral waters freely. Oil by injection by the 
urethral catheter, to remove calculi forming obstruction (Hirsch). Colon 
Vaccine, has caused recovery when there was no obstruction to drainage 
(Billings). Lavage of the pelvis by means of a hydrostatic apparatus may 
be practised and is often most useful (Da Costa). For lavage, use a return 
flow catheter; first wash the pelvis gently with normal salt solution or sterile 
distilled water (Id). Silver Nitrate in solution, of a strength of T 0-770 "o> ma y 
be used in lavage (Id). Operation, nephrotomy or nephrectomy if a tumor 
has formed or if the symptoms are serious and severe (O). [Compare Cal- 
culi renal, Cystitis chronic] 

Pyodermia. 

The treatment of this disease will be found fully described under Impetigo 
Contagiosa. 

Pyrosis and Cardialgia. 

Capsicum, in atonic dyspepsia, with heartburn and diarrhea (P). Nux 
Vomica, of the highest possible value in atonic dyspepsia with heartburn, 
hiccough, and regurgitation; an excellent combination is Tfl,v-x of the tincture 
with TTlxv of dilute Nitric Acid for one dose (P). Bismuth as antiseptic and 
sedative, is often successful in pyrosis (W). Ant-acids to correct acidity in 
cardialgia. Charcoal dry, as an absorbent of gases (W). Podophyllin, gr. 
T V night and morning in obstinate heartburn, with liver derangement (P). 
Rhubarb, and other purgatives are often useful; also Magnesia, Bismuth, and 
Ginger (Beale). Opium in small doses has been advocated for waterbrash 
(Id). Catechu and Kino, also other astringents, sometimes do good, and 
bitter infusions, especially that of Calumba, have been given with advantage 
in » waterbrash (Id). Diet, lemon-juice, aerated bread, plain biscuit; but 



Si 6 RACHITIS — RECTUM. 

avoid new bread, much vegetable food, and pastry. [Compare Gastric 
Acidity, Dyspepsia.] 

Rachitis. 

Lime, as Lime-water, or the Carbonate, or the Syrupus Calcii Lacto-phos- 
phatis (B); in small doses (R); the Phosphate may be advantageously com- 
bined with Cod-liver Oil (Wa) ; the Phosphate of Calcium is especially indi- 
cated (Teissier) ; when there is a deficiency of lime salts in the nutriment (W). 
Phosphorus is valuable in rachitic cases, especially where there is a tendency 
to osteoporosis, and should be given in doses as large as can be borne without 
derangement of the digestion (W) ; the Elixir, Tfl,vj-xij thrice daily (Jacobi) ; 
gr. T ^-o in olive oil 2 or 3 times a day (O). Iron, the Syrup of the Iodide may 
be given with cod-liver oil (O) ; the Phosphate with that of Calcium an excel- 
lent combination (B); must be continued a long time (R). Nitro-hydro- 
chloric Acid, as baths, gives excellent results (Wa). Quinine, often very 
valuable (P). Thymus Extract, is suggested as probably useful. Diet, food 
rich in Calcium Phosphate and other phosphatic salts; oatmeal, Graham 
bread (B) ; cow's milk in dilution according to age of the child, should con- 
stitute the chief food when the mother is unhealthy or cannot nurse the child 
(O) ; milk, meat-juice, cream or other fat, and for older children eggs, meat, 
vegetables and fruit (Ruhrah); a full animal diet (Wa). Cod-liver Oil, a 
valuable remedy in poorly nourished subjects (W) ; is very advantageous (O) ; 
is the best constructive agent (B). Sweet Oil with careful friction is very 
advantageous, allays the sensitiveness if properly performed (0). Hygiene, 
daily bathing in warm water (0) ; cold sponging (R) ; fresh air and sunshine 
the greater part of the day (O) ; splints to extend beyond the feet to prevent 
the child walking (O). 

Rectum, Diseases of. 

Podophyllum, in doses of gr. ^\ to T V night and morning, for a child, may 
relieve prolapsus of the rectum (P) . Belladonna, the extract locally in fissure 
(R) ; and irritable ulcers (P) ; internally and locally to remove ulcers, also ex- 
cellent for burning pain following defecation; or with mercurial ointment, 
equal parts of each, for fissures and ulcers (P). Acetanilid, in fine powder, 
is an excellent application to ulcers of the rectum. Phosphorus, in chronic 
inflammation of the rectum, has been highly recommended (R). Cocaine, 
gr. xl to 5 j of glycerite of starch, applied by Seeley's Pile-pipe, very efficient 
in controlling spasm of the rectum. Potassium Bromide, in 5 parts of glyc- 
erin, locally, for fissures and painful growths (R). Iodoform, as suppository 
in painful diseases, relieves greatly (R). Pepper, the confection, as gentle 
stimulant in fistula, ulcers, hemorrhoids (P). Castor Oil, in fissure and hem- 
orrhoids, is commonly used as purgative (R, P). Sulphur, with Confectio 
Sennae, in irritable rectum, is very soothing (Wa) . Stramonium, an ointment 
of the fresh leaves to alleviate pain (P). Purgatives, are best for proctalgia 
(D). Surgical, an incision through mucous membrane, and in severe cases 
to divide part of the sphincter, in ulcer or fissure ; a flake of cotton should be 
laid in the wound, so that it may heal by granulation (D). [Compare Anus, 
Diarrhea, Dysentery, Hemorrhage (intestinal), Hemorrhoids, Pro- 
lapsus, Rectum, ulceration of, Sprue.] 



RECTUM — RETINA. 



817 



Rectum, Ulceration of. 

Mercury, the Red Oxide, 5j to the 3 j of Unguentum, as ointment in flat 
ulcers of rectum existing just within the anus (Coulson). Belladonna, the 
extract locally for rectal ulcers, is very efficient (P). Chloroform, as oint- 
ment, in irritable ulcer of rectum (Curling). Iodoform, in suppository, ex- 
tremely useful in painful ulceration (R) ; used in many cases with satisfactory 
results, but in some instances poisoning occurs; hence it should be used with 
caution (Wa). Phosphorus, as an internal remedy, is highly recommended 
in chronic inflammation of the rectum (R). Copper Sulphate, or Silver 
Nitrate, locally (Curling) ; the writer had a case resisting treatment for three 
years, in which a cure was effected by the persevering use of a pill of Cuprum 
Sulphate, Extract of Opium, and Quinine Sulphate [see formula below]. 
Silver Nitrate, gr. J-j combined in pill with Opium, gr. ss, and a solution, gr. 
x-xx to the pint, by enema (B). [Compare Dysentery.] 



1$. Cupri Sulphat., 

Morphinae Sulphat., aa gr. ij. 

Quininae Sulphat., gr. xxiv. 

M. ft. pil. no,'xxiv. Sig. — One pill thrice 
daily. {Potter.) 



1$. Chloroformi, 3 j-ij. 

Zinci Oxidi, 5ss. 

OleiOlivse, 5j. 

Cerati Cetacei, 5iv. 

M. ft. unguentum. {Curling.) 



Relapsing Fever. 

Prophylaxis. — Stitt states that the sole question is the avoidance of places 
infested with ticks, bed-bugs and lice. In Africa, the habitations of the 
natives, where infected ticks may hide themselves in cracks in floors and walls, 
are to be especially avoided. As the tick feeds at night a night light is of 
value. Arsenic, Salvarsan, and Neosalvarsan are specific. Neosalvarsan, 
being less toxic is better adapted to the treatment of the icteric type of the 
disease (Stitt). Atoxyl has practically no value in treatment (Id). Cathar- 
tic, a mild one at beginning (H) ; if jaundice or other hepatic derangement, 
a Calomel purgative, cautiously lest irritation (Wa). Potassium Citrate, as 
cooling diaphoretic. Opium may be demanded for pain in back, limbs, and 
joints (O). Ammonia and Digitalis, with other stimulants, if collapse occurs 
at the crisis in feeble subjects (O). Leeches or Cupping, best for headache 
(A). Alcohol, required by some patients. Diet, supporting, especially in 
third week, beef-tea, etc. 



Retina, Affections of. 

Mercury by inunction, using a drachm daily, is of much benefit in syphilitic 
retinitis. The Protiodide may also be used, gr. \ thrice daily in ascending 
doses. Potassium Iodide, gr. x-xx thrice daily is also useful. Atropine, 
locally to put the eye at rest, is indicated as soon as the case comes under 
observation. Dark glasses, to afford protection from the light, are useful. 
In the nephritic type (the so-called albuminuric retinitis) treatment is that 
of nephritis. High frequency currents may be tried in retinitis pigmentosa. 
Rest in bed with the application of a firm bandage to both eyes may 
be of service in detachment of the retina. Sweat baths may also be tried. 
Normal salt solution injected beneath the conjunctiva may be of service. 
Posterior sclerotomy may be tried, although the benefit derived is usually 
not permanent. 



8l8 RHEUMATISM. 

Rheumatism, Acute. 

Plans of Treatment, may be resolved into three, — that by Salicylic Acid 
or the Salicylates, that by Alkalies, and that by Iron (Da C). Salicylic Acid 
is suited to vigorous, sthenic subjects, whose stomachs will bear it, in these 
it often effects a cure in 3 or 4 days; it is better than the salicylates, but should 
be abandoned if not effective in the time stated (Da C). Salicylates are the 
standard remedy in all forms of rheumatism (W) ; large doses of the Sodium 
salt frequently (Huchard); Sodium Salicylate is specific, but must be used 
in larger doses at first than those commonly employed, gr. xxx every hour in 
severe cases (Moule). Quinine Salicylate has few equals and is surpassed 
only by the sodium salt (Sir J. Moore). Aspirin is an effective salicylate 
and has but slight effect on the digestion (W) ; gives excellent results, reduc- 
ing the fever rapidly and relieving the pain in joints and the swelling (Thesen). 
Methyl Salicylate, Oil of Gaultheria, TUxx every 2 hours in milk, if sodium 
salicylate disagrees (O) ; locally to the joints is especially helpful (McCrae) ; 
the Salicylates are the standard remedies in all forms of rheumatism (W). 
Salicin in doses of gr. xx every hour or two, until the pain is relieved; is less 
depressing than the sodium salt, and is perhaps the best drug for children, as 
Sodium Salicylate is for adults (O). Salophen is alleged to be almost equal 
to the ordinary salicylates and much less disturbing to the digestion (W). 
Salipyrin has been used in all forms of rheumatism (W) ; the daily dose should 
not exceed 45 grains (Kollmann); it has been frequently used in 15-grain 
doses every \ hour or hour, until about 5 ij has been taken, continuing with 
smaller doses for a long time after convalescence, to prevent relapses. Salol, 
the great remedy, none superior (B); given in doses of 15 to 30 grains, up to 
5ij in 24 hours, and continued for some time after acute symptoms have 
subsided; may prove toxic in large doses, with symptoms of phenol poisoning; 
is not very powerful (W). Salicylic Acid relieves pain quickly (Dixon); re- 
lieves pain and hyperpyrexia, and probably has a direct curative effect on 
morbid metabolism (W) ; with Iron in combination, should be most valuable 
but as heretofore prescribed has always made an insoluble precipitate; this 
is overcome by Dr. Peabody in the formula given below, which makes a 
ruby-red mixture, and has advantage of preventing the anemia which results 
from the Acid given alone. Benzoic Acid, in daily doses of about 3hj, is 
equal to Salicylic acid (Senator). Alkalies, for flabby, fat subjects; alkaline 
carbonates, as Potassium Carbonate 5 jss in 24 hours, alone or with a vege- 
table acid, until the urine becomes neutral or alkaline, when it may be re- 
duced one-half, and so maintained for some days, when Quinine or Iron may 
be used; if successful, this treatment brings about a cure in two weeks; the 
alkaline treatment is now seriously questioned; an injurious dyscrasia results 
from their use (B) . Potassium Bicarbonate, gr. xxx every 4 hours, in a dilute 
solution, until joint-symptoms and fever disappear (Wa). Sodium Bicar- 
bonate in solution on lint locally, for the joint-pains. Ammonium Carbonate 
in 5-grain doses frequently, for cardiac complications (B). Potassium Ace- 
tate freely, followed after a few days by Potassium Iodide and tonics; or gr. 
xxx of the former and gr. x of the latter 3 or 4 times a day, is sometimes very 
efficient in cases subacute from the beginning (W) ; Potassium salts do good 
by lowering arterial action, favoring oxidation and elimination, and neutral- 
izing excessive acidity (W). Ammonium Bromide, an excellent treatment, 
followed by Quinine; gives a very low proportion of cardiac complications; 
gr. xv-xx every 4 hours (Da C) ; is disagreeable but strongly recommended 



RHEUMATISM. 819 

(B). Iron, the tincture of the Chloride is suited to feeble, anemic and nerv- 
ous subjects, Tfl,xxx every 4 hours, with an occasional saline laxative, blisters 
around joints, and Atropine, as an anodyne rather than Opium, used hypo- 
dermically in the vicinity of affected joint (B); very serviceable in pale, deli- 
cate subjects, TTlxx-xxx every 4 hours; also as prophylactic where tendency 
(Anstie); harmful to the plethoric and overfed (B). 

Aconite, very serviceable when much heat and dry skin (B) ; subdues pain 
in inflamed joints and perhaps shortens the fever (R); in small doses fre- 
quently repeated is of the greatest value, and if used from the start prevents 
organic cardiac disease (P) ; not reliable as a curative agent, but is a valuable 
adjunct to other remedies (Wa). Veratrum Viride, said to be useful (R); 
small doses as antipyretic, may be combined with Opium (P). Antipyrine 
has some specific action in rheumatism but is inferior to salicylic acid (W) ; in 
large doses gr. xlv~3j is fully as efficient as the salicylates, and markedly 
lessens the tendency to cardiac complications (Linnosier). Acetphenetidin 
is efficient and safe. Phenocoll is a safe, prompt, and efficient antipyretic (W) ; 
is valuable in rheumatism (Hertel). Ichthyol in 10 per cent, ointment 
painted over the affected joint and covered with cotton wool, is effective 
(Unna) ; used in 1 1 7 cases with most satisfactory results (Kolbl) ; its results 
are superior to those of any other drug (Lorenz). Quinine after the acute 
symptoms have abated, when the patient is weak and sweats profusely during 
sleep, gr. xv daily are often of great service (W) ; is efficiently used for head 
symptoms (Da C). Phenol, Tfl.xv of a 3 per cent, solution by parenchyma- 
tous injection (Senator). Formic Acid, gtt. v of a 2 per cent, solution hypo- 
dermically, preceded by gtt. viij of a 1 per cent, cocaine solution, gives instant 
relief (Couch). Bee-stings, 6 at a time, up to 18 or 20 weekly, give marvellous 
results (Maberly) ; promptly cured myself of a severe attack of acute arthritis of 
the right hip (Burton) . Hydriodic Acid, the Syrup, in dessertsp. doses every 2 
or 4 hours, the best remedy for acute and subacute rheumatism, relieving pain 
and swelling in 18 to 24 hours (Craig). Cimicifuga, has excellent reports (B) ; 
much used, and is said to quell the pain speedily (R) ; found very serviceable 
(P) ; has been highly recommended, but is rarely employed now (W) . Lime- 
juice, 5 viij daily, Lemon-juice inferior (R); Lemon-juice freely may be of 
service (Rees) ; is less efficacious than the alkalies ( W) . Blisters are not to be 
compared with the light application of the Paquelin thermocautery (O) ; are a 
very effective method; a number of small blisters applied to vesication around 
a joint (B); large flying blisters around a joint (R). Water, cold baths for 
the hyperpyrexia (Da C) ; the wet pack efficacious in rheumatism, also a vine- 
gar vapor bath (B) ; the wet pack, 20 or 30 minutes, and tepid (70 F.) shallow 
bath 1 or 2 minutes. Cold applications only when skin hot and dry, and 
temperature high. Warm baths, or hot compresses very useful. Spongio- 
piline an excellent vehicle for applications. Rest should be absolute for not 
less than three weeks after the joint symptoms are in abeyance, to avoid car- 
diac complications. Diet, low during the fever, water, barley-water, milk- 
and-water, gruel; use liquid food throughout, avoid malt liquors, port wine 
and sugar; milk is the most suitable diet, and may be diluted with alkaline 
mineral waters (O). Blankets to sleep in, instead of sheets, and flannel 
underclothing, are useful adjuncts. Pack the joints with cotton covered with 
rubber cloth or oiled silk. Dry Heat, applied by the Tallerman apparatus is 
of great value in tendinous inflammations, also in subacute rheumatism 
through its sweating and local influence (W). 



820 



RHEUMATISM. 



1$. Olei Gaultheriae 5 j. 

Acidi Salicylici, .*. . gr. lxxx. 

Sodii Boratis, 5j- 

Syr. Picis Liquidae, 

Aquae Anisi, aa § ij. 

M. Sig. — A dessertsp. every two hours. 

1$. Potassii Iodidi, 3ij- 

Vini Cochici Sem., 

Syr. Simplicis, aa 5iv. 

Aquae Menthae Pip., 5 v. 

M. Sig. — Tablesp. every 4 hours. 

(New Orleans Charity Hosp.) 

IV Ichthyolis, gj. 

01. Cinnamomi, ttjxx. 

Adipis Lanae Hydrosi, §ij. 

M. Sig. — Use as ointment on lint to the 
inflamed joint, in acute stage. 



]$. Acidi Salicylici, 5ij- 

Ferri Pyrophosphat, 5 j- 

Sodii Phosphatis, 5 v. 

Aquae Fervent, §vj. 

M. Sig. — A tablesp. every two hours. 

(Peabody, modified.) 

1$. Sodii Salicylatis, gss. 

Tinct. Lavand. Co., 3iij- 

Glycerini, 5 v. 

Aquae, q. s. ad gvj. 

M. Sig. — A tablesp. every three hours 

well diluted. 

]$. Sodii Carbonat., 5vj. 

Tinct. Opii, gj. 

Glycerini, gij. 

Aquae, §ix. 

M. Sig. — Locally on hot cloths to the 
affected joints. (Fuller.) 



I 



) 



Rheumatism, Gonorrheal. 

A much better term is gonococcic arthritis. 

Opium, as Dover's Powder, full doses in the acute stage (Wa) . Potassium 
Iodide, with tonics and stimulants, after the acute stage has passed, followed 
by friction, shampooing, and passive movements of the joints (Wa) ; is useless, 
even in large doses (O). Quinine, Iron, and in the chronic cases Arsenic, as 
general tonics, the most suitable internal medication (O). Ammonium 
Chloride, in free doses, especially when the muscles are affected (Fuller). 
Potassium Chlorate, internally, and as urethral injection, until urethral dis- 
charge is entirely stopped, then Til xx of Tinct. Ferri Chlor. 4 times daily, with 
gr. x. of Quinine daily, and good food (Da C). Silver Nitrate, in solution, 
I to 1 per cent., about 3ij by instillation into the deep urethra, to eradicate 
the foci of infection, is of great importance (Hirsch). Ichthyol or Belladonna 
ointment, combined with Mercurial ointment, may be used with considerable 
benefit in mild cases (Id). Antigonococcic Serum has proved to be practic- 
ally a specific (Stellwagon) . Vaccines have given good results in a few cases, 
but cannot be compared with those obtained by the serum (Mackinney) ; the 
autogenous vaccine is more potent than any other, given in small doses at 
short intervals, say 1 or 2 millions every 3 to 5 days (Jack) ; are valuable in 
the chronic form, not in the acute (Williams) ; are of very considerable value 
(Eyre). Passive Congestion by Bier's method, for 20 to 22 hours, followed 
by passive motion and massage, has cured many cases in the large joints 
(Baetzner). Counterirritation with the thermocautery, to allay pain and 
reduce swelling (O). Fixation of the joints is very beneficial in acute cases; 
massage and passive motion in chronic ones (0). Aspiration and irrigations 
of the affected joint, when there is extensive hydrarthrosis (Hirsch); Incision 
and irrigation have given strikingly good effects (0) ; Aspirate when pus is 
discovered around the joints; the case will be one of pyemic rheumatism, and 
may involve more joints than one (Da C). 

Rheumatism, Muscular. 

Salicylates possess the greatest power for good of all known agents in mus- 
cular rheumatism, rheumatic neuritis, and other irregular forms of rheuma- 



RINGWORM. 821 

tism (W). Aspirin is an excellent salicylate for this affection (Merkel). Salo- 
quinine benefits the most obstinate cases (Tauszk). Colchicine, a 10 per cent, 
solution in 5-minim doses hypodermically thrice daily into the affected 
muscles, very effective in cases resisting other treatment. Colchicine Salicy- 
late is used with benefit. Pilocarpus, or Pilocarpine hypodermically, to get 
the skin acting freely, a great desideratum (Da C). Potassium Iodide and 
Colchicum, or Quinine, gr. xij-xvj in 24 hours, if the case lingers over a week 
(Da C). Nux Vomica in large doses, is sometimes beneficial (O). Acetani- 
lid often gives marked relief in subacute cases. Veratrine as ointment locally 
may give great relief temporarily. Capsicum, powdered, with Lard, § ij to 
the 5 , rubbed over the part, night and morning, with a gloved hand, is very 
efficient (Macdonald) . Cimicifuga, is often very efficient in lumbago, myalgia, 
pleurodynia, and similar conditions ( Wa) . Xanthoxylum, gives relief in some 
cases of muscular rheumatism (B). Morphine and Atropine together hypo- 
dermically, for severe pain; are of great service in most forms (R). Diaphor- 
etics, as Dover's powder made with potassium nitrate, or Ammonium salts, 
with dry heat to the part involved, and rest in bed (Da C). Liniments are of 
little use except to amuse the patient, but Chloral §j in §vj of Linim. 
Saponis, makes a good one (Da C). Electricity, the constant current daily 
renders good service. Alkaline Waters, with restricted diet, in gouty sub- 
jects (O). Clothing should be warm, and exposure to cold and damp should 
be avoided (O). [See Lumbago, Pleurodynia, and Torticollis for the 
principal forms; and compare Gout, Lithemia, Myalgia, Neuritis.] 

Ringworm of Body. Tinea Trycophitina. 

If there is marked scaling, the parts should be washed freely in soap and 
water or in alkaline water before any applications are made. Chrysarobin, 20 
grains to the ounce of chloroform painted on every other day is very useful at 
times. Collodion should be painted on after the application of the Chry- 
sarobin and Chloroform. Tincture of Iodine is one of the best drugs for this 
type of ringworm and is much more efficacious if 2 grains of the Biniodide 
of Mercury are added to the ounce. Sabouraud claims that Tincture of 
Iodine accomplishes more in the treatment of this disease if it is diluted four or 
five times its volume in alcohol. Mercuric Chloride, 1 to 3 grains to the 
ounce of water, is of considerable value. Salicylate of Soda, 3 to 5 per cent, 
in petrolatum is of value. Sodium Hyposulphite, a drachm to the ounce of 
water, is frequently used. Sulphur Ointment may be used, 20 to 30 grains to 
the ounce of petrolatum. Tar and Pix Liquida, full strength or one part to 
two of water may prove efficacious if the odor is not too objectionable. 

Ringworm of the Genito -Crural Region. 

The preparations mentioned above are also used for treatment of ring- 
worm of this part of the body but in reduced proportions on account of the 
moisture and friction. If a dermatitis has resulted, Saturated Solution of 
Boric Acid to which 5 minims of Carbolic Acid to the ounce are incorporated 
is useful as a temporary measure. Bismuth and Lead Water Lotion (See 
Eczema) is of the greatest value where marked inflammation exists. Calamin 
Zinc Oxide Lotion is also of great importance under the same conditions. 
Resorcin, 5 to 10 grains to the ounce of either alcohol or water may be 
painted on three or four times a day. 



822 RINGWORM — SCABIES. 

Ringworm of the Scalp. 

The hair around the affected area should be clipped close or shaved and 
any applications should go far beyond the diseased spots. 

As the hairs are so extremely brittle that complete depilitation is not 
practical, it is better to resort to some depilatory drug such as Barium Sulphide 
made into a paste with water, allowed to remain on for a few minutes until it 
begins to burn and then wiped off. Following this, various applications can 
be made directly to the scalp. This partial depilitation may be repeated in 
7 to 10 days. Chrysarobin, 20 grains to the ounce of chloroform is also 
of considerable importance. Frequent washing with Tincture of Green 
Soap is of prime importance. Tincture of Iodine to which 2 grains of biniodide 
of mercury has been added is one of the best preparations used in the treatmen. 
of this disease. Sulphur, § drachm to the ounce of petrolatum is of value, 
particularly if 10 or 20 grains of Beta-Naphthol are incorporated. Probably 
the best treatment for ringworm of the scalp is by the X-ray but as it requires 
great experience and the proper adjustment of the dosage, it should be used 
with the utmost caution. [See text-books on Roentgenology.] 

Ringworm of the Bearded Region. 

For the superficial variety, there is nothing better than the 2 grains of 
Biniodide of Mercury incorporated in one ounce of Tincture of Iodin, as 
mentioned before, though any of the above remedies may be used. For the 
deep, nodular type, Sodium Hyposulphite, a drachm to the ounce in water 
applied frequently is of great value. Biniodide of Mercury, 1 to 1000 solu- 
tion, may be applied frequently to the face. Sulphur, \ drachm to the 
ounce of petrolatum, may be used and is more valuable if 10 to 20 grains of 
Beta-Naphthol are incorporated. Staphylococcic Vaccines are of consider- 
able value as is the official Sulphur Ointment. 

Roseola. 

Aconite or Belladonna, according to the symptoms, in epidemic roseola or 
German measles. Ammonium Carbonate may be indicated in severe cases. 
Treatment is expectant and symptomatic, and very little is required; saline 
expectorants and gargles for throat symptoms, as in measles, also rest in bed 
in a warm room. Local applications are seldom called for, the rash being but 
slightly irritant. [Compare Eruptions, Erythema, Measles; and for other 
forms of Roseola see Syphilis, Typhoid Fever, Vaccination.] 

Sarcinae. 

Sulphites and Hyposulphites, have been employed to destroy sarcinae and 
torulae in the stomach (R); or Sulphurous Acid, diluted, before each meal 
(Wa). The treatment of these microscopic fungi is that of the primary gastric 
affection. [Compare Cancer, Dyspepsia, Gastric Dilatation.] 

Scabies. 

In treating any case of Scabies, it is essential that all clothing and bed 
clothing should be thoroughly boiled or fumigated as one impregnated female 



SCARLET FEVER. 823 

parasite remaining on the clothing may cause a reinfection. One of the most 
important drugs is Sulphur, i drachm to the ounce of petrolatum. Beta- 
Naptha, 20 grains, incorporated in this will aid materially. The patient 
should take a bath in hot water and scrub vigorously with soap. After dry- 
ing the body, the ointment should be thoroughly applied and long drawers 
and long-sleeved shirt put on. Six applications are necessary, two daily for 
three days, replacing the same underclothes after each application and wearing 
them continuously day and night. At the expiration of the third day, the 
patient can take the second bath and put on clean underwear. Balsam of 
Peru three parts, Glycerin one part, is used by the writer almost exclusively 
in private practice. This viscid substance is rubbed on with a varnish brush, 
thoroughly and vigorously, every portion from the neck down being given a 
thorough coating-especially the moist surfaces. The patient is instructed to 
put plenty between the fingers before retiring and wear cotton gloves. This 
will produce a considerable amount of erythema which, however, very quickly 
subsides. The underwear is to be worn for forty-eight hours. As a rule, 
one application is sufficient. In extreme cases where there is an eczema 
associated, this Balsam of Peru treatment will kill all parasites and then the 
eczema can be treated by suitable means. Potassium Sulphuret, 3 to 6 
ounces in a tub of water may be used as a bath, the patient remaining in half 
an hour, scrubbing himself thoroughly with soap and water. Sulphur Pow- 
der used alone is very efficacious and can be rubbed in over the entire surface 
and put between the sheets. Tar is very frequently used in the treatment of 
this disease, particularly in the form of Wilkinson's Ointment but its odor 
more than counter-balances its efficacy. If a dermatitis results from the ap- 
plication of any of the above drugs, they should be withheld and the super- 
imposed condition treated. (See Acute Eczema). 

Scarlet Fever. 

Aconite, in the early stage, when patient is not decidedly adynamic, is very 
useful (W). Belladonna, during the eruptive stage, when depression exists 
(B); as prophylactic has been recommended (R); has no specific action, but 
is valuable as a stimulant (W). Mercury, gr. § of Gray Powder every hour 
has marked effect on inflamed tonsils (R). Ammonium Carbonate, feeble 
circulation, cyanosis, delirium (B); in all forms, especially if given early (R); 
one of the most reliable remedies, gr. iij-vij, according to age, in milk or 
Cinnamon- water, every hour or two (Wa). Potassium Iodide, in full doses, a 
very satisfactory remedy (Mitchell). Salicylic Acid, given in 125 malignant 
cases, with mortality of only 3I per cent. (Shakowaki). Salol, in doses of 7 
to 30 grains daily, according to age, internally, with gargles of a solution of 
Phenol, used in several cases with recovery in all and without albuminuria 
or other complications (Quioc). Quinine Salicylate is an excellent adjuvant, 
especially in the advanced stages when a tonic is required (Sir J. Moore). 
Phenol used internally and as a gargle, is used with benefit; seems to exercise 
some influence as prophylactic (Wa); is good for the vomiting and for its 
general effect on the disease; 711 ss, every 2 or 3 hours (Da C). Sodium 
Phenolsulphonate, as a means of introducing Phenol into the system; has been 
successfully employed (Wa). Chloral with Paregoric, is highly efficient for 
calming the patient; given throughout the course Chloral acts as a urinary an- 
tiseptic. Potassium Chlorate, in grain-doses every J hour, will not injure 
the kidneys, and will give results equal to those of larger doses on the throat 



I 



I 



I 



824 SCARLET FEVER. 

inflammation (Smith). Sodium Benzoate, is highly efficient, having slower 
but more permanent effects on the fever than Quinine or the Salicylates 
(Klebs). Boric Acid, makes an excellent gargle (Da C). Juniper, as diuretic 
when dropsy (R). Magnesium Sulphate, as purgative, to prevent sore 
throat and other sequelae (R). Ichthyol in 5 per cent, ointment, causes rapid 
decline of the cutaneous symptoms (Seibert). Antipyrine for high tempera- 
ture (W). Mineral Acids, Hydrochloric internally and as gargle, Nitric 
locally to sloughs in the throat (R). Veratrum Viride for convulsions (R). 
Potassium Permanganate, locally to throat, and internally, gr. J-j ter die, 
of undoubted benefit (B). Sulphurous Acid, by inhalation, spray, or fumiga- 
tion, in malignant sore throat (R). Chlorine Water, in sloughing of throat 
(R); seemingly prophylactic (Wa). Quinine, small doses in adynamic 
states, large in hyperpyrexia (B) ; very successful when used systematically 
from the start (Wa). Ferric Chloride, the tincture in doses of Tfl.x-xv, ac- 
cording to age in advanced stage; when albuminuria and hematuria, is 
very valuable (Wa). Antistreptococcus Serum has been used for second- 
ary infection with the streptococcus occurring in this disease (W) ; used with 
benefit (Josias). Kolmer states that in severe anginose or malignant scar- 
let fever large doses of serum from horses especially immunized with strains 
of streptococci from scarlet-fever patients have, on the whole, yielded favor- 
able results. Not all cases of severe scarlet fever, however, are due to 
secondary streptococcal infections: those patients who are overwhelmed 
and prostrated at the very outset are probably intoxicated with the true 
scarlatinal virus, whatever that may be, and such cases are not likely to 
be benefited by serum treatment (K). The patients most likely to improve 
under serum therapy are those who become severely ill after the onset of the 
disease and the appearance of the eruption (K). Medication is not required 
in ordinary cases, at most a simple fever mixture, with antiseptic washes for 
the mouth and fauces, and a bitter tonic during convalescence; the vaunted 
specifics are all useless (O). Blood-serum from scarlatinal patients has been 
used, with the result of shortening the course of the disease and ameliorating 
the symptoms. Mustard Bath, on recession of rash, to bring it back (R). 
Oil Inunctions, very grateful, especially useful in desquamative stage. Ca- 
cao-butter the most elegant (B). Ice, sucked, for the sore throat (R). Hy- 
drotherapy is valuable, tepid sponging in mild cases, the cold pack in severe 
ones, or the warm bath gradually cooled, the ice-cap when high fever (O); 
cold baths with oil inunctions, are all that is needed in mild cases; when tem- 
perature above 104 , urine scanty and rash retroceding, the cold- wet pack 
renders signal service (R); cold wet compress to neck through the whole 
course, renewed every 3 hours (R). Streptococcic Vaccine used as a pro- 
phylactic, has proved valuable in Russia, the mortality in the vaccinated 
cases being but 0.123 P er cent - against n.i per cent, in the unvaccinated 
(Gabritchevsky) ; Vaccines made from the organisms present in the individual 
case are very efficient in suppurative otitis media due to scarlet fever (Wes- 
ton). Diet, fruit, if ripe, in season, toast, gruel, etc., in simple cases; in ma- 
lignant, extract of beef, stimulants as per pulse. Milk the most suitable ali- 
ment both as nutrient and as diuretic; a strict milk diet was enforcedduring 
the illness in all the cases mentioned above under Salol (Quioc); milk diet is of 
great value to prevent nephritis (Jaccoud). Puncture of the membrana tym- 
pani, if its tension becomes great, may save the hearing of the child (O). 
[Compare Albuminuria, Bright 's Disease, Uremia.] 



SCIATICA. 



825 



]$. Acidi Borici, 3ss. 

Potassii Chloratis. 

Tinct.Ferri Chloridi, aa 5ij- 

Syrupi, 

Aquae, aa g ij. 

M. Sig. — Tablesp. every 2 hours, to a 
child of rive years. {Smith.) 



1$, Acidi Salicylici, 5ij- 

Tinct. Aconiti, gtt. xij. 

Infusi Digitalis, Sjss. 

Spt. Ammon. Aromat.,. . . . 5iij- 

Syr. Aurantii Cort., 5ss. 

Aquae, 5j. 

M. Sig. — Teasp. every 3 hours, for 

child of five years. {Brown.) 



Sciatica. 

Morphine, hypodermically, is especially curative in sciatica (B); 3 or 4 
injections of gr. £ each may almost be regarded as specific (Wa); a single 
injection sometimes cures long standing cases permanently; if not it may be 
repeated every second day or so (R) ; should be injected deeply into the ad- 
jacent muscular structure (Pepper) ; a dangerous remedy, prone to create the 
habit, should be withheld as long as possible (O). Apomorphine, gr. T \ 
hypodermically, given by accident instead of morphine, caused immediate 
disappearance of the pain in a very severe and intractable case, not returning 
again for 12 months, and then only a slight attack which progressed favor- 
ably under Potassium Iodide and Gelsemium (Owen). Antipyrine or Ace- 
tanilid, efficiently analgesic. Salipyrin has been employed with excellent 
results in rheumatic sciatica. Salicylic Acid, as paste locally, 3j with 3iv 
of Lanolin and 01. Olivae, q. s., also Rhus Tox., gtt. j of a 1 per cent, solution 
of the fluidextract internally every 4 hours, cured one very obstinate case 
(Aulde). Salol, gr. vij in evening and gr. xv more at midnight, completely 
cured me after three weeks' suffering in bed, unrelieved by other remedies 
(Aschenberg). Salophen in 10 per cent, solution by injection into the gluteal 
muscles, successful in two cases of long standing (Ghetti). Saloquinine in 
30-grain doses, is very efficient (Overlach); is both analgesic and anti- 
rheumatic, but is slow of absorption (W). Ichthyol in 10 to 50 per cent, 
solution applied by rubbing, is superior to any other established remedy 
(Schweninger); frequently gives surprising results (Eulenberg); also intern- 
ally in doses of ulij twice or thrice daily (Crocq). Veratrine, in strong oint- 
ment or oleate locally; also the tincture of Veratrum Viride internally is 
recommended (R). Aconite, locally (P); as ointment controls sciatica in 
some cases (R); valuable in many obstinate cases (Wa). Ammonium Chlo- 
ride, in mild forms (R); in cases occurring in the young (Anstie). Iodides, 
in syphilitic or metal poisoned subjects (B) ; often fails (R) ; Potassium Iodide 
in daily doses of 5 j dissolved in decoction of Sarsaparilla, most efficacious in 
subacute or chronic (Wa); much is to be hoped from it (W). Iodipin 75 
minims hypodermically along the course of the nerve, has succeeded after all 
other remedies had failed (Baum). Formic Acid, gtt. v of a 2 per cent, solu- 
tion preceded by gtt. viij of a 1 per cent, cocaine solution, by deep injection 
alongside the nerve, is remarkably efficient (Couch). Guaiacol, painted over 
the nerve as a local anesthetic. Chloroform, applied on flannel along the 
course of the nerve, and covered with oiled silk (Wa); TT|xv of the official 
spirit, or ttlv-xv of pure chloroform, by deep hypodermic injection into the 
vicinity of the affected nerve, gives the best results in old cases (B). Cocaine, 
a 4 per cent, solution, hypodermically along the course of the nerve, affords 
instant relief (Wa); gr. \ by subarachnoid spinal injection proved curative 
(Manega). Turpentine, causes an exquisite sensibility along the track of the 
great nerves (Tr) ; occasionally of great value in sciatica, yet not a specific, 



826 SCROFULOSIS. 

nor have we scientific indications for its use (P) ; § ss doses for 4 to 8 successive 
nights (R). Sulphur, locally, believed to relieve the pain; effect probably 
due to the flannel surrounding it (R) ; is worthy of trial after active symptoms 
are subdued (Wa). Nux Vomica is often successful in chronic sciatica (Wa). 
Strychnine Nitrate hypodermically into the gluteal region at intervals of one 
to several days, is the most effective remedy yet employed (Sartsin). Gel- 
semium has been used with varying success (B). Belladonna, has afforded 
relief (R) ; Atropine, hypodermically, is curative, gr. -%\ to %\ in the vicinity 
of the nerve (B). Stramonium, gr. J to \ every 3 or 4 hours for 4 or 5 doses, 
often affords decided relief, but should be stopped when the slightest symp- 
toms of narcotism appear (P) . Duboisine, is a good substitute for Atropine, 
and equally effective. Phosphorus, in neuralgic form; less satisfactory in 
sciatica than in other neuralgias (R). Nitroglycerin, in doses of THj thrice 
daily, gradually increased to Tfl,v, of a one per cent, solution promptly cura- 
tive in a long-standing and severe case (Lawrence) ; its powerful anti-neuralgic 
properties were well exhibited in 3 cases which would not respond to other 
agents, two being cured and one remarkably improved thereby (Mikhalkine). 
[See formula below.] Sulphuric Ether, Hlv and Cocaine (1 in 12) TTLij, by 
injection daily into the sciatic nerve, employed for 30 years with exceptionally 
good results (James). Alcohol, 80 per cent, r-4 mils by injection into the end 
branches, also T V mils into the sacral foramina, has given good results (Kiliani). 
Normal Salt Solution by injection in the vicinity of the nerve is highly efficient 
(Schleich); the solution should be cold when injected (Schlesinger) ; by in- 
jection at the sciatic foramen or at the gluteal fold, according as pressure 
causes greater pain at the one point or the other, cured 8 out of 12 cases 
(Hay). Salines should be given in gouty cases (O). Cod-liver Oil should 
always be tried in obstinate cases (W). Cold of intense degree, produced by 
refrigeration of limb by Methyl Chloride, extremely efficient (Jacoby); has 
been effectual when applied to the sound limb. Cantharides as counter- 
irritant, to free vesication (R). Acupuncture, occasionally affords instant 
relief (B); often cures cases of long standing (R). Nerve-stretching, by 
forcibly flexing the thigh on the abdomen (Lange) ; is sometimes successful, 
but often fails (O). Poultices, applied very hot (R). Turkish-Baths, are 
often very useful (R). Electricity, produces excellent results (B); does great 
good, but often aggravates; the continuous current best, when stage of acute 
inflammation past (W) ; galvanism often quickly relieves the pain (Pepper) ; 
is uncertain, used with massage renders best service in chronic cases (O). 
Rest in bed, with fixation of the limb by a long splint, most valuable in many 
cases (Weir Mitchell) ; relieves and sometimes cures the most obstinate cases 
(O). [Compare Neuralgia, Rheumatism chronic] 

1$. Tinct. Colchici Seminis, I 1$. Spt. Glycerylis Nitratis. . . . 3jss. 

Tinct. Belladonnae Fol., Tinct. Capsici, 3ij- 

Tinct. Aconiti, aa 5j- Aquae Menthae Piper.,. . . . §iv. 

M. Sig. — ttjvj every 6 hours. Remark- j M. Sig. — 5 to 10 drops to be taken three 

ably efficient. (Metcalf.) \ times a day. (Mikhalkine.) 

Scrofulosis. 

Ammonium Iodide, when glandular enlargement (Wa) ; Ferrous Iodide, 
when debility and emaciation, a powerful and efficacious remedy; also in 
anemia of scrofula, the syrup TJtxx-5 j ter die (Wa); useful in simple glandular 
hypertrophy, but disappointing in scrofulous (B). Strontium Iodide has 



SCURVY — SEA-SICKNESS. 827 

been used with varied results in scrofulous otorrhea. Iodine, tinct. or oint. 
applied over scrofulous glands — take care not to increase inflammation (R) ; 
Iodine and Iron the best remedies, but all medicines utterly useless without 
strict hygiene (A). Calcium Salts, the Chloride in doses of gr. x-xx in milk 
after food, when glandular enlargement of neck and chronic diarrhea; the 
Phosphate of great use for sores (R) ; is of eminent service as a palliative (Wa). 
See Sulphides below. Phosphorus, eminently serviceable in scrofuloderma, 
gr. x in 01. Olivae §j, doses of Tflflv-x, thrice daily after meals (Broadbent). 
Phosphates, Ferrum and Calcium Phosphates combined give good results, 
also chalybeate waters (B); must be long continued (R). Sulphides, for 
sores, abscesses, suppurating glands- gr. ^\ or T \ of Calcium Sulphide every 
hour or two (R). Cod-liver Oil, the best remedy to promote assimilation 
(B); of great service in the various manifestations of this disease (R). Diet 
as for tuberculosis; broiled meat for children. Abundance of fresh air and 
sunshine. Sea-air, sunlight, moderate exercise, and light digestible food 
are necessary. Scrofula is tubercle, as it has been shown that the bacillus of 
Koch is the essential element; the cure is a question of nutrition, digestion 
and assimilation control the situation (O). [Compare Cachexia, Coxalgia, 
Glandular Affections, Ophthalmia, Tabes Mesenterica, Tubercu- 
losis.] 

Scurvy. 

Citric Acid, used with great advantage, though inferior to Lemon-juice 
(Wa) ; Lemon- or Lime-juice, of the utmost value, both as preventive and a 
curative agent; its efficacy believed to be due to its Potassium salts; Oranges 
are highly useful (Wa). Lemon- juice is specific, and the only remedy of value, 
but it is absolutely necessary that it be of good quality (W). Acids, espe- 
cially Vinegar, to prevent scurvy, in the absence of lime-juice or fresh vegetables 
(R) ; dilute Hydrochloric Acid, gtt. v, thrice daily with juice of three lemons 
daily, vegetables and fresh meat (Da C). Cinchona, a decoction, or the dilute 
tincture with Myrrh or the Chlorates, a very useful gargle. Alcohol, diluted, 
as gargle (R). Phenol dilute, or Potassium Permanganate, makes the best 
mouth- wash (O). Silver Nitrate in tolerably strong solution, applied by 
pencil to the gums is very useful (O). Atropine, hypodermically for saliva- 
tion (R). Myrrh, the tincture locally for spongy gums. Alum should not 
be used, as it acts very destructively on the teeth (W). Liquor Sodae 
Chlorinatae, 5 vj ad 5 xij aquas, as a mild application to gums (Wa). Dietetic 
Treatment, alone required; Lemon-juice plays no essential part in the treat- 
ment; the full diet of an hospital, comprising fresh meat, vegetables, and milk, 
is generally sufficient. [Compare Cancrum Oris, Gums, Purpura.] 

Sea-sickness. 

Antipyrine, is successfully employed. Hydrated Chloral dilates the cere- 
bral vessels and is preferred to all other agents (Binz) ; in doses of gr. xv-xxx 
every 4 hours is the most effective remedy (R). Chloretone, gr. x followed 
by gr. v every 3 hours, is a reliable remedy (Still) ; is very successful (Wynter) ; 
gr. x at night followed by gr. v thrice daily, gave extraordinarily good results 
in many cases during a recent voyage from Sydney to London (Welsh); gr. 
v for 2 doses with a 15-minute interval is thoroughly effective, both as a 
prophylactic and curative agent (Bowles). Bromides, in full doses (Beard); 



828 



SEBORRHEA. 



the Sodium Bromide preferred, in doses of 30 grains thrice daily for 3 days 
before sailing and continued for the first 3 or 4 days of the voyage, is by far 
the most effective treatment and never produces evil effects (Rockwell); 
Strontium Bromide preferred, gr. xx every 6 hours for at least 2 days before 
sailing (O'Reilly). Bromipin in doses of 5ij every 2 or 3 hours, gives very 
good results, both in preventing and curtailing the attack (Wulff). Atropine 
hypodermically will relieve (B); small doses given with Strychnine are spe- 
cific in most cases, and in many cases a single dose administered before sailing 
will effectually prevent sea-sickness. Veronal an excellent prophylactic 
(Barnett); in the treatment it is most efficacious in the majority of cases 
(Schepelmann) ; Veronal-Sodium gr. viij thrice daily in as little water as possi- 
ble, produces the most marked improvement, and deserves the first place in 
the treatment (Gallern). Medinal is particularly effective, and being solu- 
ble in water it may be used hypodermically. Menthol Valerate gtt. x-xv on 
sugar, has failed in but few cases of many hundred (Koepe). Cocaine, is 
quite efficient; the Hydrochloride 1 in water 100, of which Tfl.iv-v on a bit of 
ice thrice daily (Otto); a 2 per cent, solution, as spray high up into nasal 
passages, is specific against nausea. Morphine, gr. ^ to J hypodermically, 
will often relieve severe cases (B) ; often fails (Wa). Amyl Nitrite, by inhala- 
tion (B); is strongly recommended, but must be cautiously used. Nitrogly- 
cerin, in doses of gr. T ^ ¥ ameliorates the symptoms of depression, even though 
vomiting persists (O'Reilly). Creosote to check the vomiting (R). Chloro- 
form in drop doses (R); in doses of TTLij-v on sugar (B). Staphisagria has 
given relief (P). Calomel followed by Salines every other day for a week be- 
fore sailing, also a full meal about an hour before going to sea, and the re- 
cumbent posture, will do much to prevent sea-sickness in most cases. Cham- 
pagne iced, in small doses every quarter-hour (B). Icebag to the spine, is 
often successful (R). Fresh Air and the recumbent posture are the two most 
important conditions, and frequently accomplish a cure without medicine 
or diet (Bachmann). Fixing the vision on the horizon is an important and 
efficient prophylactic. [Compare Nausea, Vomiting.] 



1$. Atropinae Sulph., gr. ss. 

Strychninae Sulph., gr. j. 

Phenolis, TTgiij. 

Aquas Destillatae, gij. 

Solv. Sig. — ttrxv hypodermically every 
2 hours for 3 doses. (Potter.) 



1$. Sodii Bromidi, 3 j- 

Ammonii Bromidi, 3ss. 

Aquae Menthae Pip., 5 v. 

M. Sig. — A tablespoonful before meals 
and at bedtime, for 3 days before sailing. 

(Bedard.) 



Seborrhea. 

As a rule, external treatment is sufficient for this disease. However, 
if there is any associated constitutional disturbance, it should be treated 
systematically. A patient who has a chronic case of seborrhea is prone 
to have acute attacks if he has been suffering from some other disease which 
has produced marked debilitation or lowering of the body resistance, in 
which case the treatment must be directed along those lines. It is neces- 
sary to remove the scales and crusts before applying any medicaments 
and this can be done, preferably by the use of Olive Oil, though pomades 
such as Vaselin, Lanolin, Lard, etc., may be used. The head should then be 
wrapped up from 8 to 24 hours and the softened crusts removed by thorough 
washing. Tincture of Green Soap, is well adapted to the treatment of this 
condition and should be used more frequently than when the scalp is healthy; 



SEPTICEMIA AND PYEMIA. 



829 



particular care should be taken that it is thoroughly dried. Resorcin is an 
extremely valuable drug in this disease and should be used, 10 to 30 grains 
to the ounce of water or water and alcohol (see prescription below). It 
should not be applied to the scalp of a person with light hair as it will very 
frequently turn it dark. Neither should it be applied to a person with gray 
hair, as it often turns it yellow. Glycerin may be incorporated in the lotions 
to overcome excessive dryness. Where there is an oiliness of the scalp, it 
should, of course, be avoided. Salicylic Acid is also of value in the strength 
of 4 grains to the ounce of water, although more can be used if alcohol is 
included in the prescription. Alcohol is stimulating and is incorporated in 
a very large percentage of prescriptions for the treatment of this disease. 
Ammoniated Mercury, 10 to 30 grains to the ounce of lanolin or petrolatum, 
may be applied but ointments as a rule are not so satisfactory as liquid appli- 
cations and require more frequent washing. It is often necessary to incor- 
porate Phenol, 2 to 5 minims, as the disease is in many instances accompanied 
by itching. The odor of the drug can be readily disguised by a few drops of 
oil of rose geranium. Bichloride of Mercury, 1 to 1000, alone or in combina- 
tion with other stimulating drugs is of considerable value. The High Fre- 
quency Current is used to some extent in the treatment of this disease and 
with a considerable degree of satisfaction. The flat vacuum electrode should 
be passed slowly over the scalp and treatments given at frequent intervals. 
The Mercury Vapor Lamp has been used for the past few years and very satis- 
factory reports have been recorded by several observers. Red Oxide of 
Mercury, 2 to 4 grains to the ounce in ointment is of considerable value. 
Tar is also of value but in this as in other skin conditions, its objectionable 
odor prevents its frequent use. Tincture of Capsicum on account of its 
stimulation is at times of help in obstinate cases. 



1$. Resorcini, 3ij- 

Acidi Salicylici, 5ss. 

Glycerini, 5ij vel 5iv. 

Phenolis, ttrxx. 

Alcoholis, gif. 

Aquae, q. s. 5iv. 

M. Sig. — Apply daily to scalp. 



. Acidi Salicylici, gr. xxx. 

Aquas Ammoniae, . 5iv. 

Phenolis, njjxx. 

Alcoholis, §lss. 

Aquae, q. s. § iv. 

M. Sig. — Apply to scalp if oily. 



Septicemia and Pyemia. 

Quinine in large doses (B); acts as an antipyretic (R); to cinchonism the 
best remedy in childhood (Wa); is probably the most useful remedy in full 
and frequently repeated dosage (Haward); is recommended as a germicide 
(Binz) ; has no such influence (W) ; only changes the fever to another hour of 
the day (O). Formaldehyde, 500 mils of a 1 to 5000 solution by intravenous 
injection in puerperal septicemia (Barrows); proved futile in two cases 
(Bauer); a temporary check only (Shrady). Salicin, to reduce the tempera- 
ture in septicemia and to relieve the cerebral symptoms (R). Salicylic Acid, 
has decided value (B). Potassium Permanganate, is given with advantage, 
gr. f-gr. j thrice daily in distilled water (B). Boracic Acid, a saturated solu- 
tion to wounds, ulcers, etc.; also Chlorine as disinfectant (B). Oleum Cary- 
ophylli, locally, or oleum gaultheriae, oleum thymi (B) ; as antiseptics. Anti- 
streptococcus Serum, has been used successfully in 14 severe cases of puer- 
peral septicemia with only two deaths (Williams) ; also in acute hemorrhagic 
septicemia (Ballance) ; serum treatment has not proved of much value (O) ; has 



830 SHOCK. 

not given brilliant results (W) ; was of great value in several severe cases of 
puerperal form with very high temperature, one case showing 109 F. (Fa- 
gaines). If serum is administered at all, it should be given early, in large 
doses, and intravenously. Vaccines of Staphylococci give excellent results in 
septicemia and pyemia if begun early. Sodium Nucleinate, gr. v by deep 
injection into the muscles once or twice daily, has been exceedingly valuable 
in general septicemia. Hypodermoclysis aids elimination of the toxins 
(Kemp); injection of a quart of normal salt solution into the subcutaneous 
cellular tissue, has given excellent results in acute septicemia (Lanphear); 
hypodermic injection fully as effectual as intravenous, used in 12 cases of 
which 10 recovered (Duret). Water, hot water as dressing for wounds, to 
avert pyemia, Hamilton's immersion plan (B); stumps to be immersed in 
warm bath (R) ; every wound, however slight, should be immersed in Bichlor- 
ide solution, 1 to 10,000, as prophylactic, then dried with a sterile cloth and 
coated with collodion (Wyeth). Aliment, plentiful, with good ventilation, are 
not to be neglected (Wa); concentrated food, milk and alcohol (Currier). 
Stimulants are necessary, brandy the best (Wa) ; alcohol should be given 
boldly in pyemia (W); Turpentine is a better stimulant than alcohol (B). 
Abscesses must be opened early, especially when in joints, to prevent pyemia. 
Evacuation of the pus if accessible, and thorough drainage, the only success- 
ful treatment of septico-pyemia (O). [Compare Puerperal Fever, Wounds.] 

Shock. 

Drugs. The more we know of shock and collapse, the less we pin our 
faith to drugs (Bastedo). If we employ them, we must not let the stress of 
the emergency lead us into giving them in too large doses. In such an emer- 
gency we have seen drugs administered in amounts that might have proved 
fatal to a healthy person; and it seemed as if the patient might have died 
from the drugs rather than from the collapse (Id). Atropine in sudden col- 
lapse, marked by subnormal temperature, loss of arterial tension, and free 
sweating, is of great value (W). Epinephrine in minute doses frequently, 
may restore and maintain a normal arterial pressure, even when the vaso- 
motor centre is incapable of radiating impulses (Crile); in 1 to 10,000 dilution 
intravenously, is the most powerful stimulant known of the cardiac and vaso- 
motor apparatus (Martin); very quick but fugacious, a dangerous remedy, 
and of comparatively little value in shock after operation (W). Pituitrin 
has a more lasting effect but its repeated administration may result eventually 
in vasodilatation (Wiggers). Ammonia hypodermically, in cardiac failure 
from anesthetics or other poisons or after surgical operations or injuries, is 
of very great service (W). Caffeine hypodermically when very prompt ac- 
tion is required; the ordinary salts are decomposed in the presence of water, 
the Benzoate is moderately stable and free from irritant qualities (W). 
Strychnine, therapeutic doses are useless and effective ones are harmful 
(Crile). Alcohol, as Brandy or Whisky, hypodermically or by enema, is 
commonly used; is harmful, being a vaso-motor paralyzer, encourages hemor- 
rhage-, increases restlessness and in large doses weakens the heart; Strychnine 
is far better (Estes). Ether as a stimulant is open to the same objections as 
alcohol (Id); its value is doubtful (W). Heat, is a potent preventive of 
shock; the room should be warmed to at least 72 F., exposed limbs should be 
wrapped in cotton batting, and hot water bottles wrapped in towels should 



SICK-ROOM — SNEEZING. 83 1 

surround the patient's body both during and after operation. Hot Water, 
as clyster, a pint injected into colon, and repeated as required, after laparot- 
omy, in which operation the handling of the intestines sets up irritation of 
the sympathetic system, and is a potent cause of shock; this acts as a sedative 
thereto, and restores fluid to the blood, allaying thirst and supporting patient. 
Normal Salt Solution, consisting of 0.09 per cent, of Sodium Chloride in steril- 
ized water, intravenously or subcutaneously to raise the volume of the pulse, 
stimulate the heart and restore volume to the blood, renders good service. 
Saline intravenous injections are inferior to saline rectal injections, the 
effects of the former being evanescent, but the latter are frequently used with 
most satisfactory results (Estes). Carbon Dioxide by Inhalation, as this 
gas does not interfere with the oxygen-carrying power of the blood, it may be 
administered with oxygen (Bastedo). It stimulates the respiratory centre, 
tends to overcome Cheyne-Stokes or shallow breathing, and if Henderson's 
theory is correct, tends to dispel the condition of acapnia which is the cause of 
shock. Henderson says that it should not be given in a concentration above 
6 per cent. (Id). [Compare Anesthesia, Collapse, Syncope.] 

Sick-room. 

Every home of any pretensions should contain a room especially arranged 
and kept ready for the use of sick members of the family. Such a room 
should be on the upper floor, and preferably in the south-east corner, so as to 
have the best sunny exposure; or still better, should be itself the upper floor of 
a two-story annex, separate from the main building, but joined thereto by a 
light, latticed bridge. It should have no upholstered furniture, a bare but 
painted floor, and rough-plastered and painted walls and ceiling, without 
pictures or paper, curtains or hangings. It should contain a bath room nearby 
and should communicate with the kitchen by a dumb-waiter, or preferably have 
connected with it a smaller room, furnished with a gas-stove and the other 
requirements of a diet-kitchen. It should contain everything requisite for 
nursing a case of typhoid fever, scarlatina, diphtheria, measles or small-pox; 
and all its arrangements should be supervised by the family physician. The 
possession of such an adjunct to the home would enable the owner to defy the 
mandate of a Health Officer, in regard to removing an inmate thereof to a 
public pest-house, as it could be shown to the satisfaction of any reasonable 
court, that a case of infectious disease could be better isolated and more 
humanely treated in such a room than in any " pest-hospital" yet erected by 
our political administrators of health laws (Potter). 

Sneezing. 

Arsenic, a drop of Liquor Arsenical is three times a day in paroxysmal 
sneezing allied to asthma (R). Potassium Iodide, gr. x, several times a day 
(R). Iodine inhalations, in paroxysmal sneezing with itching of nose (R). 
Camphor, in incessant sneezing, with profuse running from eyes and nose; the 
powder should be snuffed, or the alcoholic solution inhaled (R). Chloroform 
5j in Spirit of Camphor to § j, of which a few drops inhaled from a handker- 
chief, is efficient. Cocaine in 3 per cent, solution applied to the nasal mucosa 
in severe cases; but should never be intrusted to the patient. [Compare 
Catarrh, Hay-fever, Influenza.] 






832 SOMNAMBULISM — SPASMODIC AFFECTIONS. 

Somnambulism. 

Potassium Bromide, will give decided relief in the somnambulism of chil- 
dren allied to epilepsy, often with squinting, which may become permanent, 
generally the result of deranged digestion; the nightmare of adults will usually 
yield to the same drug (R). Hypnotics to cause quiet sleep, but any one 
'hypnotic should not be continued long. Treatment is usually limited to 
regulating indiscretions in diet and correcting gastric disturbance, also se- 
curing the best hygienic surroundings to promote undisturbed sleep. Sugges- 
tion must be implanted in nervous subjects of impaired self-control, also in 
children, which will be operative during sleep (Church). A firm intention 
not to walk, taken to bed, is often sufficient to inhibit the attack (Id). 
[Compare Nightmare.] 

Spasmodic Affections. 

Aconite, externally and internally, for spasms not of severe type (P). 
Aconitine, as ointment in the most severe, as well as in the milder local spas- 
modic affections; in angina pectoris, spasmodic asthma, cough (P); in spas- 
modic laryngitis has good effect (R). Camphor is said to relieve in many 
forms, as strangury (R) . Hyoscine, is used with advantage in various spasms 
(Erb); in asthma, whooping-cough, and similar disorders (W). Belladonna, 
of value for spasms of sphincter muscles, especially those of pelvic organs (P) ; 
Atropine hypoder mi cally in local spasm (R). Strychnine, of great value in 
spasmodic asthma (P); also in tetanus, chorea, and epilepsy (Pf, S). Vera- 
trine, as solution, brushed over lids once a day in painful spasmodic contrac- 
tion of the orbicularis (Wa). Opium, very useful as an antispasmodic, es- 
pecially if given with a stimulant, as Alcohol, Ether, or Chloroform (R); is 
especially useful in painful spasm (W). Apomorphine has proved efficient 
in a severe case of spasmodic contractions with opisthotonos but no inflam- 
matory or organic lesion (Shannon). Chloral in tetanus, convulsions, 
strychnine-poisoning, chorea, cramps, and other spasmodic affections, is an 
efficient palliative; the standard remedy in all forms of severe spasmodic 
disorder, to temporarily suppress the motor disturbance (W). Sulphonal is 
feebly anticonvulsant (W) ; is effective for the spasm of fractures (Andrews) ; 
has been used with asserted good success in epilepsy, hiccough, chorea, and 
nocturnal cramps (W). Ipecacuanha, in spasms of respiratory organs, of 
great value (P). Chamomile Oil, in spasms of hysterical persons, in 4 to 6 
minim doses a very excellent remedy; also useful in pseudo angina pectoris 
(P). Cajuput, the Oil is recommended for intestinal spasm (W). Lobelia 
in spasm of the bronchial muscles (W) ; a valuable antispasmodic in cautious 
hands (P) ; no remedy is of more value in the various spasms of childhood and 
in spasmodic asthma (Burnett). Tobacco, in spasmodic asthma, and for re- 
laxation of muscular spasms (P). Ammonia, useful in children's colic (R). 
Chloroform, inhaled for intestinal spasm (P) ; Anesthetics act well in spasms of 
excretory ducts or canals, especially during the passage of calculi, and in 
severe hysterical and spinal convulsions, but in oft-repeated spasm they 
should be used only for temporary indications (W). Bromides are often 
efficacious in various reflex spasmodic neuroses, epilepsy, tetanus (W). 
Amyl Nitrite in arterial spasm, spasmodic dysmenorrhea, tetanus; a very 
powerful and rapidly acting relaxant for a brief period (W). Phenolsul- 
phonates, in flatulent spasm of women, usually a neuralgia of the abdominal 
nerves, the pain being excited by flatulence; act by preventing the formation 



SPERMATORRHEA — SPINA BIFIDA. 



a,33 



of wind — sometimes Phosphorus better (R). Mustard Poultice, an excellent 
counter-irritant in spasmodic affections (P). [Compare Angina Pectoris, 
Asthma, Cholera, Chorea, Colic, Convulsions, Cough, Croup, Dysuria, 
Epilepsy, Gastrodynia, Hiccough, Hydrophobia, Hysteria, Laryngis- 
mus, Pertussis, Poisoning by Strychnine, Stammering, Tetanus, Tor- 
ticollis, Trismus, also the List of Antispasmodics on page 23.] 

Spermatorrhea. 

Potassium Bromide, when due to plethora, erections normal, but per- 
sistent and teasing; is harmful in debilitated states, or daily losses (B); com- 
bined with cold sponging and the use of a hard bed (R). Camphor Bromide 
has an especial reputation, but is taken with difficulty being apt to irritate the 
stomach (W). Cantharis, deficient tone of seminal vesicles, erections feeble, 
sexual feeling torpid; the tincture, gtt. ij-iij ter die (R); with Iron internally 
in emissions (R). Gelsemium, as anaphrodisiac, may be combined with 
Belladonna or Cimicifuga (B). Nux Vomica, for relaxation and atony (B). 
Strychnine, in large doses, especially when impotence (R) . Quinine, has been 
recommended (R). Belladonna, gr. J of extract with gr. jss of Zinc Sulphate, 
three or four times a day, often successful in nocturnal emissions (R). 
Atropine, relaxed genitalia, no dream or orgasm (B). Hyoscine is useful in 
all cases of sexual excitement, through its influence on the spinal centres, and 
is the most certain remedy in ordinary cases of over-frequent seminal emis- 
sions (W). Iron, the Iodide, is useful in anemic cases (B). Ergot, beneficial 
in relaxed state (B). Hydrastis, is a useful injection, gtt. x of the fluidex- 
tract through a urethral tube to the prostatic portion of the urethra (B). 
Cimicifuga, useful in a weak, relaxed condition (B); when hypochondriasis 
exists it is beneficial (P). Sulphonal has been recommended as a sexual 
sedative (W). Silver Nitrate, a vesicating solution applied to perineum, 
generally useful and without danger (B) ; in solution, gr. xxx to the % , applied 
by urethral syringe to the prostatic portion of the urethra, is Lallemand's 
treatment, and still finds favor with many surgeons (Whitla). Arsenic, 
when from weak and relaxed seminal vesicles. Kind Advice, frequently the 
best treatment, as this affection is often due to the phantasms of a morbid 
imagination. Bladder, should be emptied after the first sleep. Electricity 
may be tried, the galvanic current, positive pole on the spinal column, negative 
in urethra, on the perineum or the spermatic cords (St). Local Treatment 
by the passage of metal sounds 2 or 3 times a week, and left in the urethra 
from 5 to 15 minutes, and the use of urethral or rectal psychrophores with 
cold or hot water; also the local application of stimulants (as silver and copper) , 
or astringents (as zinc or tannin) , to the deep urethra through the endoscope, 
— such is the principal and most important treatment (St). [Compare Emis- 
sions, Hypochondriasis, Impotence.] 



Ifc. Tinct. Cantharidis, 5ij- 

Tinct. Ferri Chloridi, 5vj. 

M. Sig. — 20 drops in water thrice daily. 
In impotence with spermatorrhea, of great 
utility. (H. C. Wood.) 



1$. Lupulini, gr. x. 

Camphorse, gr. v. 

Ext. Belladonnae Fol., gr. ij. 

M. ft. pil. no. xij. Sig. — One pill thrice 
daily. (B.) 



Spina Bifida. 

Compression. — Very small protrusions which grow slowly and are covered 
with sound skin may be treated by the use of a compress and bandage, by an 
53 



I 



834 SPINAL CONCUSSION — SPINAL PARALYSIS. 

elastic bandage, or by applications of contractile collodion (Da Costa). Iodine, 
injected into the sac, 5ss of tincture, or gr. ss, with Potassium Iodide gr. v, 
aquae 5j> has cured numerous cases (B); Iodi gr. j, Pot. Iod. gr. J ad aquae 
5j (Wa). Collodion, as a means of compression (B). Bayer's Operation, 
treats the tumor as if it were a hernia; he dissects out two lateral flaps from 
the skin covering it and removes the sac, leaving only two lateral flaps of the 
dura, which he sews together, afterwards bringing the skin and muscles to- 
gether separately. 

Spinal Concussion. 

Lead-water and Opium, as lotion over the seat of injury (A). Leeches, 
if pain persistent (A). During the early stage the treatment of shock must 
be instituted, stimulants and restoratives being administered; traumatic 
neurosis may be treated with electricity, massage, hydropathy and the rest- 
cure; inflammatory symptoms require the treatment for acute or chronic 
myelitis (Lyman). The condition is probably one of laceration of capillaries 
and of cord-substance, and the treatment is the same as that of sprains 
(J. C. Da Costa). [Compare Myelitis, Neurasthenia.] 

Spinal Congestion. 

Ergot, gives excellent results (Brown-Sequard) ; is still much used (W); 
in drachm doses of the fluidextract every hour, will sometimes relieve the pain 
and check the progress in caisson disease, the autopsies of which show ab- 
normal congestion of the cord (Church). Turpentine, as hot epithems, 
useful (Wa). Antiphlogistic measures, with rest and absolute diet; wet cups 
or leeches to the spinal region; cold affusion or ice-bags to the spine while the 
patient is in a hot half-bath (Ros) ; the prone position is often found beneficial. 
[Compare Meningitis Spinal, Myelitis.] 

Spinal Irritation. 

Aconite, as ointment locally (R). Belladonna preparations, locally- 
generally are better than Aconite (B). Strychnine, persistently, will amelio. 
rate wandering neuralgic pains due to irritability of nervous system (B), 
Ergot, large doses for congestion (Hammond). Conium, in functional de- 
rangement of the cord, with excessive irritability of the reflex function (Wa). 
Firing, sometimes very beneficial (B). Electricity, the inverse galvanic 
current gives much relief (Hammond). Blisters, with hot- water bag to 
spine, large doses of Strychnine, Phosphorus, Phosphoric Acid and Opium, 
are the methods based upon the anemic theory of the disease; out of 156 cases 
so treated 133 were thoroughly cured (Hammond). Rest-cure, systematic- 
ally and rigidly carried out, with hydrotherapy properly applied, in a suitable 
sanitarium, does great service in neurasthenia, of which spinal irritation or 
spinal neurasthenia is a part (O). [Compare Hysteria, Meningitis 
Spinal, Myelitis, Neuritis, Neurasthenia.] 

Spinal Paralysis. 

Urotropin is eliminated in some degrees into the subdural space, and 
promises to become a remedy for acute spinal paralysis (epidemic polio 



SPINAL SCLEROSIS — SPLENIC AFFECTIONS. 835 

myelitis) of infants (Flexner). Ergot, to starve the inflammation by occlud- 
ing the spinal arteries (Hammond) . ■ Ergot and B elladonna have been warmly 
recommended for acute infantile paralysis, but it is unlikely that they have 
the slightest influence (O). Strychnine maybe used with advantage in the 
later stages of the same disease (O). Mercury and Potassium Iodide, a 
thorough course, in spastic paraplegia when syphilis is suspected (O). 
Phosphorus is often serviceable in myelitic paraplegia from excessive venery 
(W) . Silver Nitrate is employed in chronic inflammation of the cord affect- 
ing the anterior columns, and giving rise to paraplegia, but is of doubtful 
value (W). Massage with forcible flexion and extension and proper appara- 
tus, to overcome rigidity and contracture in infantile spastic paraplegia, 
have often enabled a patient to get around comfortably (O). Electricity, 
galvanic current from spine to nerves and muscles affected (Ros) ; the f aradic 
current to the muscles which respond, but cannot be compared to massage 
in maintaining nutrition of the muscles, the essence of the treatment of in- 
fantile paralysis (O). Treatment of acute ascending (Landry's) paralysis 
should be directed against any general toxic condition present or suspected; 
a narrow sinapism the whole length of the spine, frequently repeated, is of 
service, even the thermocautery is advised (Church). Baths, warm, of every 
description, are useful in spastic spinal paralysis (Lyman). Suspension, has 
been tried with some degree of success (Id). In softening the treatment 
must be palliative and supporting only (H). [Compare Locomotor Ataxia, 
Myelitis, Paralysis.] 

Spinal Sclerosis. 

Strychnine hypodermically, gr. ^\ gradually increased to T V and even gr. 
I thrice daily, under proper supervision, should be faithfully tried in spinal 
scleroses, though the treatment of such cases is practically futile (Church); 
the Nitrate in amyotrophic lateral sclerosis, injected into the wasting muscles 
in rapidly increasing doses (Gowers) ; should be avoided in primary lateral 
sclerosis (Taylor). Silver Nitrate is the only remedy of value in idiopathic 
anterior and posterior sclerosis, but often fails. Arsenic as Fowler's solution 
by the mouth, is useful in various spinal scleroses and in disseminated sclero- 
sis; Arsenic, also strychnine hypodermically, in amyotrophic lateral sclerosis 
(Gowers). Mercury with Potassium Iodide, when syphilis is suspected to 
be the causative factor. Cod-liver Oil and other general tonics, may be 
serviceable. Massage and passive movements of the wasting muscles, are 
said to be serviceable in lateral sclerosis. Rest prolonged, in bed, gives the 
best results in primary lateral sclerosis (Taylor). Electricity, a weak gal- 
vanic current is sometimes of benefit, but as a rule electricity is disappointing 
in central nervous diseases; should not be used in lateral sclerosis. [Compare 
Locomotor Ataxia, Paralysis, Sclerosis.] 

Splenic Affections. 

Mercury Biniodide, gr. j to 5j of ointment, rubbed in before a hot fire, 
has given excellent results in chronic malarial enlargement of the spleen 
(Wa). Quinine, in simple malarial enlargement (B); gr. xv or xx or more 
daily, one of the most effectual remedies (Wa). Ergot, the most effectual 
remedy for enlarged spleen (Da C). Ammonium Iodide, effective in chronic 
splenitis with Unguent. Hydrargyri Iodidi Rubri externally; also small doses 



836 SPRAINS — SPRUE. 

frequently repeated in all splenic derangements from malaria (B). Iodine, 
locally in chronic forms (B). Cold Water as douche to the abdomen for 2 
or 3 minutes at a time, contracts the spleen and sensibly affects the enlarged 
spleen of malaria or typhoid fever (Mosler). Operation. — Rupture of the 
spleen is usually treated by splenectomy, abscess of the spleen is treated by 
incision and drainage or splenectomy, the enlarged spleen of Band's disease 
in the early stage and the enlarged spleen of pernicious anemia and primary 
tumors are often removed. Splenectomy in the various anemias is still in 
the stage of trial, although numerous good reports have been published. 
X-ray reduces the enlarged spleen of leukemia. [Compare Leucocythemia.] 

Sprains. 

Aconite, the liniment to painful sprains, often affords relief (Wa). Tur- 
pentine, as a liniment (P). Ammonium Chloride, in solution, as lotion, or 
with bread as poultice, to remove discoloration due to sprains (W). Oil 
of Bay, as a stimulating liniment (P). Ichthyol with glycerin, equal parts, or 
with alcohol and ether as a liniment, relieves pain and reduces swelling 
(Schmitz). Camphor in liniments as a stimulating application, is much used 
(W). Vinegar is often very useful as a topical application (W). Lead Sub- 
acetate, the strong solution 5 j-iv to a pint of water, is a favorite application 
(W). Cold Douche, salt may be added; the force must be regulated by the 
condition of the tissues (R). Heat, by fomentations alternated with cold 
affusions (D). Rest, is the most essential measure and should be perfect; 
a roller bandage with splints may be required to secure the rest of the part. 
Massage is of great value after subsidence of the acute inflammation (W). 
Strapping the foot and ankle in sprain of the latter, by strips of strong rubber 
adhesive plaster open behind, involves no loss of time, requires no crutches, 
and is not attended with any impairment of function (Gibney). [Compare 
Bruises.] 

Sprue. 

Santonin, the yellow form, gr. v in 3j of olive oil, once or twice daily 
for a week, has given good results (Begg); tried without benefit (Mn). 
Castor Oil, as an aperient before commencing the milk-cure (Id). Rhu- 
barb, the compound powder as an aperient occasionally, when relapses of 
diarrhea, sore mouth and flatulent dyspepsia (Id). Silver Nitrate, in solution 
by enema, for cases of dysenteric origin (Id). Cocaine, in solution, gr. v 
to the § , brushed over the painful mouth before taking food, relieves suffer- 
ing (Id). Borax, a weak solution as mouth- wash after taking milk (Id). 
Fruit-cure/ has given good results in Java; the diet must consist entirely 
of such fruits as are pulpy and free from coarse seeds, fibers, and excessive 
acidity, except pineapple, which is interdicted (Van der Burg). Milk-cure, 
is by far the most successful treatment; at first not more than 60 ounces in 
the 24 hours, sipped through a glass tube in small quantities hourly; \ pint may 
be added daily after a few days, until 100 ounces are reached, and after 10 
days more this may be increased gradually to a daily maximum of 6 or 7 
pints; for 6 weeks after the stools become solid, and the mouth free from 
irritation, no other food should be permitted (Mn). Kumyss, sometimes 
agrees for a time when milk fails to give satisfaction (Id). Diet, after the 
above-mentioned six weeks, may be varied by a raw egg added to the milk, 



STAINS — STAMMERING — STERILITY. 837 

later, some artificial malted food, arrowroot or other digestible starch; 
still later, fish or chicken (Mn). Meat-juice, obtained by squeezing a 
pound of good beef-steak, cleared of fat and under done, every 2 hours 
for 7 to 8 days daily, in those cases where milk does not agree (Macleod). 
Hygiene, the patient must never feel cold, and hence must dress warmly. 
He should not return to the tropics (Mn). [Compare Aphthae, Dysen- 
tery.] 

Stains. 

Silver Nitrate Stains may be removed by washing with Potassium 
Cyanide, 5ij ss > Iodine, gr. xv, Water, §iij; or, after moistening the spots, 
drop on them a few drops of Tinct. Iodine, and wash out with a solution of 
Sodium Thiosulphate, 5ss to 5 j (B). Iodine Stains are removed by a 3 per 
cent, solution of Carbolic Acid (Stretton). Potassium Permanganate 
Stains are removed by washing with a saturated solution of Oxalic Acid, 
which should be washed off with warm sterilized water, as in Kelly's 
method of disinfecting the surgeon's hands. Blood Stains on dark-colored 
material are best seen by artificial light. After a few hours they become 
of a rusty, reddish-brown color, which they maintain for years. The micro- 
scope shows the characteristic corpuscles. These stains when on iron 
are difficult to distinguish from rust; the latter is not soluble in water, 
while blood is extremely so. Heat applied to the metal will cause the blood 
to peel off, unless the stain has been exposed long enough to have rust 
mingled with the blood. A solution of blood in water, heated, forms a 
coagulum which is soluble in hot caustic potash, the solution thus formed 
is green by transmitted light, and red by reflected light. Menstrual blood 
cannot be distinguished from that resulting from a wound (Husband). 

Stammering. 

Vocal Training, the rhythmical method, the most successful, the chief 
end in view being to regulate the precipitate, irregular form of respiration; 
but long continuance necessary, six months, a year, or more, in special 
institutions (Ros) . The patient must be taught to use the language anew, 
treated with special kindness, and never subjected to mockery or punish- 
ment. [See Potter on Speech and its Defects, Lea Prize Essay, Philadelphia, 
1882.] 

Sterility. 

Potassium Iodide, when due to syphilis (R). Dilatation of os and cervix 
carefully when sterility depending on obstruction, with dysmenorrhea (H). 
Sterility is frequently associated with uterine displacement (Meadows); 
less often with atresia. In persons of good health it may be caused by an 
acid discharge from the uterus, which kills the spermatozoa; for this Vichy 
water internally and per vaginam, also alkaline baths (Charrier). Is due 
to aspermatism of the husband in more cases than generally believed (Gross). 
Many cases are due to blocking of the cervical canal with a morbid discharge 
from the cervical glands, and such may be relieved simply by repeated cleans- 
ing of the canal with a cotton- wrapped probe or forceps. Surgical, the 
operation of epididymo-vasostomy for the relief of sterility in the male, due 



830 STINGS AND BITES. 

to obstruction of the spermatozoa lodged in the tail of the epididymis, has 
been done in several cases with complete success (Martin). 

Stings and. Bites. 

Ammonia or other alkali in weak solution, locally for stings of insects to 
neutralize the formic acid (R); Ammonia internally as a nervine stimulant 
in snake-bites, more useful than brandy or any other stimulant; Tftx-xx 
of Aqua Ammoniae in water or wine, every hour or oftener; also externally 
or hypodermically, 1 in 2 of water into a vein (Wa). Ammonium Car- 
bonate, gr. v hypodermically, is used for wounds by poisoned arrows. 
[See under Wounds.] Salicylic Acid, 1 to 19 of flexible collodion, locally 
for bites of insects; allays pain at once, and only in rare cases is the neighbor- 
ing tissue swollen. Mercury, the Bichloride, 1 to 1000 of flexible collodion, 
is equally effective. Iodine, the crystals in saponated petrolatum, 30-40 
grains to the 5 , rubbed over bites of mosquitoes and wasps with rapid relief 
to pain (Moloney). Potassium Permanganate, in strong solution, 1 to 
6 locally, is promptly efficient for all reptile-bites and insect-stings; if wound 
is small, make incision to enlarge it, and insert lint soaked in the solution; 
if a rattlesnake-bite, inject the solution hypodermically above the wound 
(Dupon) ; the crystals rubbed into an incision, after placing a ligature above, 
the most effective antidote for serpent- venom (Br). Phenol. — To treat the 
bite of a poisonous spider or sting of a scorpion tie a fillet above the bitten 
point; make a crucial incision, favor bleeding, and paint the wound with 
pure carbolic acid or some caustic or antiseptic (if in the wilds, burn with 
fire or gunpowder); dress antiseptically if possible, and stimulate as con- 
stitutional symptoms appear (Da Costa). Arsenic, 1 part to 5 of black 
pepper, is the Tanjore pill, highly esteemed in In dia for bites of venomous snakes 
(Wa). Echinacea, a strong tincture used locally and internally with invari- 
able success in rattlesnake-bites, also for those of tarantulas, spiders scor- 
pions, the stings of wasps and other insects (Ellingwood). Hydrogen 
Dioxide, applied to the place stung by a hornet, is said to give instant 
relief. Calcium Chloride, a filtered solution injected into wound from 
snake-bite, successful in seventeen cases (Binz). Silver Nitrate, the sharp- 
ened stick applied to every sinuosity of the wound; excision safer (Wa). 
Sugar, applied to stings of wasps, said to relieve almost instantly (Wa). 
Ipecacuanha, as poultice or paste, allays pain or irritation; is regarded by 
some as almost specific (Wa) ; the powdered drug made into a paste, is said 
to relieve the pain and swelling due to bee-stings. Ichthyol pure, or as a 50 
per cent, paste with lanolin or vaselin, locally over the part, is effective 
in relieving the pain, burning, itching and swelling due to insect stings or 
bites, and is greatly preferred to Ammonia (Ottinger). Antivene is an 
effective antitoxin against the venom of several serpent species (Fraser). 
Calmette's antivenene for cobra venom is useful in the treatment of cobra 
envenomation, but is not serviceable for the treatment of other snake-bites 
as shown by Martin for Australian serpents and by McFarland for American 
snakes (K). The serums of Calmette, Noguchi, and others are useful in the 
treatment of their respective envenomations, but aside from India and a 
few other reptile-infested countries, as well as in zoological gardens and 
laboratories where snakes are kept, the serums have a very limited sphere 
of usefulness (K). Bile of the biter serpent is an effective antidote to its 



STOMATITIS. 



839 



poison (Id). Alcohol freely in snake-bites, as a stimulant is most important. 
This belief is false, in a person badly poisoned by snake venom the medullary 
centres are depressed and threatened with paralysis and large doses of alco- 
hol increased this tendency and may hasten death (Da Costa). Sting 
if left in the wound should be removed; pressing with the barrel of a small 
key will expose it. 

Used against fleas and insects are: — Phenol in weak solution sponged over 
the exposed parts of body, to keep off the mosquitoes (R). Hedeoma, the 
oil is very repulsive to insects, especially fleas and mosquitoes. Erigeron 
is popularly known as fleabane, its oil may be used against fleas. Cyllin 
and Petrolas and emulsion in 800 parts of water, is the most practical pulicide, 
ordinary germicides being powerless to destroy fleas (Birt). Pyrethrum, 
the powdered flowers of several species of this plant are known as buhach, 
and are used as insecticides. Quassia, a strong infusion is used as a wash 
in Java on mat-covered floors infested with fleas, which vanish as by magic, 
under its influence (Neale). [Compare Poisoning by Serpent-venom, 
Wounds.] 



1$. 01. Picis Liquids, 01. Olivae, 

01. Hedeomae, aa §j. 

Spt. Camphorae, 

Glycerini, aa gss. 

Phenolis, 5ij- 

M. Sig. — Shake well. Lotion against 
mosquitoes, for fishermen and hunters. 



1$. Carbonis Vegetab., lb. j. 

Potassii Nitratis, gij. 

Phenolis, Sjss. 

Persian Insect Powder, 5 vii j . 

Mucil. Tragacanth, q. s. 

To make fumigating pastilles for 
against mosquitoes. 



Stomatitis. 

Potassium Chlorate,Qocally and internally; large doses necessary, gr. x-xx; 
in ulcerative stomatitis of nursing women and aphthae, of no value in mercurial 
form (R) ; is almost specific in the ulcerative form, gr. x thrice daily for a child, 
also locally as a mouth-wash, or the powdered salt applied directly to the 
ulcers (O). Silver Nitrate, locally to the ulcers when much fetor (O); or 
when other treatment fails. Atropine, gr. ^fai is sometimes serviceable in 
mercurial stomatitis (O). Potassium Permanganate in solution, as a wash 
in various forms (O). Thymol makes an effective and pleasant mouth- wash 
having an agreeable taste (W). Hydrastis, the fluidextract locally in mer- 
curial and aphthous stomatitis (B). Hydrogen Dioxide acts favorably 
(Godet). Boric Acid and Borax are of excellent service in aphthous ulcera- 
tion and other inflammations of the mouth (W). Phenol, as a concentrated 
solution in glycerin carefully, as a mild caustic in aphthous stomatitis (Wa). 
Alcohol, Brandy-and- water an excellent lotion (B). Mineral Acids, pure 
Hydrochloric applied on pine wood to ulcers (B). Eucalyptus, a decoction 
of the leaves, locally (B). Glycerite of Tannin, in ulcerative stomatitis (R). 
Copper Sulphate, solution painted over edges of gums in ulcerative stomatitis; 
generally dry Alum better (R). Alum, in ulcerative form, applied dry with 
the finger several times a day, especially when disease affects one-half the 
jaw (R). Salicylic Acid, to ease the pain of catarrhal stomatitis; one part, 
dissolved in sufficient Alcohol, to 250 parts of water (R). [Compare Aph- 
thae, Cancrtjm Oris, Ptyalism, Sprue.] 

J$. Thymolis, gr. x. 

Sodii Boratis, gr. xxx. 1$. Acidi Salicylici, gr. vj, 

Aquse, §iv. Aquse, §vj. 

M. Sig. — A teaspoonful in half a glass of M. Sig. — Use as a mouth- wash to relieve 

water, as a mouth-wash or gargle. pain after the blisters have broken. 






840 STRABISMUS — STROPHULUS — SUPPURATION. 

Strabismus. 

Atropine (1 per cent.), one drop in each eye twice daily to suspend the 
accommodation and so relieve the strain on the muscles of convergence (inter- 
nal recti) in cases due to hyperopia. This should be continued for a month or 
two, during which time the error of refraction should be carefully estimated 
and the correcting Jens worn constantly. An opaque lens may be worn over 
the good eye, or the eye bandaged for several hours a day in cases where 
amblyopia has developed in the squinting eye. This will force the eye to 
functionate and may result in improvement of the vision. Atropine, solution 
dropped in the sound eye may also be used. These measures should be 
tried, although it is doubtful if improvement ever occurs. Training 
the fusion sense is another essential part of the treatment. This may be 
done by the use of the stereoscope with specially constructed pictures. 
Worth's amblyoscope is a useful instrument for this purpose. Operative 
measures are indicated should the above treatment prove unsuccessful. 
Potassium Iodide, Syrup of Ferri Iodide, and attention to the general 
health are measures of importance in cases of strabismus paralytic in origin. 

Strophulus. 

Zinc Oxide, dusted freely over the part. Magnesia, or some other mild 
alkali, with improved feeding and aperients, to which measures this affection 
generally yields in infants. Nitric Acid, the dilute acid 5j to 5 viij of Rose- 
water, as lotion applied frequently to the affected parts (Wa). Phenol with 
Boric Acid, Alcohol and Water, as a lotion if itching is intense (Ruhrah). 
Resorcinol, gr. j to the § , or a saturated Boric Acid solution, useful applica- 
tions (Id). Lancing the gums is proper (H). Strophulus is a form of 
miliaria occurring in infants, generally as a result of too much wrapping up. 
[Compare Miliaria, Lichen.] 

Suppuration. 

Sulphides, small doses, gr. ss-j, frequently repeated, are very serviceable 
(B). Calcium Sulphide, when ichor secreted instead of pus; also arrests 
suppuration, or if that is impossible will hasten maturation (R). Quinine, 
recommended in profuse suppuration (R) ; to sustain system when suppuration 
prolonged (B). Iron and Manganese Iodide, the syrup in cachectic states 
resulting from suppuration (B). Hydrogen Dioxide, is a most energetic pus- 
destroyer; the solution may be applied in full strength, or diluted with an 
equal part of water. Bismuth Paste injected by a blunt-nosed syringe, has 
proved exceedingly valuable in chronic suppurating sinuses, fistulae, and 
other suppurations (Willard). Chalk Paste is equally efficient and non- 
toxic, equal parts of chalk and petrolatum (Mitchell). Bismuth Subiodide, 
dusted over a suppurating surface after cleansing, is highly efficient as an 
antiseptic and a stimulant of healthy granulation. Acetanilid, is effective 
for 2 or 3 days, but ultimately fails to prevent suppuration (Foote); the 
following combination, used as a dressing, absolutely inhibits suppuration 
where it can reach the w r ound surface, and checks and quickly abolishes 
suppuration if that be already present, — Acetanilid, powdered, 48; Boric 
Acid, powdered, 15; Starch, powdered and finely sifted, 35; Phenol, the liquid, 
2. It should be changed twice daily as long as there is discharge to moisten 



SYCOSIS VULGARIS — SYNCOPE. 84I 

it, when the wound becomes dry the dressing may be left on for days (Fallas). 
Nuclein, has been used successfully in suppurative disorders (Vaughn). 
Incision, if suppuration exists or is seriously threatened, do not waste time 
by using poultices, but incise at once (Da Costa). Incision may prevent 
suppuration by relieving tension, affording drainage, and permitting the local 
use of antiseptics (Id). If pus exists it cannot be evacuated too soon; to do 
otherwise is often productive of irreparable harm (Id). [Compare Abscess, 
Boils, Carbuncle, Empyema, Phlegmon, Septicemia and Pyemia.] 

Sycosis Vulgaris. 

Shaving every day is absolutely necessary to the successful treatment of 
this disease. While depilitation is practised in some hospitals abroad and is 
good treatment, yet it is so extremely painful that shaving may be sub- 
stituted. Olive Oil followed with a vigorous soap and water scrubbing may 
be used to remove the crusts. If the inflammatory symptoms are very 
marked, mild applications are indicated for a few days until they have sub- 
sided. (See Eczema.) Alcoholic beverages in any form should be avoided. 
Ammoniated Mercury, 4 to 6 per cent, in petrolatum may be used with 
advantage. Arsenic may be used for the treatment of this disease for its tonic 
effect but it exerts no specific action on the eruption. Beta-Naphthol, 10 to 
20 grains to the ounce of ointment in which sulphur J to 1 drachm has been 
incorporated has proved to be of great importance. Balsam of Peru, J to 1 
drachm to the ounce of petrolatum, is of value especially if sulphur or some 
other drug is used. Bichloride of Mercury, 1 to 1000, as an antiseptic wash, is 
frequently used. Boric Acid has slight antiseptic effect either in saturated 
solution or as a dusting powder. Calx Sulphurata, T V to J grain t.i.d. was 
formerly used to some extent but apparently has very little influence on this 
disease. Ichthyol is of value but its dirtiness is a marked objection to its 
use. Resorcin is of great value, 2 to 4 per cent, strength in alcohol or in an 
ointment base. Salicylic Acid may be used in from 2 to 8 per cent, in petro- 
latum or lanolin. Staphylococcic Vaccines are of great importance; the ini- 
tial dose being small, the succeeding doses increased and the number of injec- 
tions depending upon the clinical manifestations. Sulphur is still very largely 
used, 2 to 1 2 per cent, in petrolatum or lanolin. The X-ray is of great value 
and if properly applied, will produce no more atrophy than is usually asso- 
ciated with the disease. 

Syncope. 

Alcohol, as brandy, when heart is suddenly enfeebled from fright (R); a 
rapidly acting cardiac stimulant, but not very powerful (W). Ammonia, 
internally, or breathed into the air-passages (R) ; the Carbonate as smelling 
salts (Wa); efficient in sudden and functional failure of the heart's action, if 
given hypodermically or intravenously, as it is not well absorbed through the 
gastric mucous membrane (W). Atropine, gr. Tfari^ subcutaneously, the 
best means of resuscitation, there being nolmedicine which so promptly exalts 
the force and rapidity of the heart's action (Harley). Amyl Nitrite, in some 
forms, especially in anemic subjects, its inhalation speedily restores conscious- 
ness (O'Neill) ; is dangerous, as the least overdose causes cardiac depression 
(W). Nux Vomica, in drop doses of the tincture every 5 minutes, to restore 
the cardiac action in extreme cases of syncope approaching heart-failure, espe- 



842 SYNOVITIS — SYPHILIS. 

daily when of neurotic origin; is promptly efficient (Macfarlan). Quinine 
Salicylate rendered good service in cases of repeated syncope due to anemia 
(Sir J. Moore). Ether by the mouth, as a powerful and rapid stimulant, is 
often indicated in sudden sinking-spells (W). Position should be leaning for- 
ward, with the head as low as possible (R) ; raising the head is a danger- 
ous procedure. Cold water over the face (B) ; cold affusion always (R) ; is 
best made by dashing cold water from the hand on to the face and neck. 
Galvanization of the pneumogastric (B) . Artificial Respiration by Sylvester's 
method, and rhythmical traction of the tongue, should always be employed in 
the first instance in syncope from chloroform (Boureau) Compression of 
the Heart has been done in 12 cases, but never with final success (Id); suc- 
cessfully performed in a laparatomy case by squeezing the heart through the 
diaphragm (Lane). [Compare Collapse, Heart Affections, Shock.] 

Synovitis. 

Potassium Iodide, with Iron and Quinine, in syphilitic patients with con- 
stitution broken down (D). Iodine, in chronic synovitis, painted around 
joint; the solution injected into white swelling (R). Quinine, and free stimu- 
lation in all cases of pyemic synovitis, such as occurs in acute rheumatism of 
gonorrheal causation, occasionally in typhoid fever, and may result from a 
trifling injury in strumous subjects. Mercury and Morphine, the Oleate 
locally (R) ; an elegant and efficient application (B) ; in syphilitic cases mercury 
internally when acute symptoms have subsided (D). Aconite, for pains in 
inflamed joints (R). Silver Nitrate, locally to vesication almost, often very 
beneficial (Wa). Phenol, in a 2 per cent, solution injected into the joints once 
in 2 or 3 days, in chronic synovitis (W). Alcohol, and water, equal parts, an 
excellent evaporating lotion (B). Blisters, a flying blister every night in 
chronic synovitis (R). Cod-liver Oil, in strumous cases (B). Surgical 
Treatment, splints to keep the limb motionless in all cases arising from injury; 
during acute stage splint should be fastened at some distance above and below 
the joint, not touching the joint itself; straight position, leeches to the joint, or 
cupping near it; ice, evaporating lotions or hot fomentations; blisters inap- 
plicable until the acute stage subsides (D); if suppuration occurs the joint 
must be dealt with as any other abscess cavity (MacCormac). Heat, as 
fomentations or poultices in the acute form. The results of dry heat, applied 
by the Tallerman apparatus seem almost marvellous in traumatic synovitis, 
whether in base-ball men or other persons; its effects are more prompt and 
marked in small joints than in large ones (W). Bandage, or Strapping, to 
cause absorption of fluid; bandage with cold water after alternate bathing 
with hot and cold water, in chronic synovitis. [Compare Coxalgia, Joint 
Affections.] 

Syphilis. 

Treatment should be instituted at the earliest possible moment. The 
finding of the spirochaeta in the local lesion and the Wassermann serum test 
are early diagnostic tests. 

Arsenic was praised in 1810 by G. N. Hill in cases wherein Mercury fails. 
Arsenobenzol (Ehrlich's 606) is a true spirillicide (Ehrlich) ; the intravenous 
injection has been demonstrated to be the most efficient mode of adminis- 
tration (Schamberg); should be followed by a course of Mercury (Id). [See 



SYPHILIS. 843 

Arsenic] Atoxyl (Sodium-amino-phenyl-arsenate), gr. vj intramuscularly 
every other day for 9 injections, abolished all symptoms in 13 cases with no 
evidence of intolerance or of toxicity (Id) ; must be admitted to an equal foot- 
ing with Mercury as a specific, and is of special service in the graver and more 
malignant types of the disease (Harris); cannot compete in efficiency with 
Mercury (Charmeil). Sodium Cacodylate has theoretically several advan- 
tages over Arsenobenzol, having a greater arsenic content and being much 
safer if pure (Runnels); in 200 cases gave striking and wonderful results 
(Schirrmann). Mercury is believed to be a true vital antidote against the 
views of the disease (R); used for at least two years will eradicate syphilis 
(Keyes) ; its internal administration is best because the most practicable, and 
the two most efficient preparations are the Bichloride and the Protiodide 
(Fournier) ; by intramuscular injection, a method which offers many advan- 
tages and has given the very best results (Lambkin) ; the Protiodide in pills of 
gr. £ each, one after each meal increased by one every third day, until teeth 
get sore or bowels disordered, then drop two pills from each dose (Keyes); 
the best remedy for primary and secondary forms, not in tertiary; small doses 
are best, stopping short of ptyalism (B) ; Mercury with Chalk in pill, gr. j with 
a grain of Dover's powder 4 to 6 times a day (Hutchinson), gives excellent 
results and may be continued for months without ill effects (O) ; Inunction by 
mercurial ointment is still more efficient (O); Blackwash, Calomel, or Citrine 
Oint. very useful in mucous sores, tubercles, and elevated indurations; in 
syphilitic ozena, psoriasis, rashes, condylomata; the Bichloride, gr. ij-v in 5 j 
of Alcohol, painted over syphilitic mouth lesions daily (Keyes) ; the Salicylate 
is the best salt for hypodermic use, gr. jss in TTlxx of sterilized liquid petrola- 
tum injected deeply into the buttock (Fuller); the Succinimide by deep intra- 
muscular injection, is almost painless and does not cause abscesses; Mercuric 
Choleate (Mergal), gr. f— jss thrice daily, is the simplest, most convenient, and 
most agreeable method; may be taken for months without harm, and is indi- 
cated in all forms, whether secondary or tertiary (Boss). There are about 80 
deaths on record due to the intramuscular injection of insoluble mercurials 
(Schamberg). Calomel a 30 per cent, ointment by inunction to the penis 
after exposure to syphilis, has been known to abort an infection of the disease 
(White) ; a 33 per cent, ointment by lubrication before connection, and sub- 
sequent washing with corrosive sublimate solution 2-3 in 1000, gives good 
results in preventing infection (Neisser). Potassium Iodide, is of inestimable 
value in tertiary syphilis and is useful whenever the dyscrasia has existed for 
any length of time (W) ; is approached by no remedy in constitutional syphilis; 
also for mercurial cachexia, syphiloma of nervous system, and many disorders 
of syphilitic origin; will certainly arrest ulceration of nares, palate, etc., if 
given in large doses, gr. xx-5 j every 4 hours (R); is of little value in early 
stages; in the later should be combined with Mercury (St); is specific for the 
visceral lesions, especially for syphilitic hepatitis (O). Iodine, as gargle for 
ptyalism; the tincture applied to syphilitic sores of the throat (R); or gss 
of tincture to § iv Syr. Fusci, a teaspoonful well diluted ter die, after meals, 
when Potassium Iodide cannot be borne (St). Iodoform, powdered and 
dusted over ulcers (B); internally as an alterative and analgesic in chronic 
cases, especially for night-pains, was formerly much used (W). 

Belladonna, with Mercurial Ointment, for secondary ulcerations of rec- 
tum (P) ; the tincture 5 iv and 3 ij aquae, a teaspoonful 4 times a day in water, 
instead of mercurials (St). Iron, the Iodide in constitutional syphilis, to 



( 



8 4 4 



TABES MESENTERICA TASTE. 



promote constructive metamorphosis (B); where anemia exists (R); the 
Potassio-Tartrate, gr. xv-xx, every 4 hours, especially in the gangrenous form 
(Otis). Guaiacum, in tertiary syphilis only, or as vehicle for Potassium Io- 
dide and Mercuric Chloride (B). Phenol and Salicylic Acid, locally to syph- 
ilitic abscesses, Phenol is best (B). Sulphur, the natural sulphur waters are 
of very great value in chronic syphilis (Doit). Zinc Chloride, also the Iodide 
and Nitrate, locally to syphilitic ulcers (R). Calcium Phosphate is useful in 
syphilitic gummata (Beneke). Cod-liver Oil, remarkably improves con- 
dition resulting from prolonged use of Mercury and Iodides, the syphiloder- 
mata, and squamae; internally and by inunction (R). Turkish Baths, or wet 
packing, ameliorate and aid the cure of constitutional syphilis (B). Hygiene, 
is of great importance, alcohol should be absolutely prohibited (Bulkley). 
Intraspinal Therapy with the use of salvarsanized serum is of value in neu- 
rosyphilis (see articles on intraspinal therapy and arsenic). [Compare 
Chancre, Condylomata, Psoriasis, Ptyalism, Ulcers.] 



1$. Hydrarg. Iodidi Rubri, gr. iij. 

Potassii Iodidi, 5iij _ vj. 

Tinct. Aurantii Cort., 

Syrup, Aurantii Cort., aa §j. 

Aquae, q. s. ad 5 viij. 

M. Sig. — A teasp. thrice daily after 
meals. (Otis, for the Mixed Treatment.) 

]$. Hydrargyri Chloridi Corros, 

Ammonii Chloridi, aa gr. iij. 

Tinct. Cinchonae Comp., 

Aquae, aa 3 iij. 

M. Sig. — A teasp. thrice daily. Each 5 
contains gr. T V of Corrosive Sublimate. 

(Bumstead.) 



1$. Hydrarg. Iodidi Rubri, gr. ij. 

Ammonii Carbonatis, gr. xx. 

Potassii Iodidi, 3 iij- 

Tinct. Gent. Co.,.. q. s. ad §iv. 
M. Sig. — A teasp. in water after each 

meal. (Fox, for the Mixed Treatment.) 



3$. Potassii Iodidi, 5ij- 

Ammonii Carb., 3ss. 

Tinct. Cinchonae Comp.,.. . . 3iv. 

Glycerini,. . . § j. 

Syr. Aurantii Cort., ojss. 

M. Sig. — A teasp. in plenty of water 
after each meal. (Keyes.) 



Tabes Mesenterica. 

Calcium, the Chloride and Phosphate (R); the former is a powerful 
remedy if kept up (Wa). [See under Scrofulosis.] Iodine, with Cod-liver 
Oil by inunction (El); locally over glands; carefully, lest inflammation be 
increased (R). Potassium Iodide in small repeated doses, valuable (Wa). 
Mercury, Corrosive Sublimate with bark; gr. T V ad 3 i j Tinct. Cinchonae, after 
meals, for chronic glandular disease (D). Phosphates, for malnutrition 
(B) ; (Wa). Iron and Iodine, in various forms are the most useful remedies in 
scrofulosis, but medicine is powerless without strict hygienic measures (A); 
the Iodide or Phosphate of Iron and Cod-liver Oil, as for tubercle elsewhere 
(El). Fel Bovinum, is worthy of trial, though at best a palliative (Wa). 
Cod-liver Oil, is the best remedy to promote assimilation (B) ; of great service 
(R). Chaulmoogra Oil, is of benefit, used by inunction (Wa). Aliment, raw 
meat, cream, chocolate, and cocoa, are valuable nutriments in these cases 
(El) ; peptonized foods are of inestimable value (Wa). Hygiene, change of air, 
especially to sea-air, is all-important (El). [Compare Glandular Affec- 
tions, Scrofulosis, Tuberculous Affections.] 



Taste, Disordered. 

Mercury or Podophyllin, as purgative for cankery taste unconnected with 
alcoholism; or half-glass of pure cold water daily half an hour before breakfast 



TEETH — TEMPERATURE. 845 

(R); I gr. of Gray Powder 3 or 4 times a day will generally remove the dis- 
agreeable taste in the mouth due to dyspepsia, in the course of chronic disease 
or in early convalescence from acute illness (R). Electricity, faradization as 
a stimulant of the nerves in the tongue, may aid the recovery of function 
when loss of taste is due to nerve disease (Gowers). 

Teeth. 

Potassium Iodide, in doses of gr. x, thrice daily, often cures looseness of 
teeth from periostitis of alveolar process (Wa). Iodine, the tincture painted 
over gums close to the teeth when the gums begin to recede; also to remove 
tartar (R). Cinchona, powdered bark often used in tooth-powders (R). 
Collodion, on cotton, as filling for carious teeth (P) . Liquor Sodae Chlorinatae, 
5 vj ad 3xij aquae, a highly useful application in fetid discharges from carious 
teeth (Wa). Cotarnine, the Hydrochloride locally will promptly stop a 
dental hemorrhage after extraction (Jahl); arrests the flow of blood (Marcus). 
Ichthyol in 25 per cent, solution on cotton as a tampon, effectually checks 
hemorrhage after extraction (Floris). Mastiche is used as a temporary filling 
for carious teeth. Alum should not be used as a mouth-wash, as it acts 
destructively on the teeth (W). Salicylates are very efficient in certain 
teeth troubles occurring in gouty subjects, as periostitis or other inflamma- 
tion of the pulp or surroundings of a tooth (Haig). Emetin is useful as an 
amebacide in pyorrhea alveolaris. The correct use of the tooth brush is of 
first importance in the hygiene of the mouth and the preservation of the teeth. 
[Compare Dentition, Gums, Odontalgia.] 

Temperature in Disease. 

Average Normal Temperature, of adults, 98. 6° F.; of children, 99 ; of the 
aged, 98. 8°. Diurnal variation i° to 1.5 F., highest from 9 a. m. to 2 p. m. 
Above 108 F. is a fatal sign, which issue may be averted by cold baths, 
reduced by ice from 96 to about 6o° F. (A). The clinical thermometer placed 
in the mouth, axilla or rectum, and retained in situ for five minutes, should go 
hand in hand with Aconite in the treatment of inflammations (R). [For 
Antipyretics see the articles on Fever and Inflammation.] 

Clinical Thermometry is the principal means of positive diagnosis. The 
thermometer should be self-registering, certified, and accurately marked ac- 
cording to the Fahrenheit scale, to which scale all the temperatures mentioned 
in this article refer. The most reliable temperature is that in the rectum or 
vagina; less so in the axilla and folds of skin, and still less reliable in the 
mouth. A correct reading of the ordinary thermometer cannot be obtained 
in less time than five to seven minutes (Da Costa); but quicker-reading in- 
struments may be obtained from the trade. 

The Average Normal Temperature of the body is 98. 6°, and, like the pulse, 
will vary somewhat in individual cases ; as a general practical result it is agreed 
that in temperate regions the normal temperature at completely sheltered 
parts of the surface of the human body amounts to 98. 4 Fahr., or a few tenths 
more or less; and a rising above 99. 5 , or a depression below 97. 3 F., is a sure 
indication of some kind of disease, if the increase or depression is persistent. 
The temperature is increased at the prime of life, is raised and depressed 
temporarily by the influence of diet, stimulants, exercise, etc. The minimum 



846 TEMPERATURE IN DISEASE. 

diurnal temperature is observed at 2 a. m., the maximum at 4 to 6 p. m. 
The greatest recorded range of temperature in disease is 50.4 ; the minimum 
is 7 1. 6° in a case of sclerema neonatorum (Quain's Diet.), the maximum 122 . 
In severe and fatal cases it rarely exceeds 107 , and rarely falls below 92 , even 
in fatal collapse. It may rise 3 to 4 after death, as observed in a case of 
typhoid fever in which death occurred with a temperature of 107 , which in- 
creased shortly afterwards to no.5 . A temperature of 107 indicates 
malignancy, and when met with for two consecutive days in typhus, scarla- 
tina, measles,, pneumonia, pyemia, meningitis or rheumatism, death may be 
expected shortly. In relapsing, remittent and intermittent fevers, and in the 
initial chill of an abortion, the temperature may reach 107 without indicating 
great danger. During the last hours of life in many diseases, the temperature 
rises to ioq -iii°; for example, in tetanus, sunstroke, and typhus. With a 
temperature of 96 collapse is imminent! 

Abnormally High Temperatures reported in the British Medical Journal, 
by Dr. Donkin, include those of eight cases, all but one in females, and 
none proved fatal. Pain was a prominent symptom in all. (1) in. 6°; 
convalescing from enteric fever. (2) 108 ; no organic lesions; ovarian pain. 
(3) 115. 8°; great abdominal pain and excitement. (4) in°; convalescing 
from enteric fever. (5) 113 ; enteric fever and double pneumonia. (6) 
112 ; synovitis, this was the only male. (7) 112 ; painful stump, with 
necrosis. (8) 117 ; pyonephrosis. Dr. Jacobi of New York reported a 
case of injury in which the temperature taken in the mouth, axillae, rectum 
and urethra, before many witnesses and with many thermometers, was 
148 F. and yet the patient did not die. Dr. Welch mentioned as a well- 
known case, one Galbraith of Omaha, in whom the temperature went to 
17 1 ° F. for some hours. 

High Average Temperature (above 104 ), is found in severe pneumonia, 
scarlatina, remittent, typhus, typhoid and relapsing fevers, pyemia, etc. 
Moderate High Temperature (102 and above) is seen in peritonitis, acute 
rheumatism, pericarditis, pleurisy, dysentery, cerebro-spinal meningitis, ca- 
tarrhs, etc. A temperature of ioo° and above is found in chronic affections, 
incipient inflammations and mild fevers. When, in effervescence, the heat in- 
creases rapidly, it will in defervescence decline proportionately fast and vice 
versa. Look for a grave affection when high temperature is continuous. A 
distinct interval between the morning and evening temperature is a favorable 
sign. A slow and gradual increase indicates typhoid fever; in rheumatism 
and anomalous fevers the increase is more rapid, and still more so in acute 
inflammatory disease, as pneumonia, pleurisy, typhus, scarlatina, rubeola, 
etc. The rise is usually rapid in intermittent fever, febricula, and ephe- 
meral fevers. A rapid effervescence and slow defervescence indicates some 
complication of disease; the reverse order indicates great danger. When the 
temperature begins to fall from the evening to the morning, it is an indication 
of improvement; while a rise of temperature from the evening to the morning 
is an indication that the patient is worse. Stability of temperature from 
morning to evening is a good sign, but from evening to the morning is 
unfavorable. 

Decrease of Temperature below the normal point is rare. It occurs 
sometimes transitorily, announcing a favorable crisis, and preceding return 
to the normal temperature. It is also met with occasionally during the morn- 
ing remission of remittent fever; also during the apyrexia of intermittents; 



TESTICLES — TETANUS. 847 

in acute collapse, preceded or not by fever, in chronic wasting diseases, and 
sometimes also on the approach of death, especially in typhus fever. 

In Phthisis, the temperature is higher in the evening than in the morning ; 
later, higher at early bedtime than at noon, and high again at dusk. This is 
a valuable and delicate test of the progress of tuberculization. 

In Typhoid Fever, the accession is by a rise of one degree each day, with 
the diurnal variation. If the evening temperature does not exceed 103. 5 , 
the disease will probably be mild; but a temperature of 105 in the evening 
indicates a severe type and much danger. A sudden reduction to 95 in the 
third week denotes intestinal hemorrhage; a lingering temperature of 101 - 
102 in the fourth and fifth weeks indicates non-cicatrization of the intestinal 
ulceration. 

In Scarlatina, the rise of temperature is rapid, 104. 7 may be reached in a 
few hours and 105 by the second day. It seldom rises above 105 and almost 
never above 106 ; is continuous until the eruption begins to fade, when re- 
missions take place unless complications arise. 

In Measles, 103 is the usual temperature, with daily variations increasing 
with the eruption and catarrhal symptoms. A high temperature lasting 
beyond the tenth day denotes complications. 

In Diphtheria, the temperature by the end of the third day, in uncompli- 
cated cases, will not exceed io3°-io4°. It falls temporarily when the exuda- 
tion appears. Defervescence occurs in the severe but favorable cases, from 
the twelfth to the fourteenth day; in the milder cases not before the sixth. 
In some fatal cases it occurs early, from the third to the fourth day. In 
asthenic cases the temperature of the surface falls, while that of the interior 
remains high, ioo° in the axilla and 103 in the rectum. During convales- 
cence, the temperature is low and readily depressed, but may be raised by 
intercurrent maladies. Any increase after the first five days, or a continuous 
high temperature after the first ten days, is unfavorable. A sudden rise may 
indicate complications. . 

Co-Relation of Pulse and Temperature. — As a general rule the co-relation 
of pulse and temperature may be stated as follows, namely: — an increase of 
temperature of one degree above 98 F. corresponds with an increase of ten 
beats of the pulse per minute. This co-relation does not hold good in yellow 
fever after the first two or three days; the temperature remaining high, while 
the pulse declines, often to 50 or even 40 beats per minute. 

Testicles. 

Mercury, the ointment, locally in indurations and enlargements of testes 
(Wa). Camphorated Naphthol, used hypodermically in tuberculosis of the 
testis with very gratifying results (Reboul). Water, cold applications in 
neuralgia of testes with tonics and neuralgic treatment generally (D). 
Suspensory Bandage, with rest, in many affections of the testes (D). Potas- 
sium Bromide, Belladonna, and some other drugs, long continued, have been 
followed by atrophy of the testes (Hirsch). [Compare Epididymitis, 
Hydrocele, Orchitis, Varicocele.] 

Tetanus. 

Phenol used by parenchymatous injection, is fully as efficient as the serum 
treatment (Babes); used in 40 cases with one death (Bacelli); in 33 cases with 
one death (Ascoli); in 42 cases with 16 deaths (Symmers); in doses of 1 mil of 



848 TETANUS. 

a 4 to 5 per cent, solution hypodermically 3 to 5 times daily given to a bad 
case not seen until 20 days after injury and infection, a Chinese boy of 13 
years, with recovery after 103 injections (Phillips). Chloretone, 40 to 120 
grains daily in olive oil per rectum, used in 6 cases with 1 death, is the best 
remedy hitherto employed (Hutchings). Chloral, in full doses, gr. xx, no 
remedy more effectual (B); has sometimes cured (R); best used in combina- 
tion with Potassium Bromide (W). Chloroform, in small and frequently re- 
peated inhalations, also by friction, has been useful in many instances (Wa); 
anesthetics give temporary relief (B); four cases of acute tetanus treated 
successfully by chloroform inhalations, the daily dose varying from 3 ij to iv 
(Preobrajensky). Magnesium Sulphate, 1 to 4 mils of a 25 per cent, solution, 
by intraspinal injection, abolishes fhe convulsions and tides the patient over 
until the antitoxins overtake the balance of free toxins, 10 cases treated with 
mortality of 30 per cent. (Wilcox); is the most effectual of all treatment, 
producing complete relaxation lasting for 24 hours, used in 24 cases with 
serum and hypnotics, with mortality of 46 per cent. (Fox); n cases treated 
with mortality of 55 per cent. (Miller); by spinal injection, in doses which do 
not affect the respiratory centre or other vital functions, is capable of abolish- 
ing completely all clonic convulsions and tonic contractions incases of human 
tetanus (Meltzer). Curare, hypodermically, has much evidence for its power 
(P). Cannabis, used with marked success in traumatic form (P); should be 
used to intoxication, which is not dangerous (W). Antipyrine is worthy of 
trial, especially when hyperpyrexia (W) ; it antagonizes excitability of the motor 
nerve centers, and has been used with benefit. Aconite, has benefited many 
cases (P); its success warrants further trial (W). Creosote in large doses 
hypodermically, gave good results in a traumatic case, after antitoxin and 
phenol had failed (Higginson) . Potassium Bromide is one of the best suited 
remedies, as indicated by its physiological action, not less than § ss should be 
given in the day and Chloral at night as a hypnotic; used in 34 cases with but 
4 deaths (W); in largQ doses, § j every 3 or 4 hours, has given better results 
than any other remedy (B). Paraldehyde in full doses, 5ij> promises well, 
does not depress the heart, as chloral and the bromides do (B). Morphine, 
given to its full influence, in order to control the spasms (O) ; hypodermically, 
deeply into tetanized muscles, and if possible to the point of entrance of the 
nerves, used with successful results (Demarquay) ; as ordinarily used it is of 
no value (Wa). Apomorphine may prove antagonistic (P). Cocaine and 
Morphine, of each a 5 per cent, solution, 3 syringesful hypodermically, im- 
mediately relieved and finally cured a bad case of idiopathic tetanus unrelieved 
for 3 days by chloral, morphine, etc. (Lopez). Eucaine gr. T V and Morphine 
gr. T V injected into the spinal canal after aspiration of the fluid, aspiration and 
injection repeated daily for 3 days, then twice more at intervals of 3 days, 
cured a very severe case of traumatic tetanus in a child of 8 years (J. B. 
Murphy) . Belladonna, successfully used in many cases ; the extract internally, 
and locally to wound (Wa); Atropine, gr. T ^g injected into muscle (B) ; bleed- 
ing, vapor-baths, and large doses of Belladonna have cured tetanus (Tr) . Hy- 
oscyamine, also Duboisine, in gradually increasing doses, have proved very 
efficient (Oulmont). Amyl Nitrite, a valuable remedy, given hypodermically 
to allay the spasm which threatens immediate death, but too fugacious for 
constant use (W); has been used with success (R). Gelsemium, has cured 
several cases (P); its spinal action is opposed to that of tetanus (B). Cam- 
phor is strongly indicated, as it causes both nervous sedation and cardiac 



THIRST — THROAT, SORE. 849 

stimulation (Bacelli). Antitoxin is advisable when the case is seen early, since 
it need not interfere with other methods of treatment, and there is much evi- 
dence of its value as a prophylactic (W); has been disappointing after the 
disease has once developed (O); in 226 reported cases the mortality under 
antitoxin treatment was 37 per cent., in those treated by other methods 36 
per cent. (Goodrich). Antitoxin with other measures in 22 cases gave a mor- 
tality of 45I per cent., against 89 per cent., in 18 cases treated otherwise 
(Fricker). Absolute Quiet in a darkened room is essential, all possible 
sources of irritation should be guarded against (O) . Excision and local anti- 
septic treatment should be carried out (O). Water as warm baths, also cold 
applications as ice, afford temporary amelioration (B); the spinal ice-bag is 
very useful (R). Cold by placing the patient in a cold-storage room at 
freezing-point for several days, cured a severe case in a boy of 10 years 
(McGrann). Division, or stretching of any nerve-trunk connecting the 
wound with spinal cord. [Compare Spasmodic Affections, Trismus.] 

Thirst. 

Acid Drinks, allay thirst by promoting the secretion of the alkaline saliva; 
but excessively used will derange the stomach (R) ; Citric Acid with Sodium 
Bicarbonate and flavoring substances, form the thirst tabloids of certain 
English druggists. Bitters, in drinks with acids slake thirst most effectually 
(R); a weak infusion of Cascarilla or Orange-peel, acidulated slightly with 
HC1 acid, an efficient thirst- quelling drink for fever patients (Graves). Ice, 
sucked, is very grateful, and allays thirst in fevers (R). Tepid Drinks, are 
useful in the thirst of diabetes (Prout). Fruit Juices, or these made into 
drinks, but the most harmless agents must be used in moderation, and their 
consumption has to be checked, otherwise patients will take them to excess 
and may thus do themselves considerable injury (Fenwick). 

Throat, Sore. 

Acacia dissolved in the mouth is soothing in acute inflammations (W). 
Aconite, when temperature high, half-drop doses of the tincture, every J 
hour for 2 hours, then every hour, will almost certainly prove efficacious (R) ; 
valuable in ordinary sore throat (P). Belladonna, is admirably adapted to 
the treatment of ordinary sore throat; when much fever combine with 
Aconite (R). Potassium Nitrate dissolved in the mouth, to abort a sore 
throat (Wa). Tannic Acid, as powder, gargle, spray (P); the Glycerite of 
Tannin, after acute inflammation; in ulceration of aphthous sore throat daily 
when tendency to catarrh (R). Ipecacuanha, the wine as spray, in non- 
inflammatory sore throats and hoarseness from congestion of vocal cords 
(R). Capsicum, 3 J of tincture to 0| aquae as gargle, in some sore and malig- 
nant sore throats (R, P). Potassium Chlorate, in grain doses every half- 
hour (Smith); is valuable locally in sore throat (Mastin). Chlorine, the 
Water as a disinfectant gargle in violent infections (W). Phenol, a con- 
centrated solution in glycerin applied carefully with a pencil or mop in 
ulcerated sore throat (W). Sumach, the berries make an excellent astringent 
gargle (W). Alum dry or in solution (R) ; should not be used in the mouth as 
it is destructive to the teeth (W). Myrrh, the tincture as a gargle for ulcer- 
ated sore throat (P). Salicylates do good in rheumatic angina and quinsy 
54 



8 5 o 



TIC DOULOUREUX. 



(W). Ichthyol in 2 or 3 per cent, solution as a gargle for inflammations of 
the throat (Herz) ; in 40 cases of ordinary sore throat removed symptoms in 
24 hours (Sonnenberg). Hydrogen Dioxide as a disinfectant and deodorant 
gargle in various affections of the throat and mouth (Courtin). Guaiac, the 
compound guaiac gargle is often very efficient in simple sore throat and com- 
mencing tonsillitis. Chloral, internally and locally, is an excellent remedy 
for ulcerated sore throat (Brodnax). Cimicifuga, in simple sore throat (P); 
also in malignant forms when the mucous membrane is dry and spotted with 
inspissated mucus (R). Mercury, in acute tonsillitis, which see (R); the 
Bichloride as a gargle [formula below], in ulcerated forms of syphilitic sore 
throat (Sir Chas. Bell); the perchloride, 30 to 60 minims of the liquor in 
mixture with Sodium Salicylate, is almost specific in many cases of tonsillar 
sore throat (Mackay). Rhus Glabra, a decoction, 5j to Oj boiled to Oj, 
with Potassium Chlorate §ss, is a very efficient gargle (W). Arsenic, in 
medicinal doses, for sloughing of throat or malignant sores (R); the Iodide 
is an excellent remedy for the so-called diphtheritic sore throat, gr. iij trit- 
urated with gr. xx of sugar of milk, one-half of which is dissolved in 5 iv of 
water, and a teasp. given every hour or so. Methylene Blue, in simple non- 
diphtheritic ulceration of the throat, patients have expressed themselves 
with delight as being cured, after one or two applications of the solution 
(Rose). Iodine, the tincture, locally to sores, whether syphilitic or not (R). 
Nitric Acid, undiluted to sloughs (R). Silver Nitrate, locally, in early stage 
of inflammation, may cut it short (R) ; is sedative, astringent, and germicidal 
(W). Thymol makes an agreeable antiseptic application (W). Sulphurous 
Acid, by inhalation, spray, or fumigations for malignant sore throat, scarla- 
tinal or otherwise (R). Water, cold compress nightly, to harden the throat 
when tendency to catarrh (R). Ice, constantly sucked (R). [Compare 
Diphtheria, Laryngitis, Pharyngitis, Tonsillitis.] 



]$. Tinct. Guaiaci Ammon., 

Liq. Potassii Hydroxidi,. . .aa 5iij. 

Tinct. Opii,.... 5ij : . # 

Aq. Cinnamomi, q. s. ad 5 y iij- 

M. ft. gargarisma. 

Sig. — To be used as a gargle, every hour, 
in clerygman's sore throat. {Garner.) 



]$. Hydrarg. Chlor. Corros., gr. iv. 

Alcoholis, gij. 

Solve, et adde — 

Decocti Cinchonae, Mellis Rosae, 

Tinct. Myrrhae, aa gij. 

M. ft. gargarisma. Sig. — Gargle, to be 
diluted if too severe. (Sir Chas. Bell.) 



Tic Douloureux. 



Croton-chloral, has special effect on the 5th nerve (B); is palliative in 
doses of gr. v every i hour till gr. xxx are taken (W). Salicylates, in large 
doses, cured a case of 1 2 years' standing. Stramonium, gr. J to J of the ex- 
tract every 3 or 4 hours for 4 or 5 doses, often affords decided relief; stop if 
narcotic symptoms appear (P). Arsenic, cures by influencing nutrition (B). 
Phosphorus, is useful in doses of gr. t ^q to gr. T V every 3 hours (R). Mor- 
phine, with Atropine, hypodermically, gives relief (B). Aconitine, has lately 
been given with good results (B). Cannabis, gr. f to J rarely gr. j, of a good 
extract, is very effective and ranks in value next to morphine and atropine 
(Reynolds). Physostigma, a few drops of a solution of the extract, 1 in 30, 
or one or more gelatine discs of Physostigmine introduced within the eyelids 
of the affected side, effectively relieved or cured several cases (Munro). 
Antipyrine, and Acetanilide, are sufficiently analgesic to relieve pain in many 
cases. Iodides, are promptly curative when tic is due to syphiloma of the 



TINEA — TONGUE. 85 1 

nervous system, the pain being nocturnal chiefly (B). Cimicifuga, is fre- 
quently very effective (B). Turpentine, when rheumatic in origin or pro- 
duced by fecal accumulations (B). Quinine, holds a foremost place in the 
list of remedies (Wa). Gelsemium has strong evidence in favor of its value 
(W). Ammonium Chloride, in doses of 30 grains 4 times daily, is of great 
service in numerous cases, especially when the pain partakes more of a rheu- 
matic than of a neuralgic character (Sir Thos. Watson). Nitroglycerin in 
large doses, should be tried in the minor form of trigeminal neuralgia (O). 
Alcohol is a valuable though dangerous remedy, and should not be ordered 
for women (O) ; 2 mils of 90 per cent, alcohol with 4 grains of Cocaine to the 
5 by deep injection, not to the superior branch on account of the danger, is 
the method with which I have had almost unfailing success (Weisenberg). 
Chloroform, the liniment applied with friction is sometimes serviceable 
(Wa); a few drops by deep injection in the vicinity of the nerve trunk (B). 
Galvanization of the fifth nerve, gives decided relief to the pain, and fre- 
quently results in permanent cures in cases which belong to the category of 
the so-called essential neuralgiae (B). Extirpation of the Gasserian ganglion, 
must be contemplated in severe cases (O). Diet, a strict vegetable diet in 
gouty cases, with outdoor life and plenty of exercise (O). [Compare Hemi- 
crania Neuralgia, Neuritis, Odontalgia.] 



]$. Croton-chlorali, 3 j- 

Pone in capsulas no xx. Sig. — One cap- 
sule every two hours until the pain is re- 



Potassii Iodidi, 5iv. 

Phenylis Salicylatis, 5ij- 

M. — Fiant tabellae vel capsulae no. xxiv. 



lieved. | Sig. — One after each meal. 

Tinea Circinata (See Ringworm of the Body). 

Tinea Favosa— (See Favus). 

Tinea Versicolor — Pityriasis Versicolor. 

As a rule, this an extremely simple condition to treat, it being necessary, 
however, that all clothing should be boiled and the treatment kept up 
for a week or two after the eruption has apparently disappeared, because 
the spores are very difficult to kill and the few remaining may cause a recur- 
rence. The treatment consists in daily bathing with hot water and soap and 
vigorous scrubbing with a brush, after which Sodium Hyposulphite, 1 drachm to 
the ounce of water is applied to the skin. This is usually all that is necessary 
to effect a cure. Chrysarobin, 20 grains to the ounce of Chloroform painted 
over small areas will completely destroy the fungus. Mercuric Chloride, 1 
or 2 grains to the ounce of water, is recommended. Sulphur, 5 to 10 per cent., 
in the form of an ointment or incorporated in soap, is at times valuable. 
Tincture of Chloride of Iron painted over one or more small lesions will have 
the same effect as Chrysarobin. 

Tongue. 

Potassium Chlorate, gr v. internally and 3HJ ad Oj aquae locally; in 
ulcers of tongue (Wa); also for rawness of tongue in advanced phthisis. 
Potassium Iodide, in syphilitic ulcers of tongue (D); and in hypertrophy 



852 TONSILLITIS. 

(A). Potassium Bromide, 5 3 to gvj water as wash, may soothe morbid 
sensibility of the tongue (A). Borax, Sodii Boratis gr. xl, Glycerini 5j, 
Aquae 3iv, as application in cracked tongue (Wa). Iodine, the tincture 
locally by a fine brush, or as a gargle with 7 or 10 parts of water and some 
honey, has given uniform success in malignant ulcers (Wa). Aurum, in- 
ternally and locally, has cured hypertrophy of the tongue with induration 
thereof in scrofulous subjects, also strumous ulceration of the tongue. Con- 
ium, is thought to act specifically with benefit in ulcer of the tongue (Wa). 
Cinnamon, the oil as a powerful stimulant in paralysis of tongue (P). 
Ginger, Cochlearia, Pyrethrum, as gargles. Cloves, Mezereon, Pepper, 
as masticatories, in paralysis (P). Frenum, should be divided in tongue-tie; 
use blunt-pointed scissors, directing the points down close to the jaw, so as 
to avoid wounding the ranine artery (D) ; better to cut as little as possible, 
and directly backwards, as the artery of the frenum may proceed from the 
sublingual (Holmes). [Compare Glossitis.] 

Tonsillitis. 

Aconite, when high fever and elevated arterial tension, relieves greatly, 
gtt. ss-j of tincture every I hour or hour (B); every J hour for 2 hours, then every 
hour, will almost certainly prove efficacious (R) . Ammonium Benzoate, large 
doses in whisky every 2 hours, the best treatment (Seiler) ; checks the disease 
within 24 to 36 hours (Coston). Aspirin, in fine powder, applied by rubbing 
the tonsil with cotton application, after a detergent gargle or swabbing with 
Sodium Bicarbonate solution (1 to 30), and repeated every 12 hours for 3 to 4 
applications, is very successful treatment of acute follicular tonsillitis 
(Kieffer); used in 24 cases with marked and prompt relief (Fetterolf); Sali- 
cylates are often serviceable in rheumatic angina, and in quinsy (W). Bella- 
donna, of surprising efficacy, gtt. v of tinct. every 3 hours in § ss aquae (P). 
Mercury, often speedily removes; Calomel, gr. -fa, or Hydr. cum Creta, gr. 
J every 2 hours; not in chronic forms (B); gr. J of Gray Powder every hour 
when tonsils almost meet, has marked effect; the Oleate of Mercury and Mor- 
phine in obstinate and painful tonsillitis (R); the Perchloride 30 to 60 minims 
of the liquor in mixture with Sodium Salicylate every 4 hours, has almost 
specific action in many cases of tonsillar sore throat (Mackay) ; the Succini- 
mide, one injection intramuscularly cured 9 cases of acute follicular tonsillitis 
in from 24 to 36 hours, and one case in 48 hours, without any local or other sys- 
temic treatment (Wright), Iodine, the tincture applied by mop is an excel-, 
lent application (Woodbury). Silver Nitrate, locally may abort, if applied 
early (R) ; the solid stick, once thorougly applied in the first stage, rarely fails 
to prevent suppuration (Howard). Guaiac, disagreeable, but very effective 
(P); §ss doses of tincture every 4 hours has remarkable power; should be 
given in emulsion with mucilage or yolk of an egg (B); makes an excellent 
gargle, the tincture of Guaiac and glycerin, equal parts, in 3 doses every hour 
or two, gives excellent results in acute tonsillitis. Opium as Dover's powder, 
gr. v-x at bedtime, is curative in many cases (Shoemaker). Cocaine in 10 
per cent, solution, locally, at intervals of 15 minutes, removes pain at once 
and promotes resolution; a very efficient application in 5 to 10 per cent, solu- 
tion, but causes temporary paralysis of palatal muscles, so that liquids re- 
gurgitate through the nose (Boeckel); a strong solution painted freely over 
the affected tonsil in cases which commence on one side of the fauces, will 



TONSILS. 



853 



cut short the attack in most cases and prevent suppuration. Tannic Acid 
as an astringent gargle is useful (P). Hydrogen Dioxide, the solution is 
used as a gargle with great benefit. Quinine in a dose of gr. x-xv, will 
sometimes abort the disease (B). Capsicum in powder applied on a swab, or 
the diluted tincture in a gargle, is useful in severe tonsillitis, especially that 
accompanying scarlet fever (W). Sodium Bicarbonate locally by a wet 
swab or ringer to the surface of the tonsils every five minutes for half an hour, 
then every hour during the same day, will often prevent a tonsillar abscess. 
Emetics, at the very onset of the disorder, will sometimes succeed in cutting 
it short (Sir Thomas Watson). Potassium Chlorate internally is valuable 
(Kerley) ; in grain doses every half -hour is very efficient (Smith). Potassium 
Iodide in solution locally, gr. j-v to the § , is useful (B). Picratol in 2 per 
cent, glycerin solution, applied' by a swab, is very efficient (Yale). Ichthyol 
in 30 per cent, aqueous solution as a paint, applied twice daily after cleansing 
with an alkaline solution (Kyle); will abort abscess of the tonsil (Unna). 
Antiseptics may be used with benefit at the beginning, but should be avoided 
when the disease is fairly under way," as they check the establishment of 
immunity (Goodale). Streptococcic Serum, a polyvalent serum is used with 
great benefit (Menzer). Rest, complete local and general rest is essential 
(Goodale). Water as ice and wet pack around the neck, extremely grateful 
(B) ; a cold wet compress covered with oiled silk and a dry bandage to the neck 
at night, is very serviceable. Scarification of the tonsils gives immediate and 
marked relief in all cases, especially those which are not amenable to ordinary 
treatment; if done early the patient may be spared several days of suffering 
(O). [Compare Pharyngitis, Throat, sore.] 



1^. Tinct. Aconiti, 5ss. 

Tinct. Guaiaci, 

Syr. Zingiberis, aa gss. 

Syr. Simplicis, 5 ij- 

M. Sig. — 5 ss— ij every 2 hours, accord- 
ing to age. In severe cases, with high fever, 
bounding pulse, headache. {Shoemaker.) 



T$. Tinct. Aconiti, 5 j. 

Sodii Salicylatis, 5jss. 

Spt. ^Etheris Nitrosi, §ss. 

Syr. Aurantii Flor., ........ 5 j. 

Aquae Destil., q. s. ad 5iv- 

M. Sig. — A teaspoonful every hour or 
two, early in the acute stage. 



Tonsils, Enlarged. 

Ammonium Iodide, 5 ss in 5 j of glycerin, applied every night by a camel's- 
hair brush, very efficacious (Wa). Liquor Ferri Chloridi, diluted, 3HJ 
to the § , painted over tonsils twice daily, is one of the most effective astrin- 
gents (Mackenzie) ; the syrup of the Iodide of Iron is a good tonic for strumous 
children with enlarged tonsils. Aluminum Sulphate, a saturated solution 
applied daily by a brush, as a mild caustic (W). Zinc Chloride, as caus- 
tic, the most efficient and least annoying method; a saturated solution applied 
on a wire cotton-holder to each crypt and held there a few seconds ; a few appli- 
cations will shrink the gland in a week. Tannin, a strong solution touched 
daily to tonsils (H); a few sips of a saturated solution, § ss in §iij aquae, 
slowly sipped, will stop bleeding, if profuse (A); gr. xx to 5 j aquae, hypo- 
dermically, as in nasal polypus. Silver Nitrate touched daily to tonsils, will 
sometimes make them shrink (H). Catechu, a serviceable astringent gargle; 
the infusion 5vj with tincture of Kino 5ij> as gargle (Wa). Citric Acid, 
rubbed daily to the tonsils, is highly praised in enlargement thereof. Ex- 
cision of the tonsil (H). Surgical measures should receive unprejudiced 
consideration, as the medical treatment is tedious in the extreme. 



854 TONSILS — TORTICOLLIS — TOXEMIA. 



fy Tinct. Iodi, 5j. 

Glyceriti Ac. Tannici, §j- 

M. Sig. — Apply to the tonsils with a 
swab night and morning. 



1$. Syr. Ferri Iodidi, ojss. 

Syr. Aurantii Flor., g jss. 

Aquae, q. s. ad giv. 

M. Sig. — A teasp. after each meal. 



Tonsils, Ulcerated. 

Potassium Chlorate internally, Silver Nitrate locally, and the use of 
antiseptic mouth-washes, as for ulcerative stomatitis, in the ulcero-membra- 
nous tonsillitis caused by Vincent's bacillus (Ruhrah). Sulphurous Acid, 
dilute, locally by spray, or a solution of Sodium Sulphite 3j in water § j (B). 
Potassium Iodide, will arrest syphilitic ulcerations at once (B). Phenol, in 
a 5 per cent, wash with tincture of Myrrh, a good application by sponge to 
throat (Wa). Cimicifuga, a decoction of the root as a gargle (Wa). [Com- 
pare Ulcers.] 

Torticollis. 

Atropine relaxes spasm and has been especially useful in rheumatic torti- 
collis (W) ; hypodermically into the affected muscle in increasing doses until 
the limit is reached, which is sometimes as much as gr. J (Leszynsky); used 
successfully in spasmodic torticollis, up to gr. ¥ V (Potts). Guaiacol, a few 
drops rubbed in gently, immediately relieves the pain (Brodnax). Cimici- 
fuga, has curative efficacy (P). Potassium Bromide, in large doses with 
Arsenic, may always be tried in the spasmodic form, which is sometimes one 
of the most obstinate complaints (Whitla). Gelsemium, some cases have 
been reported as cured by its hypodermic administration after tenotomy or 
myotomy had failed (Id); very large doses, Tfl.iij of Wyeth's fluidextract 
thrice daily, increased until eight times this amount is taken, so as to produce 
very pronounced physiological symptoms, in spasmodic torticollis (Weir 
Mitchell). Morphine, hypodermically, has been successful in some cases, 
but there is great danger of establishing the habit (O). Opium as liniment 
with friction, or as plaster, is often serviceable (Wa). Drugs are rarely used 
with benefit, a temporary relief is sometimes obtained, but a permanent cure 
is exceptional (O). Electricity, galvanization of the affected muscles and 
faradization of the opposed ones, quickly relieves (B); has given excellent 
results in spasmodic torticollis, and if resorted to early may succeed, but 
must be persisted in for some time (Whitla). Surgical Treatment, by 
stretching or resection of a portion of the spinal accessory nerve, has suc- 
ceeded sometimes in spasmodic torticollis, but it has also failed, and being 
so unsatisfactory should not be tried except as a last resort (Id) ; resection of 
the posterior branches of the upper cervical nerves is most likely to give 
relief (Risien Russell); temporary relief may follow surgical measures, but 
as a rule the condition returns (O). 

Toxemia. 

Elimination of toxins the only resource, by stimulating action of skin, 
kidneys, and bowels; abundance of water to promote the flow of urine, saline 
infusion acts helpfully in this way, saline laxatives to keep the bowels open 
(O) ; sweating by the Turkish bath or the hot pack. Hypodermoclysis aids 
the elimination of toxic products by the kidneys (Kemp); saline injections 






TREMOR — TRICHINIASIS. 855 

hypodermically and intravenously, are used successfully in various forms of 
toxemia. If the patient is robust and his condition sthenic, with venous in- 
fusion on one side may be conjoined venesection upon the other. The 
object is to hasten the dilution and elimination of the poison, both directly 
and through the skin and the kidneys particularly. The results are good in 
a certain proportion of cases and sometimes extraordinary, while the pro- 
cedure is practically harmless. Procotoclysis, the administration of salt 
solution by the drop method is of the greatest value in the lessening of toxe- 
mia. It also increases the activity of the eliminative organs, especially the 
kidneys. [Compare Septicemia, Shock, Uremia.] 

Tremor. 

Hyoscyamus, the tincture in full doses will palliate mercurial tremor; or 
Hyoscyamine, gr. -^ gradually increased to T V CB). Hyoscine, is a useful 
drug in diseases having tremor as a marked symptom, as disseminated sclero- 
sis, delirium tremens, and is usually safe (Weatherly); quiets the tremor of 
paralysis agitans and chorea, also senile trembling (Robin). Conium con- 
trols excessive tremor temporarily; has been used in chorea and paralysis 
agitans (W). Gelsemium in full doses; or a combination of Hyoscyamus, 
Conium and Gelsemium, the first to keep the brain quiet, the latter to quiet 
the nervous irritation at both the central and peripheral extremities (Lavers). 
Sparteine, gr. J-gr. ss, thrice daily, is of value (Potts). Chloral depresses 
the motor tract of the cord and is a valuable remedy for tremor. Cocaine 
influences alcoholic and senile tremor more favorably than any other remedy; 
large doses and frequent .administration are unnecessary (B). Veratrine, 
has been used successfully in alcoholic tremor. and that of disseminated scler- 
osis, also in the trembling weakness of typhoid fever (Ferris). Calcium Salts, 
were given by me in one case of tremor at the beginning of general paralysis, 
resulting in its cessation for several months (Br). Arsenic, TlUj-iij of 
Fowler's solution, diluted with two parts of water and given hypodermically, 
was successful in several case (Eulenberg). Phosphorus, in alcoholic and 
mercurial tremor (De Mussy). Silver Nitrate, gr. f-iij daily, used in six 
cases of mercurial palsy with fairly rapid recovery (Sementini). Zinc Phos- 
phide, is effective in the tremor of mercurial and arsenical poisoning (De 
Mussy); not so in the tremor of sclerosis (P). Parathyroid Gland may be of 
service as it causes tremor in animals; has done good service in paralysis 
agitans (Berkeley). [Compare Chorea, Delirium tremens, Paralysis 
agitans.] 

Trichiniasis. 

Benzol, in doses of Tfl.x, every hour or two, up to 5jss daily, followed by 
a brisk laxative, was very successful in 27 cases, treated simultaneously 
(Putter). Purgatives as Rhubarb and Senna, or an occasional dose of Calo- 
mel, to thoroughly evacuate the gastro-intestinal canal. Ammonium Picrate 
is said to be an efficient remedy (W) ; experiments show that it has no effect 
on the trichinae (Erb). Glycerin in large doses, to destroy the worm by its 
hygroscopic qualities, has been recommended. The indications, in the stage 
invasion, are to relieve the pains, to secure sleep, to combat the fever, and 
to support the patient's strength; there are no medicines which have any 
influence upon the embryos in their migration through the muscles (O). 



I 



856 TRISMUS — TUMORS. 

Trismus. 

Chloral is valuable in trismus neonatorum, gr. j-ij by the mouth or double 
that amount by the rectum, to a young babe (W). Chloral and Bromides, 
either alone or in combination, are the remedies most used (Ruhrah). Potas- 
sium Bromide, gr. iij-v or more, every 2 or 3 hours, reducing the dose as 
improvement takes place (Id). Physostigma, the extract hypodermically,- 
may be given in doses of gr. r ^ (Id) ; has been used, but with no more encour- 
aging results than in tetanus (W). Atropine hypodermically, has been used 
with benefit (R). Opium in doses of nl| of the tincture, with castor oil and 
a warm bath, in infantile trismus. [Compare Tetanus.] 

Trypanosomiases (Sleeping Sickness) 

Prophylaxis. — Isolation, in the fly free districts, of infected natives has 
not proven a very practical measure but that of rendering their peripheral 
blood free of trypanosomes by atoxyl injections would seem more desirable. 
In this we aim to cure the patient as well as render him safe to others (Stitt). 
The most practical measure is that employed in Uganda of clearing the plant 
and tree growth for at least 15 feet from the streams of water, it having been 
noted that the tsetse flies confine themselves to a narrow strip not 
more than 15 feet from the water's edge (Id). The tsetse fly requires con- 
siderable moisture for its existence; the catching of flies in traps or with a 
sticky lime does not offer much encouragement (Id). Treatment, Stitt 
states that the general opinion is that trypanosomiasis is only curable at a 
time prior to the appearance of trypanosomes in the cerebro-spinal fluid. 
Consequently, the stage of sleeping sickness offers little chance of cure by 
treatment. Probably the best treatment is one in which three doses of 
atoxyl are followed by from ten to fifteen daily injections of 0.1 gm. (i| gr.) 
of tartar emetic. The course is repeated after an interval of 3 weeks. It 
is advisable to give a hypodermic of caffein a few minutes before the tartar 
emetic to lessen depression. Tartar emetic is also given intravenously 0.1 
gm. in 100 mils water (Stitt). 

Tuberculosis, Acute. 

Cold, to the surface of the abdomen, with ice sucked freely, the body 
sponged with iced vinegar and water, food and drinks to be iced, and even 
iced enemata sometimes ; with Quinine, gr. x-xxx once in 48 hours, or the pill 
of Quinine gr. j, Digitalis gr. ss, and Opium gr. J, every 4 hours, fluid food 
every hour or half hour day and night, in acute miliary tuberculosis, may 
bring about a cure if energetically followed from the beginning (McCall 
Anderson). Treatment of acute pulmonary tuberculosis, either the miliary 
form or acute pneumonic phthisis, is only palliative (Bruce) ; little can be done 
beyond making the patient comfortable by good nursing, by the use of Bro- 
mides and Opium, and by refraining from meddlesome interference (Suther- 
land). [Compare Meningitis tuberculous, Phthisis.] 

Tuberculous Affections (See Phthisis). 

Tumors. 

Carbon Dioxide, solid, applied to inoperable blood tumors, produces freez- 
ing of their blood and thrombosis of their vessels, and the tumor is gradually 



TYMPANITES. 857 

absorbed (Bernstein). Most superficial nevi and some cavernous angio- 
mata can be treated by solid CO2, and, if this fails, by excision (Da Costa). 
Mercuric Bromide, in J-grain doses, has benefited abdominal tumors (Wa). 
Chloroform, to aid in diagnosis of abdominal tumors when deep-seated, and 
when walls of the belly are hard and rigid; also in phantom tumors (R). 
Pepsin hypodermically into the substance of morbid growths which are homol- 
ogous to the tissues, especially fatty tumors, to arrest their growth and cause 
their absorption. Hyoscyamus, the leaves as cataplasm or fomentations to 
painful tumors, afford great relief (Wa). Iron, the Liquor Ferri Chloridi is 
found to be valuable as a curative application to fungous or hemorrhoidal 
tumors (Wa). Galbanum, as plaster to indolent, non-malignant tumors, to 
diminish or cause their absorption (Wa). Thiosinamin, in 5 to 20 per cent, 
soap or plaster locally for keloid and fibrous tumors (Unna); by injection into 
the growth in keloid and hypertrophic scar (Crocker). Electrolysis, is 
employed in large angiomata involving the skin and also deeper parts, or 
involving a structure like the lip, which it is undesirable to remove (Da Costa). 
With aseptic care one or more needles connected with the positive pole are 
inserted into the tumor, the needles being insulated to within about \ inch 
of their points. A flat moist pad is placed upon the skin near the tumor and 
is attached to the negative pole, and the pad is moved from time to time dur- 
ing the operation. From 25 to 75 milliamperes is the proper strength, 
and the current is passed for 10 minutes. The current is increased for a 
moment before withdrawing the needles, otherwise they will stick to the 
tissue and cause bleeding when torn loose. After the withdrawal of the 
needles the nevus will be found to be hard, but the hardness will gradually 
disappear. It may be necessary to repeat the operation a number of times 
at intervals of 10 days (Cheyne and Burghard). [Compare Cancer, Cysts, 
Glandular Enlargement, Goitre, Keloid, Polypus, Uterine Tumors, 
Wen.] Surgical, Enucleation or excision of adenoma, lipoma, fibroma, 
chondroma and lymphangioma. Osteomata are removed if they produce 
pain by pressure, if they press upon important structures, if they cause annoy- 
ing deformities, or if they grow rapidly (Da Costa). 

Tympanites. 

Turpentine, often greatly benefits (P); 5j every 6 hours in tympanites of 
typhoid, with prostration but without diarrhea (R); is of little value for 
severe cases in typhoid, which too often resist all treatment, but may be 
tried for the tympanites of peritonitis, in injections given by the long tube 
(O). Asafetida is especially valuable in debilitated subjects (W); internally 
or as enema is beneficial in hysterical tympanites (P) ; also in that of fever 
(W). Guaiacol, the Carbonate, in doses of gr. ij-iij every 3 or 4 hours, in 
typhoid or any cases where there is intestinal fermentation. Cinnamon, the 
Oil, TTtiij-v every 2 hours (Caiger). Capsicum, gr. ss-ij, every 4 hours (P). 
Surgical Measures by celiotomy should be done promptly, when cathartics, 
posture, enemata and the use of the rectal tube have failed to give relief 
(Porter). Puncture or Aspiration only in extreme cases and as a last resort, 
and then only in such cases which present no other cause for celiotomy than 
tympany itself, as typhoid fever without perforation, pneumonia (Id). 
Diet, if beef-juice and albumen-water are substituted for milk the distention 
will sometimes lessen (O). [Compare Peritonitis, Typhoid Fever.] 



858 TYPHOID FEVER. 



1$. Olei Terebinthinae, gj. • 

Olei Olivae, , § jss. 

Camphorae, gr. xx. 

Decocti A venae, § viij. 

M. Sig. — Inject into the rectum. 

{Copland.) 



ty. Olei Terebinth., 3 j. 

Olei Olivae, 3iv. 

Emulsi Asafcetidae, ad 5 viij. 

M. ft. emulsum. Sig. — For use as a 
rectal injection, with turpentine stupes to 
the abdomen. 



Typhoid Fever. 

Drugs play a minor part in the treatment of typhoid fever. Rest in bed, 
hydrotherapy, careful regulation of the diet, soap suds enemas for 

constipation and turpentine stupes for tympanitis with occasional stimula- 
tion in toxic cases will suffice in the vast majority of cases. The value of 
intestinal antiseptics is questioned (Funk). Water abundantly by mouth is 
useful in lessening the toxemia. Acetozone, the solution may be given inter- 
nally ad libitum; used early and regularly it shortens the course of the disease 
and ameliorates all the symptoms, used in 128 cases with mortality of 8J 
per cent. (Harris); in 40 cases, no death (Westinghouse) ; in 24 cases, no 
death (Wasdin) ; in 40 cases with 2 deaths (Abt) ; in 53 cases with no death 
(Woods). Guaiacol Tfl,ij, or the Carbonate gr. iij, every 2 hours as an intes- 
tinal antiseptic, was used in 408 cases with a mortality of 5 \ per cent., against 
13 per cent, in 1998 cases treated otherwise (McCormick); Tfl,x-xv painted 
over the skin where it is readily absorbed, is efficient in reducing the tempera- 
ture (Montagnon) ; as antipyretic is dangerous (W) ; the Carbonate gr. xxv- 
xxx twice daily, is highly efficient, used in 60 cases with no deaths (Hoelscher). 
Thiocol is an ideal intestinal antiseptic in this disease (Johnston). Salol 
is probably the most effective intestinal antiseptic (W) ; is of great value as 
an intestinal disinfectant, promoting healing and preventing reinfection; 
given in 5 to 10-grain doses, according to age, every 4 hours until the urine is 
tinged, then reducing the amount and frequency, but maintaining a faint 
coloration of the urine, has for 10 years afforded me the most gratifying 
results (Bramwell) ; it should not be given in the compressed tablet form for 
many reasons. Salophen has proved equally efficient. Mercury as Calomel 
in small doses at the onset (R); to move the bowels at first (McCormick). 

Antipyrine and Acetphenetidin, as antipyretics, but all such agents of 
energetic action cannot be be too emphatically condemned in this disease 
(Sir J. Moore); these drugs, used daily, are most injurious (O); may so 
impair the blood as to give rise to serious sequelae. Lactophenin gr. xv 
for adults thrice daily, reduced the temperature from 2 to 4 F. in 450 
cases, where water treatment could not be obtained (Schuler). Phenocoll, 
the Hydrochloride is used as an antipyretic. Veratrum Viride, to reduce 
temperature (R); for delirium ferox (B); is irritational and dangerous (W). 
Turpentine, invaluable when hemorrhage and extreme tympanites (P, R). 
ulxxx-lx in Starch mucilage and Ttlx of Tinct. Opii (P) ; TU v-x frequently 
for hemorrhage or TTU every 2 hours in advanced stage, with dry tongue 
(R); when coma, stupor, it often arouses the vital powers (Wa); Tfl.vij with 
gr. ¥ ] g of Morphine; of especial value when marked fever and congested lungs, 
as well as for the tympany (Da C). Chloral, is the best drug for nervous 
symptoms, but must be not used when the heart is weak (Da C). Opium, 
small doses at night, for insomnia with delirium; also as injection for the 
diarrhea (R) ; it is the last drug to be used for the diarrhea or hemorrhage 
(McCrae). Belladonna, when contracted pupils, low, muttering delirium 



TYPHOID FEVER. 859 

(B); is thought to counteract the poison of typhoid (Wa). Bismuth, gr. 
x-xxv of the Subnitrate with gr. J-j of Opium every 3 hours for the severe 
diarrhea (Da C). Thymol as an intestinal antiseptic is valuable (Henry); 
gr. ss-ij in solution (Da C); is of little value (W). Urotropin liberates for- 
maldehyde by the mucous membrane of the bladder and gall-bladder, which 
has specific influence on the bacillus, and prevents the latter viscus from 
being, as it generally is, a hot-bed of future infection (Crowe); should be 
given in doses of gr. x as long as bacilli are found in the urine (O). Euca- 
lyptus Oil, not Eucalyptol, Tfl.x-xxx in whisky, a very efficient intestinal 
antiseptic, also antipyretic and abortive to the disease, gives greater relief 
to all the general symptoms than any other drug (Kesteven). Camphor 
as an arterial stimulant, especially when nervous symptoms are prominent 
and there is a tendency to insomnia (McCormick) ; gr. j-ij in ttrxv of sterilized 
olive oil hypodermically, is unequalled in extreme cases (Stengel). Tan- 
nalbin to control excessive diarrhea, is very efficient (Moore). Ichthoform 
as an intestinal disinfectant and for excessive diarrhea, gr. xlv~5j daily, 
used in 20 cases with entire satisfaction (Polacco). Calcium Chloride gr. 
xv-xxx every 2 or 4 hours in hemorrhage, to increase the coagulability of 
the blood (Butler). Gelatin in 10 per cent, solution, a pint in 24 hours, for 
the same purpose (Id). Suprarenals desiccated, gr. v every 4 hours to 
constrict, the vessels (Id). Caffeine with Strychnine hypodermically for 
the myocarditis, has rendered great service by sustaining the heart (Aikins). 
Calcium Lactate in 20 to 30-grain doses daily, together with the subcutaneous 
injection of normal salt solution is useful for the relief of intestinal hemor- 
rhage (McCrae). Lactobacilline used to sour milk, which eradicated the 
bacilli in several cases of typhoid carriers, and convalescents (Liefmann). 
Sodium Citrate gr. xx-xl to the pint of milk used as diet to secure partial 
decalcification of the excess lime salts and prevent thrombosis (Wright). 
Trional for insomnia (Loomis). Serpentaria, useful when much depression 
exists, cautiously if intestines at all irritable (B). Hydrastine, when copious 
sweats (P). Lead Acetate, with Opium, for the purging (R) ; in full doses for 
hemorrhage from the bowel (O). Lime-water, as an astringent and antacid, 
is efficient. Sodium Chloride, should not be withdrawn from the food (Wa). 
Aromatic Spirit of Ammonia, for great accumulation of mucus in the throat 
(Da C). Copper Sulphate, gr. T \ with Opium, gr. J, for the diarrhea 
(Da C). Stiychnine, is the remedy for the functional palsies (Da C). 
Purgatives, only the very mildest, and they with the greatest caution (Wa). 
Medicine will never abort a case of true typhoid; its natural duration is 
from 28 to 30 days (Jenner) ; medicines should not be given in pills or tablets, 
which are liable to irritate the intestinal lesions. Serum Treatment, both 
antitoxic and prophylactic, has been successfully employed (Chantemesse) ; 
preventive inoculation of sterilized cultures of the bacilli were successfully 
employed during the Boer War, and in the U. S. Army. (See section 
on Typhoid Vaccination in preceding section of book). Vaccines, though 
successful in the prevention of typhoid fever, have not been of value in 
treating the disease (Miller); the only successful treatment of typhoid 
carriers has been that by autogenous vaccination (Meakins). (See section 
on Typhoid Vaccination in preceding section of book.) Hydrotherapy 
gives very good results, has reduced the general mortality of the disease 
by one-half (O); the bath at 70 F. gradually lowered by ice to 65 F. 
whenever the temperature reaches 103 F. (Loomis) ; a most important agent 



860 TYPHUS FEVER. 

in this disease (B); in mild cases, cold wet compresses or wet sheets; or wash- 
ing with cold water; in severe cases, affusion, shower, or general cold bath, 
50 to 55 F., or better 95 cooled gradually to 6o° (R); this, the Brand (more 
justly Currie's) method, increases the flow of urine and its toxicity, restoring 
the latter to normal and sometimes to double the normal, thereby clearing the 
system of a large quantity of toxins (Ausset). Stimulants, Whisky in doses 
of o ss, as indicated by the pulse, heart action and general condition (Loomis) ; 
alcohol is an essential agent, aids digestion, acts as food, and stimulates the 
circulation (W) ; is unnecessary in a great majority of the cases (O) ; is neces- 
sary to sustain the heart (Da C) ; Coffee is a better stimulant than alcohol 
(P); Strychnine only to reinforce alcohol, when the latter proves insufficient 
(Loomis) ; Digitalin hypodermically for impending failure of the right heart, 
shown by cyanosed extremities, pulmonary edema, etc. (Id); Alcoholic 
stimulants freely, with Quinine, for pyemic cases showing joint complica- 
tions. Diet should be milk alone, with lime-water, peptonized or prepared, 
during the whole course (Loomis); Milk must be used with great caution; 
if the curd be undigested great evils arise; give essence of meat alone (Sir 
Wm. Jenner) ; milk, eggs and water are the essential foods during the febrile 
period, the latter should be freely given, to the amount of a gallon or more 
daily, as a sort of internal hydrotherapy by which the toxins may be washed 
out; no solid food until the temperature has been normal for 10 days (O); 
a rigid milk diet disorders metabolism, and does not supply sufficient calories, 
so that eggs, rice-water, gruels, corn starch, etc., should be given after the 
first week, provided that nothing solid is taken; an absolute milk diet can 
be resumed if intestinal symptoms become grave; considerable quantities of 
carbo-hydrates are distinctly advantageous, well-cooked barley, rice, corn- 
starch and wheat after the end of the first week (Shaffer). Nursing is im- 
portant, careful nursing and regulated diet are the essentials in a majority 
of cases; medicines are not often needed in hospital practice, a great majority 
of my cases do not receive a dose (O). Adjuvants, great cleanliness, good 
ventilation, absolute rest and quiet in bed from the start. Disinfection of 
the urine by Phenol solution 1 to 20, or Corrosive Sublimate 1 to 1000, of the 
discharges by Phenol 1 to 20, or Formaldehyde 1 to 40; of linen and bed- 
clothing by Phenol 1 to 20; of the nurse's hands by Corrosive Sublimate solu- 
tion 1 to 1000. Surgical methods are necessary for periostitis of the ribs and 
tibia, recurrence is inevitable unless the operation is complete (O). [Com- 
pare Hemorrhage intestinal, Tympanites.] 



]$. Quininae Sulphatis, gr. x. 

Ac. Hydrochlor. Dil., 3 iv. 

Syr. Aurantii, 5 J- 

Aquae Cari, q. s. ad §vj. 

Misce. Sig. — A tablesp. in water every 

3 or 4 hours. (Murchison.) 



1$. Ac. Sulph. Aromat, 5ijss. 

Fluidext. Haematoxyli, 5iijss. 

Syr. Zingiberis, q. s. ad §iv. 

Misce. Sig. — A teasp. in water every hour, 
for excessive diarrhea. 



1$. Salolis, 

Benzonaphtholis, 
Magnesii Oxidi, 

Sodii Bicarbonat., aa 3j- 

Misce. pone in capsulas no. xx. Sig.— 
One every 4 hours, as an intestinal anti- 
septic. (Ribiero.) 



B;. Ferri Subsulphatis, gr. xxx. 

Kaolini, q. s. 

M. ft. pil. no. xij. Sig. — One pill thrice 
daily, for intestinal hemorrhage. 



Typhus Fever. 

Antipyrine or Quinine as antipyretic, it being more necessary to keep the 
temperature within safe limits in typhus than in typhoid (B) ; in a number of 



ULCERS AND SORES. 



86 1 



cases has induced very serious collapse (W) ; medicinal antipyretics are even 
less suitable than in typhoid, as the tendency to heart-weakness is often more 
pronounced (O). Lactophenin is safer and is an efficient antipyretic. Bella- 
donna, cleanses and moistens the tongue; controls the delirium, slows and 
strengthens the pulse, reduces the temperature, shortens course of disease 
(R, P) ; in the early stages, relieves severity of symptoms (P) ; give when the 
pupils are contracted (Graves). Podophyllin, gr. J-J as mild laxative at 
onset, when constipation congestive headache, biliary derangement (P); 
mild saline purgatives if required, but not drastics (Wa). Digitalis, in large 
doses, a favorite remedy in Germany (P). Hyoscyamus, for mild brain 
symptoms (P). Opium, fulfils many important indications; never give 
when pupils are contracted ( Wa) . Tartar Emetic, with Opium in the delirium 
with insomnia (R). [See under Typhoid.] Chloral, to produce sleep and 
allay violent delirium (R, Wa) ; its use has often been followed by ameliora- 
tion of the symptoms (Wa); is highly efficient in the wild delirium of the 
earlier stages (Russell). Camphor, a remedy of considerable value, but 
contraindicated when flesh-red tongue, tender abdomen, diarrhea (Wa). 
Phenol, Phenol sulphonates, Sulphides, etc., the so-called specific medica- 
tion, is not commended by those who have had the largest experience (O). 
Alcohol as milk -punch, is useful in all stages (W); stimulants are needed 
sooner than in typhoid, the adynamia being more profound in typhus and 
appearing sooner (B); Coffee is better than alcohol for the adynamia (P). 
Cold Baths for hyperpyrexia, have been employed on a large scale (W); 
Hydrotherapy should be thoroughly and systematically employed (O). 
Treatment should be supporting from the outset, the general management 
is like that of typhoid, water should be freely given and alcohol in suitable 
doses, according to the state of the pulse; in epidemics the cases are best 
treated in tents in the open air, when the climate is suitable (O) . Diet, 
nutritious persistently, beef-tea, egg-nog, nutrient enemata, Isolation, 
imperative, as the disease is eminently contagious (B). [Compare Delirium, 
Typhoid Fever.] 



fy Tinct. Digitalis, 5ij- 

Spt. Ammon. Aromat., Bij. 

Spt. Frumenti, q. s. ad Sviij. 

Misce. Sig. — oj in water every 4 hours, 

when circulation is greatly depressed. 



fy Susci Limonis, 5iv. 

Glycerini, § iij. 

Aquas, q. s. ad § viij. 

Misce. Sig. — Apply on a soft cloth to the 
parched tongue and lips every hour or two 



Ulcers and Sores. 

Acetozone has been used locally as a germicide with excellent results for 
infected ulcers ( W) . Alum as atringent, is used when excessive secretion ( W) ; 
dry or in solution, applied to relaxed and secreting sores (R). Alcohol locally 
to cover sores with a layer of coagulated albumin (R). Acetanilid, in fine 
powder dusted on, excellent for ulcers, sores, mucous patches, and rectal ulcers. 
Arsenic, improves rodent ulcer (B). Balsams of Peru and Tolu, are excellent 
applications (P). Belladonna has a remarkable influence over various ulcera- 
tive processes (P). Capsicum a weak solution as a stimulant to scrofulous 
or fistulous sores (P). Charcoal finely powdered, locally to sloughing sores 
(R). Camphor dusted over indolent sores (R); gives best results in ulcers of 
the leg (Schulze). Chloral, as lotion for sluggish sores, 5 to 20 grains to the 5 
of water (Keyes) ; is highly efficient in ulcerated sc re throat or ulceration from 



862 ULCERS AND SORES. 

any cause (Brodnax). Chloretone in i per cent, solution as an anesthetic to 
irritable ulcers (W). Chlorine, in solution as a wash for sloughing and indo- 
lent sores (R) ; the gas as a local stimulant to promote healing in old ulcers is 
found to be highly efficient; Chlorine water properly diluted is an excellent 
stimulant, disinfectant and detergent wash for foul ulcers (W). Collodion is 
a good protective covering (P) ; may be medicated with more active agents. 
Conium locally as a poultice to relieve pain and improve the sore (R). Cod- 
liver Oil for ulceration of the glands, or indolent ulcers with excoriated edges, 
and lupus. Copper Sulphate, to indolent ulcers, especially of mucous mem- 
branes (W) ; touch lightly with a crystal, or frequently apply a solution of gr. 
ij to the § (R). Copaiba may be given with benefit in old, indolent ulcer of 
the stomach (W). Creosote, from a i per cent, solution to the full strength, 
as a disinfectant application for foul ulcers (W). Glycerin, as the official 
cataplasm of Kaolin, an excellent application in many forms of ulceration. 
Hamamelis is used with satisfaction as an application to varicose ulcers (Pf). 
Hydrastis internally and locally, gives good results in rodent ulcer, also ulcers 
of legs, rectum, and uterus (R) . Hydrogen Doxide is particularly useful in 
ulcers of the leg with atonic base, also in soft ulcer and tertiary phagedena 
(Ravasini) . Ichthyol, pure as oint. or with Lanolin, has done excellent service 
in ulcers of the leg; a 10 per cent, ointment is very efficient in old leg ulcers 
(Bulkley) ; a 30 per cent, solution applied after a 1 per cent, solution of Holo- 
caine, gave phenomenal results in corneal ulcers (Travis). Ichthargan in 1 
and 5 per cent, dusting powders made with Talcum, is extremely efficient 
in old leg ulcers (Unna). Iodine in concentrated alcoholic solution, applied 
daily to the surface of the ulcer until the slough separates, quickly converts 
a septic ulcer into a clean granulating one which heals readily (Roop). 
Iodoform for venereal ulcers, dusted over surface (B); prevents granulation 
in all ulcers, and does no good except to relieve pain (Gross); a desiccant, 
alterative, and antiseptic application (W). Lime, as the Carbonate or Lime- 
water to check discharge; the Sulphide when thin ichorous discharge; the 
Phosphate has influence on scrofulous sores (R). Mercury, Calomel levi- 
gated and dusted on, is highly efficient in ulcer of the conjunctiva; Calomel 
Ointment or Black Wash in scrofulous or tuberculous lupus, and in open 
scrofulous sores (R); Corrosive Sublimate, in 1 per cent, solution, as 
application to syphilitic ulcers (Fox); the Ung. Hydrarg. Nitratis, diluted 
one-half, for serpiginous ulceration; or the Iodide, gr. xx-xl to the § of 
vaselin, in syphilitic ulcerations (Keyes). Nitric Acid, as escharotic, ap- 
plied with a glass rod, Oil to protect the surrounding tissues, arrest its 
action by alkaline wash; 5j to Oj is a good acid lotion for washing (B); 
the lotion for indolent and painful ulcers (R). Nuclein locally, cured an 
ulcer of 20 years' standing in 4 months (Vaughn); or Yeast poultices (R), 
their value probably due to the nuclein in them. Opium or Morphine, 
with glycerin, locally to relieve pain (R); gr. j-ij daily, also locally, has 
a decidedly curative influence in phagedenic and indolent ulcers; not so 
useful in the so-called irritable ulcer (Pf); given internally improves the 
condition remarkably (Smith). Phenol and Salicylic Acid locally (B); 
the Glycerite of Phenol is a good application to fetid sores (R) ; Phenol 
pure, freely applied under chloroform anesthesia, as a powerful and 
penetrating caustic to destroy the diseased surface, in tropical sloughing 
phagedena (Mn). Phenosalyl in 10 to 30 per cent, solution, is very effective 
in varicose ulcers and ulcerated gummata, even in cases resisting other medi- 



ULCERS AND SORES. 86$ 

cation for several years (Tshitsherin). Picric Acid in i per cent, solution 
locally for chronic ulcers (Maddock). Pyrogallic Acid, is an excellent ap- 
plication for venereal ulcers (Vidal). Piperazin in i per cent, solution locally, 
relieves pain and reduces inflammation in gouty sores. Potassium Chlorate 
in solution as wash to clean and stimulate foul ulcers (R); in impalpable 
powder a better application than Iodoform (B). Potassium Permanganate 
solution is an excellent disinfectant and germicidal wash, in dilute solution 
it acts as a stimulant; in powder acts as a mild caustic, and may be applied 
with advantage to sloughing ulcers (W). Potassa, the fused stick, or the 
milder Vienna paste, as escharotic; then a dilute acid to arrest its action (B). 
Plumbum, the soluble Lead salts as lotions to unhealthy, over-secreting sores 
(R). Resorcinol, in strong or supersaturated solution, locally applied to 
tuberculous and other ulcerations of the larynx, is efficient and painless 
(Tymowski); locally in rodent ulcer (Williams). Sanguinaria locally, to 
repress fungous granulations of indolent ulcers, i to 80 of glycerin (P). 
Savin is used as an acrid, not a chemical, caustic (P). Silver Nitrate is 
mildly stimulant and actively germicidal, used especially to destroy exu- 
berant granulations (W); quickly rubbed over the surface of the ulcer (B); 
applied to unhealthy ulcers, also to ulcers of the mouth (R). Sulphuric 
Acid in dilute solution to lessen excessive secretion on old ulcers (W). Tannic 
Acid locally to check excessive secretion in chronic ulcers ( W) ; the Glycerite 
to coat over discharging sores (R). Tannoform is supposed to be both anti- 
septic and astringent (W); is efficient in fetid ulcer of the leg (v. Mering). 
Thiol, the dry form as a dusting powder of great benefit in many forms. 
Thymol Iodide is highly praised as an excellent substitute for Iodoform, 
being quite as efficient and odorless; excellent for indolent soft ulcers and 
syphilitic sores. Thyroid Extract has been employed in old syphilitic and 
other leg ulcers (W). Turpentine internally for ulceration of the bowels 
(P). Zinc Oxide as a desiccant and astringent dusting powder (W); as 
Unna's Paste, the original formula being the best, thus: — Zinc Oxide, Gelatin, 
aa part iv, Glycerin, Distilled water, aa part xvj, Ichthyol, part j. Zinc 
Chloride, the most efficient escharotic consistent with safety (B). Zinc 
Sulphate, dried, dusted over sores (R). Zinc Stearate with Thymol Iodide, 
is an excellent application for ulcers (Hellman) ; and for obstinate ulceration 
of the uterus (Hale). Section of exposed nerve-filament, in irritable ulcer, 
by bistoury passed beneath the sore (Hilton). Water, is sufficient as dressing 
in the majority of cases. Hot Water, applied by the continuous immersion 
therein of the affected limb, is perhaps the most efficient treatment of indolent 
ulcers of the leg or foot, resisting other applications; proved very successful 
in my Philippine experience for tropical ulcer and gangrenous sores of the 
leg, fissures and sores of the feet, and similar affections. Roentgen Rays pro- 
duce excellent results (Finzi). Radium Rays give most brilliant results 
(Macleod) ; are of value in rodent ulcer, especially when the ulcer is smaller 
than a shilling, in which case they act like a charm (MacLeod). Rest and 
support of great value; cleanliness, bandaging and recumbent position in 
ulcer of legs, facilitate recovery, also daily washing to restore the vitality 
of parts; elastic stocking, and the Esmarch bandage in chronic cases. 
[Compare Bedsores, Chancre, Chancroid, Throat; Gastric and Uterine 
Ulceration; Syphilis, Tonsils, ulcerated.] 



4 



86 4 



UREMIA. 



1$. Liq. Formaldehydi, nj>x. 

Aqua Hydrogenii Diox., .... §xvj. 
M. Sig. — For local use, as a cleansing and 
antiseptic wash. 



fy Iodoform!, 5ij- 

Mucil. Acaciae, ttjxv. 

01. Menthae Pip., Trjjij. 

Glycerini, ttjxx. 

M, Sig. — Apply on lint. For unhealthy 

ulcers. (Bronson.) 



1$. Balsami Peruvian, 3iv. 

Tinct. Benzoini Comp.,. . . 3ij- 

Petrolati, q. s. ad 5ij- 

M. ft. unguentum. Sig. — Apply on lint. 

For irritable, painful ulcers. 



E^. Hydrarg. Chlor. Cor, gr. xv. 

Phenolis, ttjjxx. 

Aquae, q. s. ad §iv. 

M. Sig. — For syphilitic ulcers, pack on 
cotton, and renew daily. (Fox.) 



Uremia. 

Pilocarpine, as an active diaphoretic, on the first appearance of uremic 
symptoms, as headache, drowsiness, convulsions; also free purgation by 
salines or Elaterium; a weak or fatty heart is a positive contraindication 
for this drug (B); it must not be used if edema of the lungs exists, as further 
edema and death will result (Whitla). Digitalis, the infusion internally, or 
a poultice of the leaves to the back and abdomen, to procure free action of 
the kidneys (B). Morphine, hypodermically, is most efficient in the uremic 
convulsions of acute parenchymatous nephritis (Loomis); is dangerous in 
chronic interstitial nephritis (Ty); when the kidneys are seriously diseased 
the free use of opiates is attended by much danger, because the chief channel 
through which its alkaloids escape is choked up (W); is indispensable for 
the restlessness and delirium, and of especial value in the dyspnea and 
Cheyne-Stokes breathing of advanced arterio-sclerosis with chronic uremia 
(O). Chloroform for the convulsions, if severe (O); Chloroform rather than 
morphine for the convulsions (White). Nitroglycerin may be used freely 
to reduce the tension (O) ; with brisk purgation to relieve dyspnea. Chloral 
to control convulsions (W) ; with Sodium Bromide in full doses by the rectum, 
for uremic convulsions (Whitla); Potassium salts increase the danger of 
uremia in Bright's disease (Id). Ether, in doses of gij by the mouth or 
5ss hypodermically deep into the muscles (painful), for uremic dyspnea; 
must be pushed to § ij or iij in 24 hours before good results can be expected 
(Gallois) ; being rapidly eliminated it can be given in fairly large doses with- 
out causing intoxication. Sodium Benzoate, 15 grains 4 times daily, has 
been found very serviceable in threatening uremia (Whitla). Naphthalene, 
also Iodoform and Charcoal, as intestinal disinfectants, as much of the toxic 
material in the blood is reabsorbed from the bowel (Bouchard). Echinacea 
has proved of positive value (Ellingwood). Quebracho is a valuable re- 
spiratory stimulant in uremic dyspnea (W). Saline or Hydragogue Cathar- 
tics, are of great important to secure elimination by the intestinal canal 
and to relieve the blood pressure (B); purgation by salines on the first ap- 
pearance of uremic symptoms (Y). Colchicum, is an excellent derivative in 
these cases and acts best when combined with other purgatives (B). Elate- 
rium, gr T V to J, to procure free watery evacuations — cautiously! (B); the 
compound powder of Elaterin, gr. \ to iij, may be thrown on the tongue and 
washed down with a teaspoonf ul or two of water (Y) ; clinical experience has 
demonstrated its value in uremia (W). Transfusion, in uremic convulsions 
(B). Hypodermoclysis is diuretic, and promotes elimination of the toxic 
products (Kemp); hot saline injections into the cellular tissue have given 
good results in chronic nephritis with uremia; used in 2 cases with recovery, 
the patients having been bled before administering the injections (Richard- 



URETHRAL STRICTURE — URETHRITIS. 



86 5 



iere); is worthy of a wide trial and seems to offer a chance of recovery in 
many cases which otherwise would prove fatal. Hot-pack or vapor bath, 
to induce powerful diaphoresis (B); the hot wet-pack or hot air bath, may be 
given daily or oftener when uremia is threatening. Milk is the only admis- 
sible food. Venesection, 10 to 20 ounces of blood from the arm gives strik- 
ing relief in acute forms of uremia in the robust (Y) ; leeches to the temples 
for the headache (Id). Lumbar Puncture temporarily relieves the convul- 
sions, and may save life (Wilson). [Compare Bright's Disease, Coma, 
Convulsions, Dyspnea, Scarlet Fever.] 



i^. Spt. Glycerylis Nitratis, 5ss. 

Aquae Camphorae,. . . q. s. ad §iv. 
M. Sig. — A teasp. every 3 or 4 hours, as 
diuretic. 



1$. Pilocarp. Hydrochlor., .... gr. jss. 

Aquae Destil., 3ij- 

Solve. Sig. — Ten drops hypodermically 
or by the mouth. 



Urethral Stricture. 

Aconite, is of great service in spasmodic stricture (P). Cocaine, locally 
by catheter (Smith). Buchu, in irritable urethra, spasmodic stricture, and 
gleet (P). Opium, in full dose or an opiate suppository, with fomentations 
and a warm bath, will often suffice in spasmodic stricture (CI). Atropine 
as ointment rubbed in along the canal, in spasm of the urethra (W). Thio- 
sinamin has been used by many clinicians in true urethral stricture with 
asserted success (W). Fibrolysin has made many cures, even in long-stand- 
ing cases (Lang). Adrenalin Chloride 1 part with 5 of Chloretone, in normal 
saline solution 1000, of which a few drops instilled into the urethra, will 
permit the passage of small instruments through a stricture previously 
impervious (Bartrina). Catheterization, under an anesthetic in spasmodic 
stricture if other measures fail to relieve; also for gradual dilatation in organic 
stricture, the safest and most generally applicable treatment (CI). Oil, 
injected before dilatation (Wa). Thorough Division, by a dilating urethro- 
tome, the best operation for a radical cure; 600 cases thus treated without 
a death or permanent disability (Otis). Electricity, a weak galvanic current, 
with negative pole to the stricture, will destroy it in 2 or 3 sittings by elec- 
trolysis, and if carefully done, is the most efficient and least painful method 
of treatment for radical cure. 

Urethritis. 

Aconite, is used to advantage in urethral fever; also for prevention of chill 
after passage of sound (Pf, W). Strophanthus, efficient in preventing rigors 
after instrumentation on the urethra, the tincture in doses of 5 minims 
(Fenwick). Urotropin internally, is said to effectually prevent urethral 
chill and fever following the use of sound or catheter. Uriform keeps the urine 
in a normally acid and sterile condition, and efficiently supplements the local 
treatment. Acetanilide in mixture with gum-arabic water, gr. xx-xl to the 
§ , may be injected in urethritis (W). Lysoform as an injection, is used with 
success (Simons). Ichthyol in warm 2 per cent, solution as an injection, 
gives great satisfaction in chronic posterior urethritis (Mueller). Ichtho- 
form in solution, 1 in 2000 to 1 in 1000, has marked siccative and anti- 
phlogistic effects, and is a very efficient injection in chronic urethritis (Lohn- 
stein). Silver Nitrate, locally, very efficient in chronic urethritis in females 
(W). Zinc Sulphate, a weak solution, gr. v. to the 5 > as astringent injection 
for simple urethritis, stronger solutions are required in gonorrhea. Tannin 
on bougies once a week for 15 minutes, efficient for urethritis in the female 
55 



i 



S66 



URINARY DISORDERS. 



(Wa). _ Sabal, the compound elixir of Sabal and Santal is highly praised. 
Salol, is the best drug after instrumentation of the urethra, to prevent urethral 
chill or epididymitis (Huhner). Myrtol, internally, in chronic inflammation 
of the bladder and urethra (Br). Terebene internally, may be used in 
chronic or subacute inflammations of the geni to-urinary tract (W). Potas- 
sium Bicarbonate, with Potassium Acetate, aa gr. x in a large cup of flaxseed 
tea or a glass of Vichy water, every 4 to 6 hours; with absolute rest in bed, a 
calomel purge, and urination under hot water, sufficient for most cases of 
simple urethritis which may arise from lithiasis, leucorrhea in females, etc.; 
many cases of so-called aborted gonorrhea were really simple urethritis 
(Otis). [Compare Gonorrhea.] 



3. 



M 



Zinci Sulphatis, 
Aluminis, 

Phenolis, aa gr. v. 

Glycerini, 5 j- 

Aquae Destil, ad $iv. 

. Sig. — Injection. 



1$. Zinci Sulphatis, gr. v. 

Plumbi Acetatis, gr. x. 

Tinct. Catechu, 3ss. 

Tinct. Opii, 5j. 

Aquae Destil., ad §iv. 

•M. Sig. — Injection. 



Urinary Disorders. 



I 



Aconite is of great service in sub-inflammatory retention due to chill (P). 
Alkalies, especially Potassium or Lithium salts of Vegetable acids, to lessen 
acidity of the urine (see page 13); Liquor Potassii Hydroxide is preferable to 
bicarbonates, which have diuretic action and increase frequency of micturi- 
tion; Ammonium Carbonate, Potassium Acetate, Citrate and Bicarbonate to 
lessen acidity; Potassium Bitartrate in full doses will acidify an alkaline urine; 
the Liquor Potassii Hydroxidi mixed with the Tincture of Hyoscyamus 
may undergo chemical changes, but the combination materially controls 
painful and frequent micturition in bladder troubles (Thompson). Potas- 
sium Bicarbonate, gr. xxx in a glass of water at bedtime for hyperacidity, is 
very convenient and satisfactory (Roberts). Benzoic Acid, or Sodium 
Benzoate, in 10 to 15 grain doses, to render alkaline urine acid, and check the 
formation of phosphates (B); will not do so (Hutchinson); checks am- 
mo niacal fermentation the cause of the alkalinity, but does not directly 
acidify the urine (Ashhurst) ; causes the disappearance of uric acid crystals 
and acts most happily in the phosphatic urine of vesical catarrh (W). Buchu 
renders more help than any other drug in retention or incontinence of urine 
from catarrh of bladder implicating the ureters and even the kidneys (P) ; is 
a stimulant in morbid conditions of the genito-urinary tract, subacute and 
chronic, in which the mucous membrane has lost its normal tone. Cantharis, 
frequent or involuntary micturition, especially when coughing, in women 
from weakness of sphincter; one or two drop doses (R). Cannabis, in reten- 
tion from spinal diseases (R). Diuretics (see page 30). Diuretin, Sodio- 
theobromine Salicylate, is a remarkably efficient 'diuretic in cardiac and renal 
dropsy, 1 5 grains several times daily will increase the urine three and fourfold. 
Digitalis, holds high rank as a diuretic in the diminished secretion present in 
failing heart. Mercury, Calomel, gr. v every 2 hours for 3 doses, a most 
efficient diuretic to restore! the secretion in chronic Bright's disease (W). 
Sodium Phosphate is! efficient to acidify an alkaline urine (Hutchinson). 
Salicylic Acid will render an alkaline urine acid, by checking ammoniacal 
fermentation. Sodium Sulphocarbolate, gr. xx taken in divided doses during 
the day, for indicanuria (Id). Salol is efficient and prompt, ordinarily in a 
day or two it causes the urine in chronic cystitis to lose its alkalinity and foul 
odor and to become clear (Sympson). Stramonium a good antispasmodic 



URINE. 867 

in retention due to spasm at the neck of the bladder. Turpentine, in hema- 
turia and chronic catarrh of the bladder, and incontinence from atony (B). 
Strychnine, sometimes employed with marked benefit in retention or in- 
continence of the old (P). Urotropin as a urinary antiseptic, gives the best 
bactericidal results (Sachs); very efficient in ammoniacal fermentation of 
the urine; is useful in phosphaturia; ranks high in the treatment of pyelitis, 
cystitis, and ammoniacal phosphaturia (W). Nitrohydrochloric Acid, 
dilute, gtt. x-xv thrice daily in water, for phosphatic deposits (Mears). 
Triticum, in pint doses daily of its infusion or decoction, for strangury, cys- 
titis, and many other complaints connected with the urinary apparatus. 
Calcium Sulphate in daily dosage of gr. xx-xxx, is particularly efficient in 
phosphaturia (Etterlen). Pilocarpine and hot air to cause sweating, with 
cupping over the loins, hot applications, free purgation, are indicated in 
non-obstructive anuria (O). Water is a valuable remedy in many conditions 
of the urinary tract, getting rid of metabolic poisons, diluting the blood 
passing through the kidneys, diluting the urine and rendering it more bland 
(W); copious injections are beneficial in some cases of suppression (R); 
irrigations by rectum, large and hot, of normal salt solution, should be tried 
in anuria, as they are said to stimulate kidney activity in a remarkable 
manner (O). Surgical methods are necessary in obstructive anuria. Diet, a 
milk or a vegetable diet has powerful influence in lessening the acidity of the 
urine; also fruit and fish. [See the articles on Urinary Acidifiers, etc., on 
page 12; and compare those on Albuminuria, Bladder, Bright's Disease, 
Chyluria, Cystitis, Diabetes, Insipidus, Dropsy, Dysuria, Enuresis, 
Hematuria, Hemoglobinuric Fever, Lithiasis, Oxaluria, Uremia, 
Urethral, Stricture, Urethritis.] 



fy Scillae, 
Digitalis, 
Hydrarg. Chlor. Mitis, aa gr. xij. 



Tinct. Digitalis, 5ss-j. 

Spt. Athens Nitrosi, 5iij. 

Liq. Ammon. Acetat.,. .... oss. 



M. ft. pil. no. xij. Sig. — One pill as a Aquae, q. s. ad 5vj. 



M. Sig. — One-sixth every 3 hours, to 
reestablish the renal secretion. (Goodeve.) 



diuretic twice daily. (Sir A. Clark.) 

1$. Potassii Citratis, §j. 

Sodii Bicarbonat., 5 v. 1$. Potassii Bicarb., 3iijss. 

Syr. Limonis, B j. Acidi Acetici, 3 vj. 

Aquae q. s. ad §iv. Aquae, giij. 

M. Sig. — A teasp. every 2 hours, to M. Sig. — Teasp. doses as required, as a 

render the urine alkaline. (Roberts.) \ diuretic. Each dose contains about gr. x 

of Potassium Acetate. 

Urine, Clinical Examination. 

Collection. — Urine for examination should preferably be a 6-ounce 
sample of a mixed 24-hour specimen. It is absolutely necessary in order to 
do accurate quantitative work, that the amount be accurately recorded 
and that the urine be collected in a perfectly clean bottle holding about a 
hah gallon. It should be well corked after each addition and should be 
kept in a cool place or on ice to avoid decomposition. All possible sources 
of contamination should be avoided, such as any foreign matter, i.e., dust, 
feces, sputum, etc., and the urine should never be allowed to stand in open 
or dirty containers. The object in collecting a 24-hour specimen is to obtain 
the average composition as the proportion of the constituents and the 
amounts of albumin, sugar, etc., vary a good deal at different hours of the 
day and night. 

If a sample of a 24-hour quantity is not to be had, then the best time to 



< 



868 



URINE. 



collect a sample for qualitative work only, is about three hours after a meal 
and, not the morning urine, as is so commonly done. 

Preservation. — It is very important that urine be examined in as fresh a 
state as possible. If the urine is to be sent to a laboratory, a number of 
substances may be added to preserve it. A crystal of thymol, toluol, a few 
drops of chloroform, formalin (10 per cent, solution) or, an ounce of cold 
saturated solution of boric acid to a liter of urine may be employed. The 
examiner should always be informed of the preservative which has been added 
since most of them, either give deceptive chemical reactions or else obscure 
the microscopical picture to some extent. 

Quantity. — The amount passed normally during 24 hours varies between 
40 and 50 fluidounces (1200 and 1500 mils), the quantity depending on the 
blood pressure and the condition of the renal epithelium. It is decreased 
below the normal during hot weather when the perspiration is increased; 
in fevers and exhausting diseases, in acute congestion of the kidney; in acute 
nephritis and in the acute exacerbations of a chronic nephritis; following 
anesthesia or operations on the genito-urinary tract; in cardiac decompensa- 
tion. It is increased during cold weather when the perspiration is lessened, 
in both forms of diabetes, after acute infectious diseases and hysteric or 
epileptic attacks, in amyloid kidneys in cerebral irritation, in chronic diffuse 
and chronic interstitial nephritis, in all conditions causing increased blood 
pressure, and in cases where diuretics have been freely administered or 
large amounts of water have been taken. It may be entirely suppressed 
(anuria) in cholera, acute nephritis, scarlet fever, diphtheria, severe dysentery, 
hysteria and shock, also by obstruction, as calculus or new growths affecting 
both ureters. 

Composition. — The normal urine varies widely in composition, being 
influenced by diet and other factors. The following table represents the 
composition of a normal urine: 1 



Volume (24 hours) — 1500 mils. 



Absolute 
Wt. in Grammes 



Approximate 
Percentage. 



Constituent 



Water 

Solids 

Urea 

Uric acid 

Hippuric acid 

Oxalic acid 

Aromatic oxyacids 

Creatinine 

Thiocyanic acid (as KSCu) 

Indican 

Ammonia 

Sodium chloride 

Phosphoric acid 

Total sulphuric acid 

Silicic acid 

Potassium (K 2 0) 

Sodium (Na 2 0) 

Calcium (CaO) 

Magnesium (MgO) 

Iron 



1440.00 


96.0 


60.0 


4.0 


35-o 


2-33 


o.7S 


0.05 


0.7 


0.05 


0.015 


O.OOI 


0.06 


0.004 


1.0 


0.07 


0.15 


O.OI 


O.OI 


O.OOI 


0.65 


0.04 


16.5 


I . I 


2.5 


0.15 


2.5 


0.15 


0.45 


0.03 


2-5 


0.15 


5-o 


0.3 


0.25 


0.015 


0.3 


0.02 


0.005 


. 0004 



1 Hawk. — Practical Physiological Chemistry, 1916. 



URINE. 869 

Solids in Urine. The last two figures of the specific gravity nearly represent the number 
of grains of solid matter in the ounce of urine (Bird). The same two figures multiplied by 
2 (Trapp), or by 2.33 (Hasser), give the number of parts of solid matter in 1000 of urine. 

Odor should be faintly aromatic; a fragrant smell indicates cystine or 
sugar, the smell of violets points to turpentine, an ammoniacal odor indicates 
alkalinity from decomposition; a fetid smell points to the presence of pus. 
Asparagus, cubeb, copaiba, oil of santal, impart their characteristic odors 
to the urine of persons taking them. 

Specific Gravity is determined by the urinometer, or by specific gravity 
beads of glass, and should be taken with a sample of the urine passed during 
24 hours. That of normal urine varies from 1.015, to 1.025, and averages 
1. 01 8, having 18 grains of solid matter to the fLuidounce. In disease the 
specific gravity may be subjected to wide variations. In most cases the 
specific gravity is inversely proportional to the volume excreted, with the 
possible exception of diabetes mellitus. 

Color. Normal urine has a pale yellow or amber color due to the presence 
of a pigment called urochrome. When pale and copious, of sp. gr. 1.030 
and above, it indicates the presence of glucose. Pale and copious, sp. gr. 
below 1. 01 8, is seen in hysteria, convulsions, nervous diseases. Color high, 
urine scanty, sp. gr. above normal, — in fevers and the uric acid diathesis. 
Color high, urine scanty, sp. gr. below normal, — in Bright's disease. Urine 
is colored very yellow or greenish-yellow, by bile and by rhubarb; dark, with 
odor of violets, by turpentine; dark, muddy, smoky, by blood; black, by dis- 
integrated blood, putridity of the urine, tar, creosote; olive-green or smoky, 
by phenol and by salol; brown, by arbutin; green by indigo and salicylic 
acid; dark-green, by kairin and thymol; dark-blue, by methylene blue; bluish- 
zw/e^byresorcinol; violet, by juniper; greenish-yellow, reaction acid, or reddish- 
purple, reaction alkaline, by santonin; blood-red, by hematoxylon; magenta, 
by fuchsin; reddish-brown, by sulphonal. A milky color is due to fat globules 
and indicates chyluria, or to pus corpuscles from purulent disease of the 
urinary tract. 

Reaction. Normal urine has a slightly acid reaction, chiefly due to acid 
sodium phosphate, also to uric and hippuric acids, and free acids, as lactic, 
acetic and oxalic. If excessively acid examine for crystals of uric acid. 
Hyperacidity occurs in fevers and in the uric acid diathesis; it is of slight 
diagnostic importance. On standing for some time, the urine undergoes 
ammoniacal decomposition and becomes alkaline through the agency of micro- 
organisms. Alkalinity of the urine occurs temporarily soon after a meal, 
and permanently from the presence of alkaline phosphates in large quantity, 
as in anemia and nervous depression, or from the use of a vegetable diet, the 
ingestion of alkalies (except ammonia) and alkaline salts of the vegetable 
acids, from cold bathing, in gastrectasis, from free blood in the urine, and 
from fermentation of the urine in the bladder. 

Test by litmus paper. If acid, the urine will turn blue litmus red ; if 
alkaline it will not do so, and will turn red litmus blue, or yellow turmeric 
brown. If the reaction is alkaline, dry the test-paper by gentle heat, in 
order to ascertain by the permanency or otherwise of the reaction whether 
the alkali is fixed or volatile; in the latter case the ammoniacal condition 
points to decomposition in the bladder, as in cystitis and atony of that 
organ. Fixed alkalinity is due to increased alkalinity of the blood, as in 
cases mentioned above, also when exudates and transudates are absorbed, 
and in stomach disorders when hydrochloric acid is diminished. 



< 



) 



870 URINE. 

Acetone and Diacetic Acid. For Acetone to 5j distilled urine in a test- 
tube add enough solution of potassium hydroxide to render it alkaline. Then 
add a few drops of a freshly prepared saturated aqueous solution of Sodium 
Nitro-prusside, and if acetone be present, a purple-red color will be formed 
on the addition of an excess amount of chemically pure Acetic Acid. If a 
ruby-red color results, it is not acetone but is due to creatinine, a normal 
urinary constituent. Pathologically the output of acetone is often greatly 
increased and at such times a condition of acetonuria is said to exist. It is 
met with in diabetes mellitusj in fevers, such as typhoid, scarlet fever, 
pneumonia, etc.; in starvation; in toxemia of pregnancy; accompanies chloro- 
form and ether anesthesia; acidosis, in gastro-enteritis of children, in cerebral 
irritation, and in other deranged metabolic functions of the body. Acetone 
and the closely related bodies, /3-hydroxybutyric acid and diacetic acid, 
are usually classified as the acetone bodies. 

For Diacetic Acid, add to freshly voided urine a few drops of a strong 
aqueous solution of Chloride of Iron. If a precipitate occur the mixture 
should be filtered. To a small quantity again add the solution of Chloride 
of Iron. In the presence of acetoacetic acid a Bordeaux-red color is produced. 
This color may be produced with the same reagent in the presence of salol, 
phenol, salicylic acid, etc. If the urine be previously boiled, diacetic acid 
is driven off and no reaction occurs while the reaction, resulting from the 
presence of the above-named substances will not be affected. Acetoaceturia 
occurs ordinarily under the same conditions as acetonuria. 

Albumin may occur in the urine in one of four forms, viz. — serum-albumin, 
nucleo-albumin, albumoses, and peptone; each of which has its special 
clinical significance. Serum-albumin is one of the chief constituents of the 
blood, and is the form of albumin which appears permanently in the urine 
in acute nephritis and in the various forms of Bright's disease. Nucleo- 
albumin is one of the constituents of bile, and a product of desquamated 
epithelium; it occurs in the urine in jaundice, and in catarrhal conditions of 
the urinary passages. Albumoses are intermediate products of the digestion 
of albuminoids, and are present in the urine in scarlatina, leukemia, and 
gastric and hepatic disorders. Their presence does not indicate renal dis- 
ease. Peptone occurs in the urine whenever there is absorption of destroyed 
tissue, as in phosphorus poisoning, ulcerating carcinoma, and acute suppura- 
tions. The tests for albumin in general use are as follows, the urine having 
been previously filtered: — 

(1) Heat and Acid Test. Fill a clean test-tube three-quarters full with 
clear urine and if alkaline add a few drops of acetic acid. Boil the upper 
layer slowly. If a cloudy opalescence appears in the boiled portion, which 
does not disappear on the addition of a few drops of 10 per cent Acetic Acid, 
it is albumin; if the acid causes it to disappear, it is phosphates. The white 
precipitate may also be obtained in the presence of resinous acids and bile- 
pigments. Other sources of errors such as using too strong an acid or adding 
too much acid, may lead to erroneous results. 

(2) Nitric Acid Test. Place in the test-tube about a drachm of pure nitric 
acid, and carefully overlay it with an equal quantity of urine. If albumin 
is present a white ring of coagulated albumin appears at the junction of the 
two liquids. Albumoses, resinous substances, uric acid are also precipitated, 
but not at the time of contact. Thymol gives a ring at the line of contact. 

(3) Potassium Ferrocyanide Test. Dilute the urine one-third with water, 






URINE. 87I 

and put a small quantity in each of two test-tubes. To one tube add a few 
drops of Acetic Acid, mix the contents of the two several times, and divide 
again, having some acidulated urine in each tube. To the urine in one tube 
add a few drops of 10 per cent, solution of Potassium Ferrocyanide, and com- 
pare with the urine in the other tube. If upon the addition of acetic acid a 
grayish cloud appears, which is not increased by the addition of ferro- 
cyanide, nucleo-albumin alone is present, but if it increases serum-albumin is 
also present. This test is accurate and delicate, and is sufficient for general 
office work. If it is negative, all forms of albumin are excluded except pep- 
tone, for which the 4th test is required. If positive, only albumoses could be 
confounded with serum-albumin, and by the 5 th test the presence or absence 
of the former is ascertained (Monroe). 

(4) Test for Peptone. If the urine contains serum-albumin, it should be 
removed by heat and filtration. Then add to the urine one-third its volume 
of a 10 per cent, solution of Sodium Hydrate, and follow with a few drops 
of a 2 per cent, solution of Copper Sulphate. If a purple color appears 
peptone is present; normal urine showing a bluish-green color. 

(5) Test for Albumoses. Add to a small quantity of urine twice its volume 
of a solution composed of equal parts of diluted Hydrochloric Acid and 30 
per cent, solution of Sodium Chloride. If albumoses are present a cloudi- 
ness appears which is dissipated on heating the mixture, but reappears when 
cooled. 

Other Tests for albumin are those by Picric Acid, Potassio-mercuric Iodide, 
and Sodium Tungstate. The presence in the urine of many substances 
interferes with the tests for albumin; among them are alkalcids, analgen, 
antipyrine, chloroform, copaiba, hypnone, piperazin, oil of santal, benzosol, 
and benzoic acid (contained in benzoin, benzoates, cranberries, plums, 
styrax, balsams of Peru and tolu). 

Bile Pigment. Gmelin's Test, as follows: Place on a white plate near 
each other a drop or two of urine and the same quantity of fuming Nitric 
Acid, and by manipulation bring the two together slowly. If bileUs present 
a play of colors results in this order, — green, blue, violet, red and reddish- 
yellow. MarechaVs Test, as follows: Put a drachm of urine in a test-tube, 
and let 2 or 3 drops of tincture of iodine trickle down along the side of the 
tube, held nearly horizontally, so that the fluids may touch but not mix. 
If bile pigment is present, a fine green color will be developed below the iodine 
layer. Other tests are Vogel's color-table, Noel's test, Pettenkofer's test, 
and the Silver Oxide test. Bile pigment is present in the urine in the acute 
stage of catarrhal jaundice, and in cases of cholelithiasis. 

Chloride of Sodium in the urine should be normally from J to 1 per cent. 
The quantity is increased in intermittent fever, and is decreased during other 
febrile diseases, particularly in croupous pneumonia during the stage of con- 
solidation, also in nephritis and in wasting diseases. Add to urine an equal 
quantity of a solution of Silver Nitrate, 1 in 8, which will precipitate both the 
chloride and the phosphates. Then add a few drops of Nitric Acid, which 
dissolves the phosphates, leaving the chloride as a dense, white precipitate 
of silver chloride, its bulk serving to estimate the proportion of chloride 
present. 

Cryoscopy is the study of the freezing point of the urine and blood of 
those supposed to be suffering from renal insufficiency, and is an elaborate 
procedure requiring a large quantity of blood. The freezing point is denoted 



i 



872 URINE. 

by o. The. value for normal urine varies between — 1.3 and — 2.3 C, the 
freezing point of pure water being taken as o°. The instrument usually- 
employed is the Beckmann-Heidenhiam apparatus. 

Diazo-reaction. This reaction is obtained in certain morbid conditions, 
particularly typhoid fever, acute tuberculosis, measles carcinoma, erysipelas, 
pleurisy pneumonia, syphilis, scarlet fever, etc. The reagents should be 
freshly prepared, and are (1) Hydrochloric Acid 50 parts, Sulphanilic Acid 
5, Distilled Water 1000. (2) Sodium Nitrite in 5 per cent, solution. Fifty 
minims of the first reagent and one drop of the second are placed in a test- 
tube, and an equal quantity of urine is added, then mixed carefully, and 
Aqua Ammoniae in the proportion of about f the volume is added. If a 
red color develops on shaking the mixture, the diazo-reaction is present. 
Salol, indican, urochrome, codeine, resorcinol, quinine, digitalin, creosote, 
ingested by the normal individual, produce a similar reaction (Jung); and 
the use of preparations containing tannin, iodine, or iodides inhibits it 
(Burghardt). 

Glucose. Urine containing glucose is usually light in color, has a high 
specific gravity, and froths readily when poured from one vessel to another. 
Before testing it should be freed from albumin. Fehling's Test, as follows: 
Add to the boiling Fehling's alkaline cupric tartrate solution, ten or more 
drops of urine until an equal amount has been added. If sugar is present 
a yellow, orange, or red precipitate of cuprous oxide will form; 10 mils of the 
solution being reduced by 0.05 gramme of diabetic sugar (anhydrous glucose). 
Another very good confirmatory qualitative test is the Bismuth Reduction 
test (Nylander). To 5 mils of urine in a test-tube add T V its volume of 
Nylander's reagent and heat for 5 minutes in a boiling water bath or over a 
free flame. This is then allowed to stand several minutes and if sugar is 
present, a black precipitate of bismuth suboxide will be deposited at the bottom 
of the tube. 

Other Tests for glucose are — Trommer's and Haines', which are similar 
to Fehling's; Bottcher's bismuth test, Moore's by sodium hydroxide, and 
the Picric Acid test, which are subject to fallacious results; that by Indigo- 
carmine, which is unreliable; the Polarization test, the Fermentation test by 
yeast, and the Phenyl-hydrazin test. 

Interference with tests for glucose occurs by the presence in the urine of 
the following substances: — acetanilid, antipyrine, ammonium salts, arbu- 
tin (contained in epigea, kalmia, uva ursi, etc.), benzoates, betol, bromides, 
camphor, some carbohydrates {e.g., animal gum), chloral, chloroform, co- 
paiba, creatinine, cubeb, glycerin, glycosuric acid, iodides, morphine, acet- 
phenetidin, pyrocatechin, rhubarb, rumex, salicylic acid (in salicylates, oil of 
wintergreen, oil of betula, salol), senna, serum-globulin, sulphonal, turpen- 
tine, urethane, uric acid and urates. Of the foregoing, those which actually 
reduce Fehling's solution are acetanilid, antipyrine, chloral, chloroform, 
copaiba, glycerin, morphine, rhubarb and salicylic acid. 

Temporary Glycosuria may be produced by poisoning with alcohol, 
amyl nitrite, carbonic oxide, chloral, hydrocyanic acid, morphine, sulphuric 
acid. 

Indican. Jajfe's Test, as follows: Mix 10 mils of urine with an equal 
volume of strong Hydrochloric Acid, and about 3 mils of Chloroform. Then 
add, drop by drop, several mils of a strong solution of Chlorinated Lime, pre- 
vious] y filtered, and shake after each addition. Allow the mixture to stand 



URINE. 873 

for a few minutes, when the chloroform will collect at the bottom in a layer 
which will be more or less deeply blue in color in proportion to the amount of 
indican present. Indicanuria has been considered a symptom of albuminous 
putrefactive change in the intestinal canal, but in typhoid fever it is often 
absent, and it occurs sometimes in simple constipation. It is said to be 
increased after a meat diet, and in intestinal obstruction. The extra-intes- 
tinal form, which is less important, may occur as result of protein putrefac- 
tion in such conditions as carcinoma, pulmonary gangrene, empyema, 
pulmonary tuberculosis with cavities, etc. 

Mucus and Pus are very frequently present together in suppurating 
conditions of the lower Genito-urinary tract. Mucus is more cloudy and 
flocculent to the naked eye than pus, which is generally of a stringy consist- 
ence and thickish yellow appearance at the bottom of the vessel. The super- 
natant liquid being poured off, and an equal bulk of Liquor Potassii Hydroxidi 
added, the deposit, if containing much pus, becomes gelatinized, and so 
tough that it cannot be poured out. If mucus, Acetic Acid added coagulates 
it, forming delicate molecular fibres. Pus is best recognized under the 
microscope by the enormous numbers of polynuclear leucocytes which are 
present. 

Phosphates. Deposits of phosphates are usually white and bulky. 
They are distinguished from urates by remaining undissolved on boiling the 
urine, and from albumin by dissolving on the addition of a few drops of 
Nitric Acid. Most samples of the urine give a precipitate of calcium phos- 
phate on boiling, but on adding a few drops of any strong acid the precipitate 
is redissolved. A deposit of phosphates may occur from alkalinity or defi- 
cient acidity of the urine, or from actual excess of the phosphates excreted; 
the clinical significance being different in each case. Phosphates have no 
significance when found in urine which has become stale after being voided, 
and has thereby acquired an alkaline reaction. Phosphaturia is the constant 
elimination in excess of the ammonio-magnesian or triple phosphates, or of 
calcium phosphate; and occurs in dyspepsia, cystitis, and alkaline fermenta- 
tion of the urine in the bladder. Magnesium phosphate has no special 
significance. 

Urates. Urine containing the amorphous Urates of sodium, potassium, 
and calcium in excess, has a high color, is strongly acid, and deposits on 
cooling a brick-dust sediment, which disappears promptly when the urine 
is heated. This condition occurs in fevers, renal congestion, dyspepsia, 
hepatic affections, the lithemic and rheumatic diatheses, and after severe 
exercise causing perspiration. 

Blood. With the exception of the urine of women during menstruation, 
etc., the occurrence of red blood cells in urine is always abnormal. Hema- 
turia is the name which is applied to such a condition. Blood in the urine 
may come from any part of the Genito-urinary tract. If, by the employ- 
ment of the cystoscope, the blood is found to come from one or both kidneys, 
the possibility of stone, tuberculosis, tumor, embolism, parasites, etc., must 
always be borne in mind. The detection of blood in urine by the chemical 
method is done as follows: Take 5 mils of urine in a clean test-tube, acidify 
with acetic acid and add a few drops of Tincture of Guaiac. Mix and add a 
few drops of fresh hydrogen peroxide or any other good oxidizing agent. In 
the presence of blood, the mixture will take on a blue color. 

Urea. For clinical purposes it is necessary to ascertain the proportion 
of urea present, which is obtained by any one of several ureameters sold in 



I 



I 



874 URINE. 

the shops. The most reliable depend upon the decomposition of the urea by 
a solution of Sodium Hypobromite or Sodium Hypochlorite, with evolution 
of nitrogen, the volume of which is the measure of the urea decomposed. 
These instruments are simple in arrangement, and are usually accurate 
enough for ordinary purposes. A more accurate determination may be 
obtained according to the Kjeldahl Method. 

The normal quantity of urea eliminated in 24 hours fluctuates between 
300 and 600 grains, or i| to 2 J per cent, of the urine. In cold weather it 
may fall to 130 or 140 grains in persons who lead sedentary lives; and it is 
decreased in those who have lived long in the tropics. It is increased in 
acute fevers, diabetes mellitus, dyspepsia, nervousness, by the excessive use 
of nitrogenous foods, and after the copious ingestion of water. It is de- 
creased in nephritis and starvation, by the use of vegetable foods, by the 
excessive use of tea or coffee, and after prolonged rest. 

Uric Acid. Chemical qualitative tests are usually unnecessary, as uric 
acid may often be detected by the naked eye as small, red crystals, in a uri- 
nary sediment, or deposited on the sides of a test-tube in which urine has 
stood for some time; and the crystals may be recognized with a low power 
under the microscope. The absence of uric acid or its compounds may be 
determined by the Murexide Test, as follows: On a watch-glass or the cover 
of a porcelain crucible treat the sediment with a drop or two of Nitric Acid, 
to dissolve it, and carefully evaporate to dryness. Then add a drop of 
Ammonium Hydroxide, the stronger ammonia water, and if uric acid or 
urates are present a purple color will be produced, due to murexide (ammo- 
nium purpurate). The quantitative test is best made by Maisch's modifica- 
tion of the Hopkins method, by precipitation with ammonia and hydrochloric 
acid, but the process is tedious and suited only to the laboratory. 

The normal excretion of uric acid varies from 7 to 10 or more grains daily. 
When not eliminated by the kidneys it becomes stored in the body and causes 
the uric or lithic diathesis, the manifestations of which are often serious. Its 
origin is believed to be from the disintegration of leucocytes and nuclein, not 
from the nitrogenous elements of the food, as was formerly held. It is dimin- 
ished in nephritis, diabetes, chlorosis, chronic rheumatism, and before the 
paroxysms of gout; and is increased in acute fevers, indigestion, leukemia, 
functional affections, heart and lung diseases with much dyspnea, and after 
attacks of gout. 

Microscopical Examination. The sediment may be collected by allow- 
the urine to sediment in especially constructed vessels (Gravity bottles) or 
better still, to centrifuge the urine and in this way an immediate micro- 
scopic examination is possible. The sediment is removed from the tube by 
means of a pipet and deposited upon a clean slide. A clean cover slip is 
then placed upon the drop of sediment and examined with the § inch and 
\ inch objective of the microscope. 

The unorganized sediment — the finding of the following crystals forms 
the important feature: 

In Acid Urines :|Uric acid, amorphous urates, sodium urate, calcium 
oxalate, leucin, tyrosin, cystin. In alkaline urine, calcium carbonate, am- 
monia-magnesium phosphate and ammonium urate. 

Organized Sediment. — 
1. Cells- 
Epithelium — squamous, candate and round. 



URTICARIA. 875 

Leucocytes — 

Erythrocytes — 

2. Casts. — Hyaline, granular, epithelial, fatty are the most important. 
Leucocytic, erythrocytic, crystalline, waxy, and bacterial casts may also 
be met with. 

3. Parasites and ova. 

4. Mucous shreds. 

5. Cylindroids. 

6. Spermatozoa. 

7. Bacteria. The most important pathogenic bacteria which may be 
encountered in the urine are as follows: Typhoid Bacillus, Colon Bacillus, 
Tubercle Bacillus, Gonococcus, Staphylococcus, micrococcus catarrhalis; etc. 

Urticaria. 

As the acute form, and many instances of the chronic form, are due to 
some gastro-intestinal disturbance, the most important part of the treatment 
must be directed to a correction of this factor. Although external applica- 
tions must be prescribed to allay the itching, they will not cure the disease. 
The diet should be restricted during an acute attack to lamb and chicken 
broth, rice, toast and milk. As the patient improves, one article of food may 
be added at a time but should be discontinued if it is found to disagree with the 
patient. It is at times advisable to resort to the cutaneous food tests. In 
this way, it may be found what article of diet is producing the gastro-intes- 
tinal disorder. Alcohol in any form is contraindicated. Aspirin, 5 grains 
t. i. d., has been well recommended. Bran placed in a bag and soaked in 
water and then wrung out may prevent the itching which sometimes follows 
a bath. Boric Acid, Zinc Oxide, each a drachm to the ounce of water, may be 
used with Carbolic Acid, 5 minims to the ounce, and be very soothing. Calo- 
mel is indicated in the early stage of this disease, 1 to 2 grains in divided 
doses, followed the next morning by a saline purge. Castor Oil may be used 
but the secondary constipation effect of this remedy depreciates its value. 
In order to keep the bowels acting freely, laxatives such as Cascara Sagrada 
and Phenolphthalein are of value. Charcoal is of some slight use, in 5 to 10- 
grain doses after meals. Citrate of Magnesia may also be employed as 
a laxative. Injections of Colon Bacterin have been quite extensively 
used. In chronic cases, the Galvanic Current and High Frequency Current 
and also that from the static machine have been used with considerable 
success. These, however, have no value in acute cases. Fluid Extract 
of Grindella Robusta, J drachm to the ounce of water is used. Hydro- 
chloric Acid, 5 to 10 minims, t. i. d. is indicated if there is a lack of acidity. 
Laxative Waters, taken half to one wine-glassful before breakfast is good 
treatment, the frequency of this, however, depending upon the condition 
of the bowels. Lysol, 1 ounce to the tub of water, will relieve to some ex- 
tent the itching. Phenol is of the greatest importance in the treatment of 
this disease as it aids materially in reducing the itching. Tinctura Picis 
Mineralis Comp. is of great value, 25 to 50 per cent, strength in water. The 
value of this is increased by the addition of Carbolic Acid, 5 minims to the 
ounce. Pilocarpin or Jaborandi are also indicated. Salol, 5 to 10 grains, is of 
value. Sedatives may be necessary in severe cases; Sodium Bromide, Potas- 
sium Bromide and Ammonium Bromide, Chloral and Sulphonal are often 



876 UTERINE AFFECTIONS — UTERINE CANCER. 

used, but rarely Morphine and Codeine as the latter drug is prone to produce 
more itching. Sodium Bicarbonate baths may be of assistance, using 4 
tablespoonfuls to a tub of water. Sodium Bicarbonate and Sodium Salicy- 
late, 5 to 10 grains, t. i. d. are of value in case of hyperacidity. Starch, a 
teacupful to the basin of water, will temporarily relieve the itching. Sulphur 
in the form of an ointment or in the bath possesses some decided value. Tar 
preparations are of value but their odor usually prevents their use. The 
treatment of this disease by means of Yeast is attracting the attention of 
many physicians, the patient taking a cake of yeast macerated in milk, 
water or orange juice after each meal. If this produces too much gas, the 
dose can be reduced or the cake immersed in boiling water which will destroy 
the vitality of the growth and it can be taken when cooled. 

Uterine Affections. 

Cimicifuga, to prevent miscarriage in irritable uterus and prolapsus (R) ; 
promises to be a valuable remedy in uterine affections (Wa); is remarkably 
efficient in neuralgia and sympathetic pains arising from an irritable uterus 
no matter what their precise character (P). Belladonna, with Tannin, as 
suppository in uterine neuralgia (R); as vaginal or rectal injections, in neu- 
ralgic or inflammatory pains (Tr). Arsenic, in irritable ulcers, of decided 
benefit; gr. -^ ter die, after meals (Wa). Carbonic Acid, injected up the 
vagina for neuralgia of the uterus (R). Opium, with Starch as injection 
into the rectum, will subdue the pain of uterine diseases (R); gives more 
speedy relief than any other remedy in irritable uterus, but long-continued 
is one of the worst (Wa). Iodized Phenol, has proved the most generally 
efficient agent for intra-uterine use during eight years' experience, applied 
by hard rubber probes wound with cotton- wool; it removes cervical mucus, 
gives freedom from pain, softens and dilates the cervix, heals abrasions, 
removes induration and villosities, regulates the menses, improves appetite 
and digestion, acts as a general alterative, and overcomes barrenness, if 
used long enough, but rapid results are not attainable by any method of 
treatment (Battey). Lead, as plaster, for pain in the back due to uterine 
disease (R). Chloroform, spray, in uterine neuralgia (R.) Aquapuncture, 
has had extraordinary success in uterine colic (B). Baths of warm salt 
water remarkably useful in nervous or inflammatory hysteralgia (Tr.) [See 
Abortion, Amenorrhea, Climacteric Disorders, Dysmenorrhea, 
Endometritis, Hemorrhage post-partum, Leucorrhea, Menorrhagia, 
Menstrual Disorders, Metritis, Metrorrhagia, Prolapsus Uteri, 
Uterine Cancer, etc.] 

Uterine Cancer. 

Operation, early diagnosis with complete removal offers the only chance 
for cure. 

Acetone, 5 ss-j poured into the wound after thorough curettement, and 
left 15 to 20 minutes, then packed with gauze saturated with Acetone; this 
repeated without curettement 2 or 3 times a week, effectually stops hemor- 
rhage, discharge, and odor, greatly improves the condition and prolongs the 
life of the patient (Gellhorn); a valuable palliative treatment of inoperable 
cases (Maier). Arsenic, small doses for a long time, with a strong solution 
of Iodine and Glycerin locally (Atlee); is believed to retard the growth of 



UTERINE CONGESTION. 877 

uterine cancer (Br.) Carbonic Acid, injected vaginally, to relieve the pain 
(R). Conium, useful as a palliative, 3 iij— iv ad Oj aquae, as injection for the 
extreme pain of uterine cancer (Wa). Opium, stands first in the list of 
palliatives, quieting irritation, allaying pain (Wa). Morphine, the specific 
action thereof upon the uterine circulation should be utilized in hopeless 
cases of this disease (Lutaud). Cotarnine, gives good but transitory results 
in the hemorrhages from uterine carcinoma (Nassauer). Ichthyol undiluted, 
applied on tampons, is analgesic and disinfectant, removes fetor, checks 
secretion, and is remarkably palliative (Woyer). Phenol pure, a weak solu- 
tion as injection, an excellent cleanser, healer, disinfector, and allayer of pain 
(R); used to cauterize after curettement in 3 cases which were alive and 
healthy four years afterwards (Weindler). Zinc Chloride used in 6 cases 
which showed no signs of recurrence (Fraenkel) . Bromine, the best escharotic 
for destruction of the mass (E). Glycerite of Tannin, checks discharge and 
stench; is still better if mixed with glycerite of Phenol (R). Iodoform, 
with cocoa-fat as bolus inserted into excavation produced by cancer (R); 
gr. v-x in each bolus (W). Iodine, the saturated tincture thoroughly applied 
to the entire surface of the mass, is frequently of great use in checking hemor- 
rhage, and seems to temporarily check the extension of the disease (E). 
Chloral, as anodyne, will agree with most persons (E) ; relieves the pains (W). 
Chloroform Spray, for some minutes (R). Cannabis, to allay the pain 
(W). Trypsin has proved valueless (Maier). Electricity has given no bene- 
ficial results (Id). Surgical Measures, are to be advised, as medicines can 
only serve as palliatives. [Compare Cancer.] 

Uterine Congestion and Hypertrophy. 

Ergotin, long continued, successful in chronic metritis; lessens congestion 
(B) ; long continued has produced remarkable results in fibroids and polypi 
and chronic metritis, large, spongy, subinvoluted uterus (P); by interstitial 
injection into the cervix, has been of great benefit (G). Phenol pure, 
undiluted, on cotton-wrapped probe, no better treatment for uterine catarrh 
(B) . Iodine, has proved the most valuable of all remedies as a local stimulant 
and a reliable alterative and excitant of uterine contraction; use a saturated 
tincture to any part not exposed to the air (E) ; may be injected into cervix 
(G). Iodoformi 5j, Ac. Tannici §j, a serviceable application in many 
inflammatory and hypertrophic conditions; Iodoform suppositories in 
chronic metritis (P). Potassium Bromide, our main stand-by in uterine 
troubles; aside from its soothing properties it seems to divert the blood from 
the womb, and to lessen uterine congestion (G). Digitalis, in subinvolution 
(B). Cotarnine is powerfully hemostatic and gives permanent results in 
pure subinvolution (Gottschalk) ; in both post-partum and post-abortum 
subinvolution, provided that no decidua or debris remain (Freund ) . Ichthyol 
with glycerin on vaginal tampons, has analgesic and resolvent action (Id). 
Glycerin on cotton tampon to cervix as a local hydra^ogue (Thomas). 
Potassium Hydroxide, Caustic Potassa and Potassa cum Calce, said to be 
effective in chronic metritis; used cautiously (B). Chromic Trioxide, a 
strong solution to interior of uterus, a useful application. Ipecacuanha, 
in subacute metritis of the puerperal state (Tr). Iron, locally in uterine 
catarrh (R); as a tonic, Iron and other restoratives, a cardinal rule in the 
treatment of all uterine disorders; with Ergot, Quinine, Arsenic or Potassium 



4 



878 



UTERINE DISPLACEMENTS — UTERINE ULCERATION. 






Bromide, whenever the womb as a whole is congested or hypertrophied; Syr. 
Ferri Iodidi, with Cod-liver Oil, wins half the battle (G). Zinc Valerate, 
in 2 to 4-grain doses thrice daily, is one of the best nervines in these cases (G). 
Electricity, in chronic congestive enlargement, a galvanic current of moderate 
intensity, slowly interrupted (B). Water, hot injections or douche, also 
cold alternately, one of the most effective measures, a gallon very hot ter 
die (R); especially valuable in congestion, which is generally venous; ele- 
vated hips a necessary part of treatment (E) ; cold water is often better than 
hot (G). Rest, to the patient and the organ, is of prime importance, abdomi- 
nal bandage, skirt supporters, pessary if anteversion or retroversion; ab- 
stinence from sexual intercourse (Thomas). 



1$. Ext. Humuli, g j. 

Elix. Ammon. Valerat., 

Syr. Lactucarii, aa §ss. 

M. Sig. — A dessertsp. at bedtime, or dur- 
ing the day when needed, as an antispas- 
modic. (Goodell.) 



1$. Iodi, 

Potass. Bromidi, aa gr. xx. 

Tinct. Iodi 5j. 

Aquae Destillat.,. .q. s. ad 5iv. 
M. Sig. — ttjjxxx to be injected into the 
cervix by 3 to 5 punctures. (Goodell.) 



, 



Uterine Displacements. 

Ice, locally when parts inflamed (R). Hot-water injections, to give tone 
to the vessels, essential; also valuable after reduction of malpositions (E). 
Mechanical Means, only reliable or safe in retroversion and prolapse; the 
sound, as a means to restore a retroverted uterus to position, cannot be re- 
garded as free from risk, even in skillful hands (E). Pessaries, harmful 
unless expertly fitted; should be adjusted so as to restore the uterus to the 
normal line, where the circulation will be least obstructed, not too high; 
should never be employed where cellulitis exists (E). Cotton Roll, as a 
substitute for the orthodox pessary, is far better; use Borated Cotton in 
flat sheets, rolling it into a roll 2 inches long by 1 inch diameter, and saturat- 
ing in Boroglyceridi § j, Alumini Acetatis § j, Glycerini Pur. q. s. ad Oj; if 
an astringent is required, the Acetate may be replaced by Alumini Sulphas 
(Wylie). Anteversion, without prolapsus, is not a mal-position (E). 
Operative correction is frequently necessary. [Compare Prolapsus Uteri.] 

Uterine Tumors. 

All uterine tumors should be removed. The malignant ones because 
radical removal in the early stages gives the only hope for cure, the benign 
ones because they may become malignant or cause profound reduction of 
health because of the symptoms they produce. 



I 



Uterine Ulceration. 

Hydrastis, quickly improves; the fluidextract undiluted as a topical 
application in uterine and vaginal leucorrhea, ulcerations and erosion of 
cervix (B). Phenol pure, undiluted, over surface twice a week in simple 
ulceration (R). Silver Nitrate, a serviceable application, but is often abused 
(B); the solid stick applied to surface, after cleansing and drying with cotton- 
wool (Wa). Alum, as hip-bath, lb. j ad Cj, and vaginal injection, is of 
great utility in ulcerations of the os uteri, or of the uterine cavity (Recamier). 



UVULA — VACCINATION — VAGINISMUS. 879 

Glycerin 25, Alcohol 12 J, and pure Creosote 1 part, an excellent application 
to ulcers of the neck. Bismuth Subnitrate, with enough glycerine to make a 
thick cream, is the best of all applications for ulcerations of the os and cervix 
uteri (Suesserott). Vegetable Astringents, infusions or decoctions of Galls, 
Oak-bark, Hamamelis, Geranium, Alum-root, etc. ; the Glycerite of Tannin, 
or Iodoform and Tannin, packed around the cervix (B). [Compare Endo- 
metritis, Leucorrhea.] 

Uvula. 

Capsicum the tincture, with Glycerin, equal parts, as a gargle for relaxed 
uvula. Ammonium Bromide, gr. xx to the 5 of water, as a gargle, is one of 
the best applications, being as soothing as it is astringent (Muirhead). 
Kino, the tincture with glycerin, equal parts, makes a good gargle. Tannin, 
or Rhatany, as astringent lozenges, for relaxed uvula (A) . Cocaine combined 
with extract of Krameria, in a pastille, is often very effectual as a local as- 
tringent for elongated uvula (Hall) ; a 20 per cent, solution applied by the 
spray or brush, will often suffice to give relief in acute uvulitis (Id). Ampu- 
tation of the elongated part (A); after applying a 20 per cent, solution of 
cocaine, by Mackenzie's uvulatome, or the uvula may be seized with forceps 
and a portion cut off with scissors (Hall) ; the hemorrhage may be severe 
and may recur some hours after the operation, but will be arrested by slowly 
sipping a mixture of Tannin, 5 vj, Gallic Acid 5ij and Water § j (Mackenzie). , 

Vaccination. 

Aconite, internally with Belladonna Ointment locally twice daily for 
erysipelatous redness after vaccination (R). Zinc Oxide, dusted over, to 
allay the subsequent local irritation (W) ; with Pulv. Amyli, equal parts, over 
the surface. Lead Acetate, 5j to Oj water, as lotion for irritable pock 
(Foster). Phenol, 3j to Oj water, as lotion for excessive redness, with 
burning and itching. Mercury, a 1 to 2000 Bichloride solution is used as 
a wash to the skin for preliminary asepsis, but if not thoroughly removed 
by hot water it will destroy the vaccine virus, and will render the vaccination 
unsuccessful. 

Vaginismus. 

Ether, by inhalation as anesthetic, to ascertain cause, usually a displace- 
ment, fissure, or cellulitis (E). Thiol j, and Glycerol ij, in which soak a 
tampon and apply for vaginal irritation (Bloom). Iodoform, in suppository 
when redness and excoriation; but Belladonna, the extract 1 part with 8 or 
9 of fresh lard, when pain alone (Gallard). Cocaine, in ointment with 
Morphine and Conium, smeared over the painful spot with the finger; or in 
a pessary with Iodoform and extract of Belladonna, may give speedy relief 
(Whitla). Piperine, gr. ^ hypodermically near the vaginal orifice, proved 
successful (Schiffer). Silver Nitrate solution, gr. xxx to the 5, applied 
to eroded or hyperesthetic spots, under anesthesia if necessary. Tents, 
to gradually dilate the vagina, may be impregnated with various sedatives. 
Hygiene, sun-baths, hot-water injections, fresh air, removal from husband 



88o 



VAGINITIS — VARICELLA. 






(E). Operation, Sims', removal of hymen with scissors and insertion of 
glass plug till parts are healed, when the cicatrix is to be divided (E) ; Atthill 
removed a narrow strip of mucous membrane on each side of the vaginal 
orifice with marked success in a very severe case. 



1$. Iodoformi, 5 j« 

Cocainae (alkaloid), gr. vj. 

Phenolis, TTgvj. 



Olei Theobromatis, 5iij- 

M. ft. suppositoria. no. vj. Sig.- 
into vagina at night. 



-One 



Vaginitis. 

Acetanilid in mixture with gum-arabic water, gr. xx-xl to the 5> as a 
vaginal injection, stimulant and antiseptic (W). Argyrol, in io to 50 per 
cent, solution, a very valuable application (Small). Silver Nitrate, in 
solution, gr. xl to the 5 s , applied within the cervical canal and over the vaginal 
mucous lining (E). Pinus Canadensis, the concentrated, colorless extract, 
locally, has a very soothing effect in acute vaginitis. Tannin, the glycerite 
in chronic vaginitis of children (R). Airol in suppository, is antiseptic and 
sedative ( W) . Hydrastis the nuidextract locally is considered valuable by vari- 
ous specialists (W). Ichthyol in 10 per cent, aqueous or glycerin solutions, is 
very serviceable (Bagot) ; quickly relieves the pain (Bloch) ; in gelatin and glyc- 
erin as pessary, to relieve vaginal congestion (Playfair). Zinc Stearate mixed 
with Thymol Iodide, used locally with satisfaction (Brown). Emollients 
with Opium, as injections (Goodell). Gonococcic Vaccine is more efficient 
than any other means in the vulvo-vaginitis of children (Williams) ; in 84 
cases cured in an average of 1.7 months, as against 10. 1 months in 260 cases 
treated by irrigation (Hamilton). If vaccines are used, a dose of from 
5,000,000 to 10,000,000 every 5 to 7 days may be employed. [Compare 
Gonorrhea, Leucorrhea.] 



1$. Extracti Hyoscyami, 

Extracti Opii, aa gr. vj. 

Liq. Plumbi Subacetatis, 5ss. 



Olei Theobromatis, 5iij- 

M. ft. suppositoria. no. vj. Sig. — Insert 
one night and morning after hot douche. 



Varicella— Chicken-pox. 

Aconite when the fever is high (B). Ammonium Acetate, in diaphoretic 
and antifebrile mixture. [See under Fever, Simple, for formula.] Inunc- 
tion, with Camphorated Oil, or thin starch, to relieve itching and allay in- 
flammation (P); or with Phenol 5ss in Cotton-seed Oil 5 viij. Quinine in 
small doses during convalescence. Water, hot and cold baths and packs are 
of great utility; cold, if hyperpyrexia; cold compress if sore throat; hot or 
warm pack when free diaphoresis required (B). Diet, no animal food, milk 
best, with careful attention to the bowels, patient to be kept cool with light 
covering, and use of a mattress rather than a feather bed, is all the treat- 
ment required (A). Complications require symptomatic treatment; care 
should be taken to prevent the child scratching pustules on the face; the 
mouth should be kept clean, also the vulvae. 



1$. Tinct. Aconiti, ttjtxv. 

Potassii Citratis, 5ijss. 

Spt. iEtheris Nitrosi, 5 v. 

Syr. Limonis, 5 v. 



Aquae,. q. s. ad § iv. 

M. Sig. — Teasp. in water every 2 hours 
for a child of 2 years. Diuretic and febri- 
fuge. 



VARICOCELE — VARICOS1S — VARIOLA. 88 1 



Varicocele. 



In treating varicocele, reassure the patient; tell him there is no real 
danger of impotence; order cold shower baths, correct constipation and 
indigestion, give occasional Tonics, and order the patient to wear a Suspen- 
sory Bandage (Da C). Water, cold douche to the perineum and buttocks, 
with suspension of testicles in cold water (R). Radical Cure, consists in 
excising about two-thirds of the plexus by the open operation, which has 
obvious advantages over other methods (Hirsch); subcutaneous ligation 
of the veins is now rarely done, by reason of the danger of puncturing the 
veins, with resulting hematocele, and other sequelae (Id). 

Varicosis. 

Bandage, or elastic stocking; with cold sponging and rubbing upwards, 
as palliatives (CI). Massage is useful, especially alcohol frictions, if eczema 
is absent, and cold baths are always forbidden (Bennett). Operation is 
rarely required if the disease involves the leg only, and it may even do 
harm; but is advisable if there are cyst-like dilatations, if thrombi form, or if 
a thin-walled vein crossed the tibia, and is thus exposed to the danger of 
injury and thrombosis (Id). [Compare Hemorrhoids, Ulcers, Vari- 
cocele.] 

1$. Strychninae Nitratis, gr. j. 

Barii Chloridi, gr. vj. 

Gland. Suprarenal. Sic, 5ij- 

M. Pone in capsulas no. xxiv. Sig. — One capsule 3 
times a day. In varicose veins of the leg. 

Variola 

Treatment, in no way differs from that of the other eruptive fevers. 
Stokes' three indications for treatment were: (i) exclusion of air, (2) keeping 
the parts in a permanently moist state so as to prevent hardening of the 
scabs, (3) lessening of local irritation (Whitla). Quinine, small doses in 
adynamic states, large doses when hyperpyrexia (B). Iron and Quinine, 
in large doses by the mouth, also Ergotin by deep parenchymatous injection, 
and Turpentine by the bowel, in the hemorrhagic form of the disease (Whitla) , 
these two drugs are the most valuable antiseptics in variola (Moore). Opium, 
low, muttering delirium; not so much used now as formerly (B); for the pain 
in back and limbs of the early stage (O) ; Morphine in the insomnia of the 
advanced stage, once or twice only, but not when copious salivation or mucous 
expectoration (Wa); useful in the advanced stages to sustain the system 
against an irremediable irritation by blunting sensibility (W). Phenol, 
pure, TTliij with gr. iij of Quinine Sulphate, every 4 hours, effectually aborts 
the disease in its various stages (Seymour); is used with advantage (Wa); 
has been used on theoretical grounds but not with success (B). Salol, 
gr. xv every 2 hours, is very successful (Begg) ; is useful but of limited value 
(Muir). Ammonium Carbonate has been used successfully (Wa). Chloral 
when the temperature is high, and there is much restlessness and delirium 
(B). Chloroform by inhalation, when the delirium is maniacal (O). Cimici- 
fuga is given internally by some who maintain that it prevents pitting (R). 
56 



882 VARIOLA. 

Camphor is said to restore the eruption, if retrocedent; in confluent malignant 
smallpox, camphor alone, or with Opium, may be used for great depression 
of the vital powers (Wa) . Belladonna, successfully used both as prophylactic 
and curative agent (Erasmus Wilson); gr. ^-j every 3, 4, or 6 hours, to dila- 
tation of pupil and some stupor, found effectual (Wa). Antistreptococcic 
Serum used in a series of cases with great benefit and rapid convalescence 
(Smith) ; used in 22 cases with mortality of 9 per cent., against 34 other cases 
not so treated with mortality of 20^ per cent. (Schoull). Diet as in other 
fevers, tea and dry toast, raw eggs beaten up with cold milk, beef-tea when 
stimulation is indicated, roasted apples, ripe fruit in season, cold water drank 
freely. 

External Applications, as powdered starch, flour, or Zinc Carbonate 3 
parts to 1 of Zinc Oxide with Olive Oil; cold or tepid water with vinegar, 
sponged over body twice or thrice daily (Wa). Ichthyol has been recom- 
mended in the strongest terms for the prevention of pitting (W), in 12 to 
20 per cent, ointment gives prompt relief, shortening the course and pre- 
venting pitting (Kamneff ) ; gives good results when applied to the scars left 
by variola (Schmidt). Phenol undiluted, applied carefully to the rash over 
a certain area each day, first on the head and face, will arrest the eruption 
in any stage, cut short the disease, prevent secondary fever and pitting, and 
lessen the patient's infectiousness (Duhr) ; will arrest the disease in any stage 
(Neech) ; in water on lint to the face and hands, is perhaps the most suitable 
local treatment (O). Mercury in ointment or plaster, to prevent pitting in 
semi-confluent cases (Wa); a solution of the Bichloride on lint to the face and 
hands (O); the Bichloride, a solution 1 to 1000 applied by scrubbing twice 
daily, gave excellent results in the Havana epidemic of 1898, reducing the 
secondary fever to a minimum, preventing the stench, and lowering mortality 
to 10 per cent. (Woodson). Guaiacol in olive oil, 1 to 80, as inunction every 
4 hours, allays irritation, checks maturation, abolishes odor, reduces tempera- 
ture, and prevents delirium (Ridge). Carron Oil makes a good dressing for 
the face. Fats, bacon fat smeared over the face, to allay itching and prevent 
pitting. Silver Nitrate, on a sharp-pointed stick inserted into each vesicle 
after rupture, to prevent pitting (B); or simply paint skin with a solution 
of gr. xx to the § (R). Iodine, the tincture to prevent pitting, is painted 10 
times over face if on first day of eruption, 12 if on the. second day, 12-16 
times if on third day (B). Collodion, or solutions of India-rubber or Gutta- 
percha in Chloroform, to prevent pitting, or cotton-wool dipped into Lime 
liniment, applied to the face or neck (R). Salicylic Acid 5j ma quart of 
hot water, applied by sponging to the skin and by gargle to the throat every 

4 hours, used also internally if much diarrhea, is my treatment and I have not 
lost a case of variola since adopting it (Pope). Eucalyptus, the Oil as inunc- 
tion from the very commencement of the disease, is to be strongly recom- 
mended as an antiseptic application to the skin (Whitla). Thiosinamin, in 

5 to 20 per cent, soap or plaster, to cure the scars (Unna). Daylight should 
be shut out absolutely or replaced by red light, in all serious cases in which 
suppuration may be expected (Finsen); red light treatment has failed to 
prevent pitting in many cases (Schamberg). Water, as cold baths and cold 
pack, of great utility (B); packing especially on retrocession of rash (R); 
cold baths at 70 F. every 3 hours, or the cold pack when temperature rises 
above 103 F., also for nervous symptoms, is much preferable to medicinal 
antipyretics (O). Scrub Baths daily with toilet sand-soap, if begun before 



VERTIGO — VITILIGO. 883 

the primary papules develop prevent vesiculation, and combined with punc- 
ture of vesicles and Hydrogen Dioxide in full strength on compresses, fol- 
lowed by a wet mask saturated with Mercuric Chloride solution i to 1500, 
will prevent pitting (Woodson). [Compare Vaccination.] 



fy Tinct. Aconiti,. ; .. .^ 5ss. 

Spt. Athens Nitrosi, § ss. 

Liq. Potassii Citratis, ad §iv. 

M. Sig. — A dessertsp. in water every 2 
hours. In early stage. 



1$. Bismuthi Subnitratis, 3iv. 

Phenylis Salicylatis, 5ss. 

M. ft. chartulae no. xij. Sig. — One powder 
every 2 hours. For diarrhea and vomiting. 



Vertigo. 

Digitalis, in small doses, alternately with tincture of Larch, and a long 
course of Iron Citrate and Strychnine, in essential vertigo, without any other 
head symptoms, and with general depraved nutrition, the most effectual 
treatment (Wa). Potassium Bromide, gr. xx thrice daily, is sometimes bene- 
ficial in Meniere's disease (O); often controls paroxysmal vertigo, without 
coexistent spasm, or organic brain-disease (Wa). Ammonium Bromide, in 
an effervescing form with Cascarilla, for vertigo from overwork, when 
there are usually restlessness, insomnia, depression of spirits, with a sense 
of impending evil (Wa). Alkalies and Bitter Tonics, give the best results in 
vertigo of gastric origin. Sodium Bicarbonate, after meals, tonics before 
meals. Strychnine, with Iron, thrice daily, gives good results. Corrosive 
Sublimate, in small doses, with attention to the bowels and diet. Cod- 
liver Oil for giddiness of the aged, when no serious brain-disease (R). Qui- 
nine, in aural vertigo, Meniere's disease, 10 to 15 grains daily, continued with 
intervals for several weeks (Charcot). Electricity, the constant current 
daily, anode over cervical vertebrae, cathode over the ear, the current strength 
being gradually increased to' toleration and continued from 3 to 5 minutes 
at a sitting, is of great benefit in aural vertigo, ameliorating the condition in 
most cases. Nitroglycerin, gives good results in epileptic vertigo (Br); 
in small doses gradually increased, sometimes acts satisfactorily in cases of 
giddiness of middle-aged persons, associated with arterio-sclerosis (O). 
Glasses to correct errors of refraction, are sometimes followed by prompt 
relief of vertigo (O). Vertigo is usually symptomatic of disorder of the 
stomach, or of the liver (cholemia) sometimes of general debility, rarely of 
disease of the brain (H). 

Vitiligo. Leukodermia. 

The treatment of this condition is, as a rule, unsatisfactory as very little 
can be done in the average case to restore the normal color of the skin. 

Pigmentation has been produced by the Actinic rays from different 
high-power lamps and also from the application of strong counterirritants 
along the border of the area. Small spots can be covered and made absolutely 
inconspicuous by the use of grease paints and powders tinted to the color of 
the skin. Arsenic internally has been found to be of value as a tonic and 
in some cases for its direct influence on the skin. The Galvanic current is 
of value in stimulating the pigment cells, using the positive electrode at the 
back of the neck and the negative over the patches. 



i 



884 VOMITING. 

Glandular Extracts. — Thyroid and suprerenal, should be tried as they at 
times produce results. Pilocarpine has been used in some few cases both 
internally and hypodermically. Resorcin, 50 per cent, in alcohol twice a 
week applied to the spots will produce considerable reaction and may restore 
the color. Tattooing has been resorted to in cases in which the areas de- 
nuded of pigmentation are at all conspicuous. 

Vomiting. 

Arsenic, in many forms of gastric vomiting, especially that of alcoholism 
and chronic ulcer (B), and the vomiting of cholera (R); gtt. ss of Fowler's 
solution, every § hour for 6 or 8 doses, often relieves vomiting after a debauch, 
the morning vomiting of drunkards, and that of pregnancy (Smith). Atro- 
pine has sedative action on the vagus, the gastro-enteric branches of which 
nerve are powerfully excited in choleraic vomiting (Harkin). Ammonium 
Carbonate, may relieve vomiting when the ejected matter is acid (B). 
Alcohol, iced brandy or champagne in teaspoonful doses every \ hour in 
vomiting of cholera, pregnancy, and delirium tremens (B). Alypin, in dose 
of 5-6 drops of a 5 per cent, solution, is useful for vomiting in nephritis 
(LaufTer) . Bismuth, the insoluble salts to allay vomiting dependent on gastric 
irritation (W), or many forms in children, especially when due to gastric 
catarrh (R); the subnitrate is sedative, astringent, and antiseptic (W). 
Bromides, in cerebral vomiting only; not in the gastric form (B); Potassium 
Bromide in that of uterine disease (W); Strontium Bromide is excellent in 
vomiting due to various causes; gr. x-xv twice daily with meals. Bryonia, 
for bilious vomiting with headache (P). Cerium Oxalate is believed to 
have a specific influence over vomiting (W) ; gr. j every 3 hours (R) ; especially 
in that of pregnancy and cancer (B). Chloretone is used for its local anes- 
thetic influence (W); in doses of gr. v thrice at 15-minute intervals prevents 
the vomiting of sea-sickness and general anesthesia (Bowles). Chloroform, 
TTUj-v, on sugar, for non-inflammatory vomiting (R). Cinnamon or Cloves, 
will check vomiting (P). Calumba, in vomiting from kidney disease and 
renal calculi; frequently allays that of pregnancy and dentition (P). 
Cocaine, in doses of gr. J thrice daily, controlled the vomiting of gastric 
carcinoma, after all other means failed (Meigs); 10-minim doses of a 4 per 
cent, solution every hour, of inestimable value in the vomiting of yellow 
fever (Jennings) ; in 2 per cent, solution sprayed high up the nasal passages 
[See under Nausea] . Creosote as a nerve paralyzant, is frequently employed 
with great advantage (W); in that of gastric cancer and ulcer (R). Hydro- 
cyanic Acid, often very serviceable in nervous vomiting, acts promptly if at 
all (R). Hydrobromic Acid, 3ss in § j of water, four times daily, useful for 
the vomiting due to gastric ulcer (R) . Ipecacuanha, in small doses, will arrest 
certain kinds — a curious fact; especially useful in certain forms, Tflj of Vinum 
Ipecac every \ hour or more (B, R, P); in sick stomach of nervous origin, 
minute doses are of undoubted value (W). Kumyss is effective when no 
other food can be retained. Limewater, is a favorite remedy for vomiting, 
especially in children; Milk and Lime-water often relieve when other methods 
fail (B). Menthol, has successfully checked persistent vomiting after all 
the usual remedies had failed in the hands of many well-known observers; 
TTlx of a 20 per cent, solution in Olive Oil, dropped on powdered sugar, each 
dose being about 1 grain (Weil). Mercury, gr. j of Gray powder every 2 



VOMITING OF PREGNANCY. 



88 5 



hours, especially in children with clayey stools (R); Calomel, gr. j to Oj 
aquae, first dissolved in 5 j of Lime-water, a teasp. every ten minutes for the 
regurgitation of food in nursing children (Smith). Nux Vomica, stands next 
to Arsenic, is useful in many ways (B) ; may be given with Ipecac, especially 
when tongue coated (R). Opium is one of the most reliable remedies in 
severe acute vomiting, and is best used in suppository containing gr. ss-j 
of the extract, or by enemata of laudanum with starch-water (W). Mor- 
phine hypodermically, will arrest many kinds, is best in that of renal or biliary 
calculi, dysmenorrhea, or sea-sickness (P). Codeine in dose of gr. } usually 
acts well in vomiting from any cause (Braithwaite). Phenocoll, with 
Piperazin, gr. xv of each daily in a pint or more of carbonated water, was of 
great service in a case of uncontrollable vomiting which had resisted every 
known remedy. Phenol is antiseptic and locally anesthetic, gr. j-ij every 
J to 2 hours in nervous vomiting (W) ; with or without Bismuth (B) . Sodium 
Bicarbonate, 5 ss-j to a pint of milk, for infants, especially if constipated 
(R) ; the effervescing soda powders in the vomiting of acute diseases and the 
exanthemata (B); the severe vomiting of acute disease is often controlled by 
5 doses in plenty of hot water. Sodium Citrate is specific in cases occurring 
in infants, and may be freely given as it is not toxic (Variot). Sulphurous 
Acid, Tfl.x-5j, well diluted, or less effectively Sodium Sulphite; Sulphites 
often curative in vomiting of sarcinae and acid matter, due to acid fermenta- 
tion of starchy elements (B). Veratrum Album, in the vomiting and 
purging of summer diarrhea (R). Water, carbonated, is an efficient remedy, 
or Ice sucked, with horizontal posture, also absolute rest and quiet (Wa); 
iced champagne, 5ss every } hour (B). Counter-irritation, at epigastrium 
(R) ; by mustard over the vagus, extending from below the right ear to the 
right sterno-clavicular articulation (Waugh). Nutrient Enemata may be 
required. [Compare Cholera, Hematemesis, Nausea, Sea-sickness, 
Vomiting of Pregnancy.] 



m. 



Mentholis, gr. xx. 

Alcoholis, 5 vjss. 

Syr. Simplicis, q. s. ad §ij. 

Sig. — 5j every hour. {Potter.) 



fy Cerii Oxalatis, gr. xxiv. 

Ext. Hyoscyami, gr. xxxvj. 

M. Ft. pil. no. xij. Sig. — One pill twice 
daily. (Goodell.) 



Vomiting of Pregnancy. 

Aconite in full doses, is often advantageous so long as its constitutional 
effects are apparent and decided (W). Arsenite, one drop of Fowler's solu- 
tion before each meal, will often relieve, when vomiting of food, retching and 
straining, with blood and pain (B). Atropine has sedative influence on the 
vagus and is frequently effective (R) ; never failed to give relief in my many 
years' experience (Boys). Bismuth, the subnitrate with Phenol, is often 
effective (B). Bromides, that of Potassium is often efficacious (W); 3ss 
doses thrice daily, exceedingly effective in the combined diarrhea and vomit- 
ing of pregnancy; the first dose should be given an hour before rising. 
Strontium Bromide proved entirely successful in severe cases; gr. xv in water 
with meals, twice daily, for a month. Calumba, drop doses of the tincture 
every hour or two, are often useful (B). Cerium Oxalate, gr. j every three 
hours (R) ; ordinary doses far too small, give as high as 10 grains (B) . Chlore- 
tone gr. iij every \ hour for 2 or 3 doses, then at longer intervals, is efficient 
in most cases (Hutton). Cocaine, locally to cervix, cured a most intractable 



886 



VULVA AND VULVITIS. 



case of several months' duration, though it failed when used internally 
(Boys); has given excellent results when used internally in triturates of T V 
grain each [or see formula below]; a 2 per cent, solution sprayed high up 
the nasal passages [see under Nausea]. Creosote is antiseptic and locally 
anesthetic (W); checks vomiting (R); successfully used in many cases. 
Ether, sprayed over the epigastric region and the corresponding part of the 
spinal column, for 3 to 5 minutes every 3 hours, gives immediate relief 
(Lubelsky). Hydrastin has received especial praise (W). Hydrocyanic 
Acid, often best (P). Iodine, Tfl,v of the tincture in §ss of sweetened water 
repeated in J hour, of magical effect in a bad case which had resisted every 
other treatment; is often useful (B). Ipecacuanha or Nux Vomica, either 
will generally succeed where the other fails (R); no other remedy of equal 
value to Ipecac (P); TflJ of the wine in 5ij of water every 15 minutes, is often 
successful (W). Menthol has proved very successful in obstinate cases. 
Nux Vomica, is useful but often fails, gtt. ss-j every hour or two in water (R) ; 
in very minute doses (S) ; gtt. ij-iij of the tincture every two or three hours, 
or gtt. x before each meal, with very hot water as a drink is the best treat- 
ment (Parvin). Opium is one of the best remedies, may be given by rectum, 
benumbs the vomiting centre (W); Morphine hypodermically, in severe 
vomiting (R); Codeine is efficient. Phenol pure, drop doses in mucilage 
thrice daily (Wa). Adrenalin, 10 drops of the 1 in 1000 solution twice 
daily, cured a very severe case in a few days (Rebaudi). Veronal is 
highly efficient in cases due solely to pregnancy (Reich). Ice-bag to 
spine, an efficient measure (R). Vesication, a single blister over the 
4th and 5th dorsal vertebrae, never failed for many years to put an end 
at once to the sickness of pregnancy, for the whole remaining period of 
gestation (Harkin). 



]$. Atropinae Sulphatis, gr. j. 

Morphinas Sulphatis, gr. iv. 

Acidi Sulphurici Aromat.,. . . oiij- 

Aquae, 3 v. 

M. Sig. — Ten to twenty drops, thrice 

daily. (Boys.) 



1$. Cerii Oxalatis, gr. xij. 

Ipecacuanhas, gr. xv. 

Creosoti, gr. xxiv. 

M. Ft. pil. no. xij. Sig. — One pill every 
hour. (Goode'l.) 



1$. Bismuthi Subnitrat., gr. clx. 

Cerii Oxalatis, gr. xl. 

Morphinae Sulphatis, gr. jss. 

Syrupi, et Acaciae, . . .q. s. ad §ij- 
M. ft. emulsum. Sig. — A teasp. every 
hour until vomiting ceases. (Van Vahali.j 



fy. Cocainae Hydrochlor., gr. xv. 

Phenolis, tt^x. 

Aq. Cinnamomi, § ss. 

Syr. Zingib, q. s. ad 5J- 

M. Sig. — 10 drops gradually increased to 
20, in a little water every hour until re- 
lieved, then every 2 or 3 hours. (Potter.) 



Vulva and Vulvitis. 



Alum, gr. lx to the pint of water, as lotion in vulvitis of children, or less 
strong if found to increase the discharge (R). Arsenic is much used for 
eczema of the vulva (T). Sodium Hyposulphite an unfailing remedy in 
lotion for aphthae of the vulva (R). Lead Acetate, a concentrated solution 
in glycerin locally for eczema of vulva (T). Lime-water, as a wash (R). 
Zinc Stearate mixed with Aristol an excellent application in vulvitis (Brown). 
Boric Acid in weak solution, 5j to the pint, as frequent cleansing applica- 
tion. Silver Nitrate in a 2 per cent, solution painted daily over the inflamed 
surface after the acute symptoms have subsided in vulvitis. Phenol un- 



WARTS — WEN — WORMS. 887 

diluted, applied to inflamed glands of the vulva after puncturing them. 
Cleanliness and local treatment of the cause in pruritus of the vulva. [Com- 
pare Leucorrhea, Gonorrhea, Prurigo, Pruritus, Vaginitis.] 

Warts (Verruca). 

Although internal remedies have been advised for the treatment of this 
condition, the best results are obtained by external applications. Not 
infrequently, they will disappear spontaneously and the patient will be 
surprised on examining the parts to find that the growth has disappeared. 
On other occasions, the treatment and removal of two or three may 
result in the disappearance of several others. Probably the best treatment 
for the removal of the adult type is by Electrolysis, the needle being 
attached to the negative pole and the positive pole attached to a wet 
electrode grasped in the patient's hand. The length of time of application 
varies from one to three minutes and the strength of the current usually 
from one to four milliamperes. The needle should be moved about in several 
directions without withdrawing it entirely from the growth. Usually one 
application is sufficient to remove a small sized wart. Before external ap- 
plications are made, it is sometimes advisable to pare off the thickened 
epidermic tissue or even sandpaper it. Carbon Dioxide Snow has been sug- 
gested but the destruction of tissue rarely goes deep enough to perfect a 
cure. Nitric Acid has been used but it is very apt to leav*e scarring. Liquor 
Potassae allowed to remain on for a few minutes and then neutralized with 
Acetic Acid is also advocated. Salicylic Acid, 40 to 60 grains to the ounce 
in alcohol, may be applied twice daily and when the wart is sufficiently 
softened, it can be scraped away. Trichloracetic Acid is one of the best 
local applications, dipping a sharp pointed hard wood applicator into the 
acid and pushing it into the wart several times; it may be necessary to repeat 
this procedure several times to perfect an absolute cure. 

In the juvenile type, where there are numerous lesions, the above treat- 
ment may be used but I have cured several cases by applying Liquor Carbonis 
Detergens full strength, twice daily. 

Wen. 

Extirpation, the least troublesome and most speedily effective method. 
Run a scalpel through it, seize the cut edge of the cyst, and gently tear it 
out with a touch or two from the knife. Dressing of lint and Phenolized 
Oil (D) ; care should be taken to dissect out the whole sac, or it will reform 
(Crocker). 

Worms. 

Ailanthus, a decoction of the fresh bark, for tape- worm (B). Aloes is 
effective for ascarides (P). Alum in solution, for injection against thread- 
worms (R). Ammonium Chloride, internally to prevent the formation of 
thick mucus which serves as a nidus for worms (R). Aspidium is one of the 
best remedies against tape-worm, but is poisonous; should never be given 
to a child under three years of age; 5ss-j of the oleoresin repeated in 2 or 3 
hours, after a milk diet for a day (W); followed by a brisk cathartic (P); 



888 worms. 

necessary for success to give light, liquid diet for 3 days, then a purge of 
Sodium Sulphate thrice on the third day, and a draught of Magnesium Sul- 
phate and Jalap; early on the fourth day 5j of the Oleoresin of Aspidium 
repeated after one hour, and followed an hour later by Castor Oil and Jalap 
to bring away the worm and the drug also, preventing any toxic action of 
the latter (Hall). Atoxyl in doses of gr. viij subcutaneously on 2 successive 
days, repeated every 10 days, if continued regularly will free the patient 
from trypanosomes and sleeping-sickness while the treatment is kept up 
(Koch); brilliantly successful in trypanosomiasis (Cook); affects the eye- 
sight. Arsenobenzol or 606 is fully as efficient as Atoxyl, and is non-toxic 
in medicinal doses. Thymol, is almost specific against the ankylostomum 
duodenale, given in doses of gr. x-xxx, well triturated and in capsules, re- 
peated 3 or 4 times; but no alcoholic drink afterwards lest the drug be ab- 
sorbed and poisoning ensue (Mn); gr. xxx for an adult, repeated after 2 
hours, for uncinariasis (Warfield). Thymotal is an efficient vermifuge, 
especially in ankylostomiasis (Pool). Beta-naphthol in doses of gr. xxx 
ranks next to Thymol for uncinariasis, and with the exception of some dizzi- 
ness it proved in every way most satisfactory (Patterson). Naphthalene, 
an excellent all-around anthelmintic, of high value for ascarides and teniae, 
thoroughly reliable for all kinds of intestinal worms, giving prompt and com- 
plete results invariably, with entire absence of all unpleasant symptoms; a 
single dose of gr. xv removed tape-worms entire (Mirowicz) ; for adults a dose 
of Castor Oil should follow, but for children it is preferable to give both to- 
gether; in case of seat-worms should be given by injection (W). Azedarach 
in decoction is used in the South for round worms (W). Cusso is excellent 
against tape-worm, and harmless, the best preparation is the amorphous 
Kosin of commerce, in doses of gr. viij-xv every \ hour for 4 doses (W) ; or the 
fluid-extract, 3ij to § j; or the same quantity of the flowers infused in §iv 
of boiling water (see page 252). Chloroform, a very efficient teniafuge, 
3j in §j of mucilage, after 20 hours' fast, followed one hour later by § j of 
Castor Oil, this is an adult dose, 5j should never be exceeded (Wilde). 
Chenopodium is a useful remedy against round worms; is also used against 
tape-worm and hook worm (W). Eucalyptus is used as an injection for 
ascarides (B). Ignatia for the convulsions of worm affections (P). Iodine, 
Pot. Iodide gr. xxxvj, Iodine gr. xij, Water § j, ten drops thrice daily in water, 
caused the expulsion of a tape-worm 11 yards long of which there were no 
previous symptoms, and proved successful in other cases (Newington). 
Iron, the syrup of the Iodide internally and a solution of the tincture locally, 
for ascarides (B); the Tinct. Ferri Chlor. §ss ad Oj aquae, a good injection 
for thread-worms (R). Kamala, is excellent for tape-worm, requires no 
purge, 150 to 180 grains for an adult (Wa); repeat in 10 hours if it does not 
purge ( W) . Lime-water as injection for thread-worms (R) ; § iij-iv repeated , 
for ascarides (Wa). Pepo, 5ij; as emulsion, taken fasting, one of the most 
efficient remedies against teniae (B). Pelletierine, the alkaloid of Granatum, 
is by far the best vermifuge for a tape-worm, repeated after a week for a 
second worm, as many as 3 having been found in one patient (Da C); gr. 
xv-xx of the Tannate, followed in a few hours by Castor Oil (R) . Quassia, 
the infusion as an injection for ascarides, conjoined with simple bitters 
internally (R) ; probably the most generally useful remedy for seat-worms 
(W). Quinine, as a tonic, also cold sponging, out-door exercise and judi- 
cious diet; useful probably by preventing the production of the abundant 



WOUNDS. 



889 



mucus which favors the growth of worms (R) ; especially useful for ascarides, 
also as injection for thread- worms and teniae (Wa). Santonin, the best 
anthelmintic, a laxative in the morning, fast all day, a dose of Santonin, 
gr. ss-v, and Calomel, or Troches of Santonin, j-x, at bedtime, a Senna 
draught next morning, for ascarides (P) ; for round and thread-worms, give 
in Castor Oil by mouth, or as injection (R). Scammony with Calomel, 
effective for thread-worms (Wa). Spigelia Sss-j for a child of 2 years, 
5iv for an adult, for the rluidextract of Spigelia and Senna, is efficient 
against the round-worm which it seems to narcotize (W). Tannin, as 
Catechu, Kino, Redgum, Rhatany, Hematoxylon in injections, to destroy 
thread-worms (R). Turpentine in doses of 5ss, is efficient against tape- 
worm and round-worm, but is liable to produce unpleasant effects, and 
should only be used when other remedies have failed, or cannot be obtained 
(W). Tonics, as Iron, Cod-liver oil, etc., to restore the intestinal canal to a 
healthy condition (R). Valerian for the convulsions of worm disease (R). 
Vinegar diluted, is occasionally used as an injection against seat-worms, 
but the infusion of Quassia is preferable (W). Medicines are of no avail 
in echinococcus disease, opening and evacuating the cysts is done with 
recovery in most of the cases (O). [Compare Chyluria.] 



]$. Sodii Sulphatis, 5iij- 

Sodii Bicarbonatis, 5j- 

Spt. Chloroformi, 5j- 

Aquae Menthae Pip., ad §iv. 

M. Sig. — One- third thrice on the 



before taking Aspidium. 



day 



(Hall.) 



fy. Resinae Jalapae, gr. v. 

Magnesii Sulphatis, gss. 

Spt. Chloroformi, 5ss. 

Aquae, q. s. ad §ij. 

M. Sig. — To be taken the evening before 
the Aspidium. (Hall.) 



J$. Oleores. Aspidii, 3ij- 

Pulv. Tragacanthae, gr. xl. 

Spt. Chloroformi, 5ss. 

Aquae Menthae Pip., ad §ij. 

M. Sig. — One-half to be taken early in 
the morning, and repeated after an hour. 

(Hall.) 



1$. Resinae Jalapae, gr. v. 

Olei Ricini, §j. 

M. Sig. — To be taken one hour after 
the last dose of Aspidium. (Hall.) 

$. Chloroformi, 

Oleores. Aspidii, aa 3j- 

Emulsi 01. Ricini (50 per 

cent.), 5iij. 

M. Sig. — One dose after 24 hours' fast- 
ing. Acts just as well if the Male Fern be 
omitted. (Smith.) 



]$. Fluidextr. Spigeliae, Bj- 

Fluidextr. Sennae, 5ss. 

M. Sig. — A teasp. to a child of 3 to 5 
years. (Smith.) 



\. Fluidextr. Spigeliae et 

Sennae, 5j- 

Santonini, gr. viij. 

M. Sig. — A teasp. to a child of 5 years. 



Wounds. 

All wounds, other than those made by the surgeon, are regarded as infected 
(Da Costa). The rules for treating such wounds are (1) arrest hemorrhage; 
(2) bring about reaction; (3) remove foreign bodies; (4) asepticize; (5) drain; 
coaptate the edges, and dress; and (6) secure rest to the part and combat 
overaction of the tissues (Id). Constitutionally allay pain, secure sleep, 
maintain the nutrition, and treat inflammatory conditions (Id). Acetanilid 
in fine powder, dusted over the surface of wounds and other breaches of tissue; 
with an equal part of Boric Acid for minor infected wounds; but freely used 
it is not entirely devoid of danger (W). Bismuth, the Subgallate (Derma- 
tol), is an excellent and non-irritant vulnerary, having great stability and 
valuable drying and bactericidal qualities; the Sub-iodide, dusted over a 



89O WOUNDS. 

wound, is one of the most efficient antiseptics, non-irritant, and a prompt 
stimulant of granulation; an excellent dressing for wounds after approxima- 
tion of the edges, the powder to be dusted thickly over the edges and thor- 
oughly covered with flexible collodion. Boric Acid in lotion or ointment, 
or dry as a dusting powder, for antiseptic dressing of fresh wounds (W); 
Boroglyceride in aqueous solution, 1 to 40, may be used as a lotion. Chlore- 
tone as a 1 per cent, solution, a good anesthetic and antiseptic application for 
infected wounds (W). Collodion as a protective covering (P); or Liquor 
Guttas-perchas, to secure primary union of incised wounds (B); as vehicle for 
Iodoform, etc. Europhen, is an ideal application to sores and wounds, also 
for the many protective requirements of minor surgery; is used as a dusting 
powder, or as a 5 to 10 per cent, ointment, with Lanolin as a base. Formalde- 
hyde is both irritant and painful to the tissues, but is used in 1 to 5 per cent, 
solutions for infected wounds (W) ; in a 10 per cent, soap, followed by mercuric 
chloride solution and sterile water, for cleaning a lacerated wound (Lathrop). 
Galvanism, the galvanic couplet to indolent wounds (B). Hydrogen Dioxide 
is especially adapted to the cleansing and disinfection of deep infected wounds 
(W); is very efficient for profusely suppurating wounds (Koslowsky). Io- 
dine, the tincture is a valuable application to contused, lacerated or suppurat- 
ing wounds (Reclus) ; should be the primary and essential act in treatment of 
wounds of the hands and fingers (Id); in concentrated alcoholic solution, 
applied to infected wounds, is extremely serviceable (Roop) ; as a disinfectant, 
used in 800 cases of scalp, incised, punctured and lacerated wounds; after 
shaving and washing the tincture injected directly into the wound, then 
coaptation and a wet gauze dressing (Dawnreuther). Iodoform is exten- 
sively used as an antiseptic dressing, but is dangerous when dusted freely 
into a large wound (W) ; powdered and dusted over sloughing wounds, irri- 
table and ill-conditioned ulcers and sores (B); Iodoform 1, Collodion 9 parts, 
painted on a superficial wound while edges are held together (Gross); may 
be painted over edges when stitched together; gives excellent results. Mer- 
cury, the Bichloride, gr. vijss to quart j of hot water, stirred with a stick, 
makes a solution of 1 to 2000; the best of all antiseptics for washing a wound 
or cavity, and for saturating the dressings. Opium by the mouth to quiet 
intestinal peristalsis in wounds of the abdomen (R) ; promotes the reparative 
process (P). Orthoform as a local anesthetic and antiseptic, for painful 
wounds (W). Phenol pure, in 2 per cent, solution injected into poisoned 
wounds (Hueter); is but little employed at present (W). Potassium Per- 
manganate in solution, gr. j-xx to the 5 , as a disinfectant and germicidal 
wash (W). Salicylic Acid is preferred to phenol (Thiersch); in fine powder 
applied to gangrenous and sloughing wounds (B). Sodium Chloride in 
solution 0.9 per cent., with Calcium Chloride 0.03 per cent., and Sodium 
Carbonate 0.04 per cent., instead of mercuric or phenol solutions, aids the 
physiological process without impairing the activity of the cells (Ibrig) ; Salt 
and Ice applied to wounds prevent inflammation (R). Thymol Iodide 
(Aristol), or a mixture of it and Europhen, equal parts, is an excellent substi- 
tute for Iodoform, being equally efficient and odorless. Turkish Bath for 
pain in the site of old wounds (R). Tetanus Antitoxin.— In every wound in 
which we have reason to suspect tetanus infection a preventive dose of anti- 
toxin should be given. We have particular occasion to apprehend tetanus 
if the wound is contaminated with feces, street dirt, stable dust, or stable 
refuse, or if it was infected with a toy pistol such as boys use to celebrate the 
Fourth of July (Da Costa). 



WOUNDS. 89I 

Carrel Method of Wound Sterilization.* — Early in the present European 
war the army surgeons were confronted with the problem of unusually severe 
wound infections which defied previously known measures. All wounds were 
infected except those caused by high velocity bullets. The bacteria most 
frequently found were the tetanus bacillus, gas bacillus (bacillus aerogenes 
capsulatus of Welch), putrefactive organisms, streptococcus and colon 
bacillus. Carrel and Dakin investigated the problem at the Beaujon Hos- 
pital, Paris, in Professor Turner's laboratory and later a research laboratory 
was established at Compiegne, Oise, in conjunction with the French Military 
Hospital No. 21. Carrel's work was started in December, 1914, and com- 
pleted in June, 191 5. Since that date, the present technique, with certain 
modifications of Dakin's solution and technical improvements in the method, 
has been in constant use. The success obtained has been most striking. 
Carrel and Dakin experimented with 200 or more antiseptics before 
the hypochlorite solution was perfected. Dakin's solution is a strong bac- 
tericide and is almost an ideal antiseptic, because it is non-toxic and non- 
irritating. It must be used, however, with discretion and judgment and 
according to Carrel's technic. It is of greatest importance to sterilize 
the wounds in the early stages, because later it becomes more difficult, as 
the microbes spread and penetrate. All foreign material should be removed 
and the antiseptic agent thoroughly employed during the first twenty-four 
hours. It is, at times, difficult and impossible to remove all foreign material 
mechanically, so we must rely upon some antiseptic solution which will 
penetrate the cavity and chemically destroy the bacteria without irritating 
the tissues or producing toxemia. The solution must be in constant contact 
with the tissues in order to bring about the destruction of the microor- 
ganisms. The solution should be made to penetrate all the diverticula of the 
wound and must be renewed every 2 hours if complete sterilization is to 
be obtained. It can be made by a competent chemist or druggist at a mini- 
mum cost. The original Dakin solution was prepared as follows: 140 grams 
dry sodium carbonate dissolved in 10 liters of tap water, to which 200 grams 
chloride of lime (chlorinated lime) is added arid 40 grams of boric acid. The 
Dakin solution (technique of Daufresne) as now in use must be free of caustic 
alkali and must contain only 0.45 to 0.50 per cent, of hypochlorite. Under 
0.45 per cent, is not active enough and above 0.50 per cent, is irritant. 
With chloride of lime (bleaching powder) having 25 per cent, of active chlo- 
rine, the quantities of substances necessary to prepare 10 liters of solution are 
the following: 200 grams chloride of lime (bleaching powder, 25 per cent, 
active chlorine), 100 grams dry sodium carbonate (soda of Sol way), 80 grams 
dry sodium bicarbonate. Put the 200 grams of chloride of lime in a 12 liter 
flask and add 5 liters of ordinary water, shake vigorously for a few minutes 
and leave in contact for six to twelve hours. (Shake until dissolved, at least 
until the big pieces are dissolved. Not all the pieces will dissolve, large 
pieces float, notice only floating pieces.) At the same time dissolve the 
carbonate and bicarbonate of soda in 5 liters of ordinary cold water. After six 
to twelve hours, pour the salt solution in the flask containing the macerated 

* In the compilation of this section on the Carrel-Dakin treatment of wounds the writer 
has drawn freely upon the very excellent article by William O'Neill Sherman entitled 
"The Carrel Method of Wound Sterilization, Its Use in Military, Industrial, and Civil 
Practice" which appeared in Surgery, Gynecology and Obstetrics, March, 191 7. The 
reader is referred to this article for a more detailed discussion of the treatment and its 
results, and for reference to the literature upon the subject. 



► 



892 WOUNDS. 

chloride of lime, shake vigorously for a few minutes and stand aside to 
allow the calcium carbonate to be precipitated. In about J hour siphon 
the liquid and filter with a double paper to obtain a good, clear liquid, 
which should always be kept in a dark place. Titration of Chloride of 
Lime (bleaching powder). Because of the variation of the products now 
obtained in the market, it is necessary to determine the quantity of active 
chlorine contained in the chloride of lime which is to be used. This must 
be done in order to employ an exact, calculated quantity according to 
its concentration. The test is made in the following manner: Take from 
different parts of the jar, a small quantity of bleaching powder, to have 
a medium sample, weigh 20 grams of it, mix as well as possible in a liter 
of tap water and leave in contact a few hours. Measure 10 mils of the 
clear liquid and add 20 mils of a 10 per cent, solution of potassium iodide, 
2 mils of acetic acid or, to free all hydrochloric acid, then put drop by 
drop into the mixture a decinormal solution of sodium hyposulphite (2.48 
per cent.) until decoloration. The number (n) of mils of hyposulphite 
employed, multiplied by 1775 will give the weight (N) of active chlorine 
contained in 100 grams of chloride of lime. The test must be made every 
time a new product is received. When the result obtained differs more 
or less than 25 per cent., it will be necessary to reduce or enlarge the 
proportion of the three products contained in the preparation. This can 
easily be obtained by multiplying each of the three numbers, 200, 100, 
80 by the factor 25N in which N represents the weight of the active 
chlorine per cent, of chloride of lime. Titration of Dakin Solution. 
Measure 10 mils of the solution, add 20 mils of potassium iodide 1: 10, 
2 mils of acetic acid and drop by drop a decinormal solution of sodium 
hyposulphite until decoloration. The number of mils used multiplied by 
0.03725 will give the weight of hypochlorite of soda contained in 100 mils 
of the solution. Never heat the solution, and if in case of urgency one is 
obliged to resort to trituration of chloride of lime in a mortar, only employ 
water, never salt solution. Test of the Alkalinity of Dakin Solution. To 
differentiate easily the solution obtained by this process from the commercial 
hypochlorites, pour into a glass about 20 mils of the solution and drop on the 
surface of liquid a few centigrams of phenolphthalein in powder. The correct 
solution does not give any coloration, while Labarraque's solution and eau de 
Javel will give an intense red color which shows in the last two solutions exist- 
ence of free caustic alkali. The stock solution should be kept in blue or brown 
colored bottles, well corked. Difficulties in Making Dakin Solution. On 
account of the unstableness of bleaching lime which varies in its chlorine 
content from 15 to 37 per cent, active chlorine, some difficulty has been en- 
countered in making the solution. Much of the sodium bicarbonate used 
today is composed largely of sodium carbonate: this is one of the causes for 
the difficulty of neutralizing the solution. If the solution is alkaline or caus- 
tic, it will burn the skin and irritate the tissues. It must be neutralized with 
sodium bicarbonate and should be frequently and thoroughly tested on 
account of its unstableness and tendency to become caustic. There is a 
difference between the solution of Dakin as originally made and the hypo- 
chlorite solution, technic of Daufresne. Dakin's original solution contains 
0.5 to 0.6 per cent, sodium hypochlorite. The solution modified by Dau- 
fresne does not contain boric acid but contains between 0.45 and 0.50 per 
cent, hypochlorite; it is very important that the solution should not be over 



WOUNDS. 893 

0.50 per cent., if it is, it will be too caustic, and if below 0.45 per cent., too 
weak. Many of the so-called Dakin solutions are not prepared in accordance 
with the formula of the name they bear and, as a result, the solution has been 
condemned where some other solution has been used in the name of Dakin. 
It is probable that the antiseptic action of the hypochlorites is due to the 
formation of chloramines rather than by the liberation of oxygen. The 
hypochlorites have in addition a hyperisotonic effect producing a flow of 
lymph from the surface of the wound. The rapid disappearance of all pus, 
necrotic or decomposed material within five to seven days, is the remarkable 
effect produced. The granulations take on a healthy glow, resembling very 
much the gross appearance of beefsteak; no other wounds or granulations 
present a similar appearance. As the infection is brought under control, the 
discharge becomes clean and free from odors. Sherman describes the treat- 
ment under the following headings: First Dressings at the Trenches, at the 
Advance Dressing Stations, and the First Aid Dressing Stations. The area 
surrounding the wound should be disinfected with tincture of iodine; and an 
injection of Dakin's solution in the wound, if it is small or narrow, should be 
made. If it is wide and freely open, a gauze pack which is saturated with 
Dakin's solution should be applied. The prognosis is materially aided if 
this dressing is used. Dressing at the Military Base Hospitals or Civilian 
Hospitals. If the wounds are extensive, or conditions warrant, a general 
anesthetic should be administered and the operating field prepared in the 
usual way. A free incision and thorough exploration for foreign bodies of 
all wounds, should be made at the earliest possible opportunity. The 
foreign bodies are localized with the fluoroscope or with stereoscopic skia- 
grams. All bleeding should be stopped; the shell tract should be freely 
opened and all devitalized tissue excised. The Carrel tubes should be carried 
to the bottom of the wound and gauze loosely placed between them. Before 
completing the final dressing, the solution can be*injected in the wound to 
ascertain the amount of solution necessary to fill the cavity completely and 
whether or not it is reaching all parts. The final dressing consists of a 
gauze pad saturated with Dakin's solution, over which a large pad of non- 
absorbent cotton, which completely envelops the extremity, is placed. 
Turkish toweling can be used instead of non-absorbent gauze pads, if de- 
sired. In order to carry out the treatment successfully special apparatus is 
necessary — a graduated reservoir, the opening of which is lightly plugged 
with cotton, a rubber connecting tube in the course of which is placed a 
glass drip which indicates the rapidity of the flow of the solution, a terminal 
glass tube attached to the connecting tube and containing outlets for the 
attachment of from two to six Carrel tubes. These Carrel rubber tubes are 
approximately 15 to 25 centimeters long, having a diameter of 5 millimeters, 
the inside lumen of which is 3 millimeters, giving a 1 -millimeter wall for the 
tube. They should be made of pure rubber so that the end of the tube can 
easily be tied off with either Pagenstecher linen or strong silk. Rubber 
tubing containing fabric or catheters will not suffice because of the difficulty 
in closing the end and the destructive action of the hypochlorite on the 
fabric. Beginning from the distal end, a series of small holes, approximately 
J ' millimeter in diameter, is pierced at intervals of \ centimeter ; 
six, eight, ten, or twelve perforations are usually sufficient and are made with 
a specially designed punch (similar to a leather punch). Both sides of the 
tube are pierced with one punch; the tube is then turned on its axis to a right 



> 



I 



894 YELLOW FEVER. 

angle and the process alternately repeated, thus staggering the perforations. 
The number of tubes to be used must be decided by the size and depth of the 
wound. They should be inserted so that all parts of the wound are con- 
stantly bathed with the solution. To prevent the tubes from bunching 
in the wound, strips of gauze are loosely placed between them. The gauze 
serves the double purpose of keeping the tubes in situ and retaining the solu- 
tion. Gauze should never be packed tightly in the wound. A gauze com- 
press is gently placed over the tubes and the dressing completed by covering 
with turkish toweling. The dressing is fixed with a bandage, care being taken 
not to constrict the tubes, but fixing them to prevent displacement. The 
most effective method is the intermittent installation every two hours, 
day and night, and not constant irrigation. The wounds should be re- 
dressed daily under the strictest aseptic care. We have every reason 
to believe that the Carrel-Dakin method of treating wounds will be 
just as successful in industrial and civil practice as it has been in military 
practice. 

[Compare Bedsores, Gangrene, Hemorrhage, Imflammation, Sep- 
ticemia, Ulcers.] 

Yellow Fever. 

Prophylaxis. — With regard to prevention Stitt states that by screening 
the patient during the first 3 days of the disease we prevent the infection 
of the stegomyia. It must be remembered that this mosquito not only breeds 
near human habitations but that it tends to remain in the same room where 
it has been feeding. Consequently we should use sulphur fumigations or 
Giemsa's spray or killing by hand to destroy insects. The larvae breed by 
preference in old tin cans near the house door. To kill these one should 
empty every old receptacle of water, and oil or cover other collections of 
water (Stitt). Treatment must all be done at the beginning, no time to be 
lost; cold sponging early and frequently repeated, Calomel, Quinine and 
Salines at the start, Potassium Acetate for the kidneys, Morphine for gastric 
irritation, the feet to be in mustard water; diaphoretics, diuretics, and laxa- 
tives are very important throughout the disease (Da C) ; while the treatment 
is purely symptomatic, there are definite indications for remedies to combat 
certain failing functions and vicious abnormal conditions (Jackson). Mer- 
cury, a Calomel purgative, gr. x at least at the start; not a few experienced 
men limit their medicine giving to a single laxative dose, given during the 
first 24 hours (Id) ; gr. ss of Calomel 2 or 3 times on the first day, followed by 
a warm- water enema, is good treatment (B); has many advocates and many 
opponents (Wa) ; should generally be abstained from (S) ; purgation is bene- 
ficial at the very onset, but must not be repeated or used at all after the sec- 
ond day (Mn). Sodium Bicarbonate to counteract the hyperacidity of the 
gastric and intestinal contents, with small doses of Mercuric Chloride (see 
formula below); of 301 white cases so treated only 7.3 per cent, died, and of 
72 blacks all recovered (Sternberg); this plan of treatment promises well 
(Mn). Phenacetin after an early purge, to relieve the backache (Geddings). 
Antipyrine for high temperature (W); the coal-tar derivatives should rarely 
be used, if at all, on account of their action on the heart and the blood, 
though they add much to the comfort of the patient (Jackson). Ice in 
small quantities, is probably the best remedy for the vomiting (O). Lime- 
water, with milk, has been found efficient for the vomiting (Wa). Capsicum, 



XANTHOMA PALPEBRARUM. 



895 



to obviate the black vomit, is highly spoken of ( Wa) . Cocaine, for the vomiting, 
nothing equals it in efficiency, it also acting as a diuretic, 10- minim doses of a 4 
per cent, solution, by mouth, every hour for two or three doses, acts like a 
charm (Jennings). Chloroform, for the vomiting, a few drops to prepare the 
stomach for reception and retention of food; its effects transitory, has to be 
repeated before each meal (Wa); the Ammoniated Chloroform in zymotic 
pyrexia, its action is sedative, analgesic and antipyretic (Richardson). 
Phenol by the stomach and hypodermically, remarkably efficacious, even 
after the ominous "coffee grounds" vomit (Lecaille). Cotarnine as a 
powerful hemostatic, for the black vomit. Morphine is dangerous and must 
be avoided (Mn). Veratrum Viride, gtt. j-x hourly, according to age, till 
pulse and temperature are subdued; successfully used in connection with 
Mercury, etc. (White). Alcoholic Stimulants in the typhus form only (B); 
in the third stage should be given boldly, promptly and constantly (DaC); 
iced champagne, §ss every J hour for the vomiting (B). Rest, as absolute 
as possible, is very important (Da C); absolute quiet of the entire body and 
particularly of the stomach. Diet should be of the blandest description (A) ; 
Milk and Lime-water, half and half, in small quantities, is the best aliment; 
in convalescence, the utmost care is necessary in giving aliments (B); many 
practitioners of great experience in Cuba forbid all food until convalescence 
is well established, and then allow only the blandest. Without doubt many 
cases die from injudicious feeding (Jackson). 



1$. Sodii Bicarb., oijss. 

Hydrarg. Chlor. Corros., gr. §. 

Aquas Destillatae, Oij. 

M. Sig. — Three tablespoonfuls to be 
taken every hour. (Sternberg.) 



1$. Cotarninae Hydrochlor.,. . . . gr. xx. 

Antipyrinae, 3 jss. 

Syrupi Simplicis, 5iv. 

Aq. Aurantii Flor.,. . .q. s. ad gij. 
M. Sig. — 5j every 3 or 4 hours, for the 
black vomit. 



Xanthoma Palpebrarum. 

The best treatment in my hands has proved to be the Micro-cautery 
which is constructed after the plan of the pyrography outfit with the plati- 
num end terminating in a very fine steel needle which does not attain the red 
heat that platinum does. The hot needle should enter the lesions many 
times until the entire colloidal contents are seared. There is very little pain 
during the operation and none afterwards. If the process produces an edema 
of the surrounding parts, cold applications of Dilute Lead Water can be 
used. This Electric Needle can be used in exactly the same way. Carbon 
Dioxide Snow may be used in extreme cases but is not the preferable method. 
Excision has been employed but extreme care should be taken not to produce 
a subsequent ectropion and there is always danger of scarring. Salicylic 
Acid Plaster, 25 per cent, strength, is at times useful. Trichloracetic Acid 
may be applied with a sharp pointed applicator directly to the lesions, the 
coverings of which are very thin and can be punctured with no difficulty. 
There is always the possibility of a recurrence in this disease, making more 
than one application necessary. 



> 



I 



APPENDIX. 



LIST OF CONTRACTIONS AND LATIN PHRASES 

USED IN WRITING PRESCRIPTIONS, WITH THE CORRESPONDING 
ENGLISH EQUIVALENTS. 



Contraction. 


Word or Phrase. 


English Equivalent. 


aa. 


Ana 


Of each. 


Abd. 


Abdomen, gen. inis 


The belly. 


Abs. feb. 


Absente febre 


Fever being absent. 


Ace. 


Accurate 


Accurately. 


Acerb. 


Acerbus, a, urn 


Sharp, sour, harsh (to the taste). 


Acerbit. 


Acerbitas, gen. atis 


Sourness. 


Ad 


Ad {prep. gov. ace.) 


To, up to. 


Ad concil. gust. 


Ad conciliandum gustum 


To suit the taste. 


Ad 2 vie. 


Ad duas vices 


At twice taking. 


Ad sec. vie. 


Ad secundum vicem 


For the second time. 


Ad 3 tiam vie. 


Ad tertiam vicem 


For the third time. 


Add. 


Adde, Addantur 


Add, Let them be added. 


Add. 


Addendus, Addendo 


To be added, By adding. 


Add. c. trit. 


Adde cum tritu 


Add with trituration. 


Ad def. an. 


Ad defectionem animi 


To fainting. 


Ad grat. acid. 


Ad gratam aciditatem 


To an agreeable sourness. 


Ad grat. gust. 


Ad gratum gustum 


To an agreeable taste. 


Adhib. 


Adhibendus 


To be administered. 


Adjac. 


Adjacens 


Adjacent. 


Ad lib. 


Ad libitum 


At pleasure. 


Admov. 


Admove, Admoveatur 


Apply, Let it be applied. 


Ad part, dolent. 


Ad partes dolentes 


To the painful (aching) parts. 


Ad sat. 


Ad saturandum 


To saturation. 


Adst. feb. 


Adstante febre 


The fever being on. 


Adv. 


Adversum 


Against. 


^g. 


^ger 


The sick one, the patient. 


Aggr. feb. 


Aggrediente febre 


While the fever is coming on. 


Agit. 


Agita 


Shake, stir. 


Agit. 


Agitetur 


Let it be shaken or stirred. 


Agit. ante sum. 


Agita ante sumendum 


Shake before taking. 


Agit. vas. 


Agitato vase 


The vial being shaken. 


Alb. 


Albus, a, um 


White. 


Aliq. 


Aliquot 


Some. 


Alt. 


Alter 


The other. 


Alt. hor. 


Alternis horis 


Every other hour. 


Alut. 


Aluta 


Leather. 


Alv. 


Alvus 


The belly, the bowels. 


Alv. adst. 


Alvo adstricta 


The bowels being confined. 


Amp. 


Amplus 


Large. 


Ampul. 


Ampulla 


A large bottle. 


App. 


Appone, Applica 


Apply, Lay or put on. 


Aq. 


Aqua, gen. ae 


Water. 


Aq. astr. 


Aqua astricta 


Frozen water. 


Aq. bull. 


Aqua bulliens 


Boiling water. 



i 



57 



8 97 



898 



LIST OF CONTRACTIONS AND LATIN PHRASES. 



I 



Contraction. 


Word or Phrase. 


English Equivalent. 


Aq. com. 


Aqua communis 


Common water. 


Aq. ferv. vel calid. 


Aqua fervens vel calida 


Hot water. 


Aq. fluv. 


Aqua fluviatilis 


River water. 


Aq. font. 


Aqua fontana vel fontis 


Spring water. 


Aq. frig. 


Aqua frigida 


Cold water. 


Aq. mar. 


Aqua marina 


Sea water. 


Aq. niv. 


Aqua nivialis vel nivalis 


Snow water. 


Aq. phag. 


Aqua phagedsenica 


Yellow wash. 


Aq. pluv. 


Aqua pluvialis 


Rain water. 


Aq. pot. 


Aqua potabilis 


Drinkable water. 


Aq. satur. 


Aqua saturni 


Lead-water. 


Aq. urb. 


Aqua urbis 


City water. 


Aqual. 


Aqualis 


Pertaining to water; 


Aquil. alb. 


Aquila alba 


Calomel. 


Aut 


Aut 


Or. 


B. A. vel Bal. ar. 


Balneum arenae 


Sand-bath. 


B. M. vel Bal. mar. 


Balneum maris 


Salt-water bath. 


B. V. vel Bal. vap. 


Balneum vaporis 


Vapor-bath. 


Bals. 


Balsamum 


Balsam. 


B. B. 


Barbadensis 


Barbadoes. 


Bene 


Bene 


Well, good. 


Bib. 


Bibe vel Bibatur 


Drink (thou), Let it be drank. 


Bid. 


Biduum 


Two days. 


Bis 


Bis 


Twice. 


Bis die 


Bis in die vel dies 


Twice a day. 


Bol. 


Bolus 


A large pill. 


Bon. 


Bonus 


Good. 


Brach. 


Brachium 


The arm. 


Brev. 


B re vis 


Short. 


Bui. 


Bulliat vel Bulliant 


Let it (or them) boil. 


But. 


Butyrum 


Butter. 


C. 


Curavel Congius 


With, or A gallon 


Caerul. 


Caeruleus, gen. i 


Blue. 


Calef. 


Calefactus, gen. i 


Warmed. 


Calom. 


Calomel vel Calomelas 


Mild Chloride of Mercury, Calomel. 


Calor. 


Calor, gen. oris 


Heat, warmth. 


Cap. 


Cape, Capiat 


Take (thou), Let him take. 


Cap. quant, vult 


Capiat quantum vult 


Let him take as much as he will. 


Capil. 


Capillus, gen. i 


A hair. 


Capsul. 


Capsula, gen. ae 


A capsule. 


Caput 


Caput, gen. Capitis 


The head, Of the head 


Carbas. 


Carbasus, gen. i 


Linen, lint. 


Caute 


Caute 


Cautiously. 


Cc. 


Centimeter cubicum 


Cubic centimeter. 


Ccu. 


Cucurbitula 


A cupping-glass. 


Celer. 


Celeriter 


Quickly, immediately. 


Cena 


Cena vel Ccena 


Supper. 


Chart. 


Charta 


Paper. 


Chart, cerat. 


Charta cerata 


Waxed paper. 


Chartul. 


Chartula 


A small paper. 


Chin. 


Chininum 


Quinine. 


Cib. 


Cibus, gen. i 


Food, victuals. 


Circit. 


Circiter 


Near, around, about. 


Cit. 


Cito 


Quickly. 


Cito disp. 


Cito dispensetur 


Let it be dispensed quickly. 


Clar. 


Clarus, a, um 


Bright, clear. 


Claus. 


Clausus. a, um 


Closed, inclosed. 


Coch., Cochleat. 


Cochleare, Cochleatim 


A spoonful, By spoonsful ( 3j). 


Coch. amp. 


Cochleare amplum 


A dessertspoonful ( 3ij). 


Coch. mag. 


Cochleare magnum 


A tablespoonful ( oss). 



LIST OF CONTRACTIONS AND LATIN PHRASES. 



8 99 



Contraction. 


Word or Phrase. 


English Equivalent. 


Coch. med. 


Cochleare medium 


A dessertspoonful ( 3ij)« 


Coch. parv. 


Cochleare parvum 


A teaspoonful ( 3j). 


Coct. 


Coctio 


Boiling. 


Cog. 


Cogantur 


Let them be combined. 


Col. 


Cola 


Strain. 


Colatur. 


Colaturae 


Of the strained liquor. 


Colat. 


Colatus 


Strained. 


Colent. 


Colentur 


Let them be strained. 


Colet. 


Coletur 


Let it be strained. 


Coll. 


Collum, gen. i 


The neck. 


Collun. 


Collunarium, gen. i 


A nasal wash. 


Collut. 


Collutorium 


A mouth-wash. 


Collyr. 


Collyrium 


An eye-wash. 


Coloret. 


Coloretur 


Let it be colored. 


Commis. 


Commisce 


Mix together. 


Commod. 


Commode 


Rightly, properly, suitably. 


Comp. 


Compositus 


Compound, compounded. 


Con., Concis. 


Concisus 


Cut. 


Concus. 


Concussus, gen. i 


Shaken. 


Concut. 


Concute, Concutiatur 


Shake, Let it be shaken. 


Conf. 


Confectio 


Confection. 


Cong. 


Congius 


A gallon. 


Conquas. 


Conquassando 


By vigorous shaking. 


Cons. 


Conserva, Conserve 


A conserve; Keep, preserve. 


Consperg. 


Consperge 


Dust, sprinkle. 


Cont. 


Contere 


Rub together. 


Cont. rem. 


Continuentur remedia 


Let the medicines be continued. 


Contus. 


Contusus 


Bruised. 


Coq. 


Coque, Coquantur 


Boil, Let them be boiled. 


Coq. ad med. con- 


Co que ad medietatis con- 


Boil to the consumption of half. • 


sump. 


sumptionem 




Coq. S. A. 


Coque secundum artem 


Boil according to art. 


Coq. in S. A. 


Coque in sufficiente aquae 


Boil in sufficient water. 


Coq. simul 


Coquentur simul 


Boil them together. 


Cor 


Cor, gen. cordis 


The heart, Of the heart. 


Cort. 


Cortex, gen. corticis 


The bark, Of the bark. 


Cot. 


Cotula 


A measure. 


Cox. 


Coxa 


The hip. 


Cras 


Cras 


To-morrow. 


Cras mane sumend. 


Cras mane sumendus 


To be taken to-morrow morning. 


Cras nocte 


Cras nocte 


To-morrow night. 


Cras vesp. 


Cras vespere 


To-morrow evening. 


Crast. 


Crastinus 


For to-morrow, early. 


Cm. 


Cruor 


Blood, gore. 


Cucur. 


Cucurbitula 


A cupping-glass. 


Cuj. 


Cuj us, Cujus-libet 


Of which, Of any. 


Cum 


Cum 


With. 


Curs. hod. 


Cursu hodie 


During the day. 


Cyath., C. vinar. 


Cyathus, vel C. vinarius 


A wine-glass ( oj-ij). 


Cyath. theae 


Cyatho theae 


In a cup of tea. 


D. 


Dies, Dosis 


A day, A dose. 


Da, Det. 


Da, Detur 


Give, Let it be given. 


De 


De {prep. gov. ablative) 


From, down. 


Deaur. pil. 


Deaurentur pilulae 


Let the pills be gilded. 


Deb. spiss. 


Debita spissitudo 


To a proper consistence. 


Deb. 


Debitus, a, um 


Due, proper. 


Dec. 


Decanta 


Pour off. 


Decern 


Decern, decimus 


Ten, The tenth. 


Decoct. 


Decoctum 


A decoction. 


Decoq. 


Decoque 


Boil down. 



900 



LIST OF CONTRACTIONS AND LATIN PHRASES. 



Contraction, 


Word or Phrase. 


English Equivalent. 


Decub. 


Decubitus 


Lying down. 


De d. in d. 


De die in diem 


From day to day. 


Dein 


Dein vel Deinde 


Thereupon; afterward, then. 


Deglut. 


Deglutiatur 


Let be swallowed. 


Dej. alv. 


Dejectiones alvi 


Stools. 


Dejic. 


Dejiciatur 


Let be purged. 


Dent. 


Dentes; Dentur 


The teeth; Let them be given. 


Det. in dup. 


Detur in duplo 


Let twice as much be given. 


Dext. 


Dexter, D extra 


The right. 


Dieb. alt. 


Diebus alternis 


Every other day. 


Dieb. tert. 


Diebus tertiis ' 


Every third day. 


Dies vel D. 


Dies, gen. diei 


A day. 


Dig. 


Digere, Digeretur 


Digest, Let it be digested. 


Diluc. 


Diluculo 


At break of day. 


tiil. 


Dilue, Dilutus, a, um 


Dilute (thou), Diluted. 


Dim. 


Dimidius, a, um 


One-half. 


D. P. vel Dir. prop. 


Directione propria. 


With a proper direction. 


Disp. 


Dispensa, Dispensetur 


Dispense, Let it be dispensed. 


Div. in p. aeq. 


Dividatur in partes 
aequales 


Let it be divided into equal parts. 


Divid. 


Dividendus, a, um 


To be divided. 


Dol. 


Dolor, Dolore 


Pain, In pain. 


Don. 


Donee 


Until. 


Don. alv. dejec. 


Donee alvus dejecerit 


Until the bowels move. 


Don. alv. sol. ft. 


Donee alvus soluta fuerit 


Until the bowels shall be opened. 


Don. dolor neph. 


Donee dolor nephriticus 


Until the nephritic pain is removed. 


exulav. 


exulaverit 




Don. hab. colat. 


Donee habeas colaturae 


Until you have of strained liquor. 


Don. len. dol. 


Donee leniatur dolor 


Until the pain is relieved. 


Dbn. sint res. 


Donee sint residuae 


Until there is ... of residue. 


Dos. 


Dosis 


A dose. 


Dr., 3 


Drachma 


A drachm (60 grains). 


Dulc. 


Dulcis, Dulcitas 


Sweet, Sweetness. 


Dup. 


Duplico 


In duplicate. 


Dur. dolor. 


Durante dolore 


While the pain lasts. 


Ead. 


Eadem (fern.) 


The same. 


Eburn. 


Eburneus 


Made of ivory. 


Ejusd. 


Ejusdem 


Of the same. 


Elect. 


Electuarium 


An electuary. 


Em. 


Emesis 


Vomiting. 


En., Enem. 


Enema, Enemata 


A clyster or enema, Enemas. 


Epistom. 


Epistomium 


A stopper, bung. 


Et . 


Et < 


And. 


Etiam 


Etiam 


Also, besides. 


Evan. 


Evanuerit 


Shall have disappeared. 


Ex 


Ex {gov. ablative) 


From, out of. 


Ex quib. sum. 


Ex quibus sumatur 


From which are given. 


Ex mod. p. 


Ex modo prsescripto 


After the manner prescribed. 


Ex paul. aq. 


Ex paululo aquae 


From (In) a very little water. 


Ex parte 


Ex parte 


Partly. 


Exhib. 


Exhibeatur 


Let it be exhibited. 


Exper. 


Experime 


Try (thou). _ 


Ext. 


Extende, Extendatur 


Spread, Let it be spread. 


Ext. sup. alut. 


Extende super alutam 


Spread upon leather. 


Ext., Extr. 


Extractum, gen. i 


An extract. 


Extr. 


Extrahe, Extrahatur 


Extract (thou), Let it be extracted. 


F. 


Fac 


Make (thou). 


F. L. A. 


Fiat lege artis 


Let it be made by the rules of art. 


F. pil. xij 


Fac pilulas duodecim 


Make 12 pills. 


Far. 


Farina 


Flour. 



LIST OF CONTRACTIONS AND LATIN PHRASES. 



901 



Contraction 


Word or Phrase. 


English Equivalent. 


Fas. lint. 


Fascia lintea 


A linen bandage. 


Fascic. 


Fasciculus 


A small bundle. 


Febr. 


Febris 


Fever. 


Febr. dur. 


Febre durante 


During the fever. 


Fem. intern. 


Femori interno 


To the inner thigh. 


Ferv. 


Fervens, gen. entis 


Hot. 


Fict. 


Fictilis, e 


Earthen, An earthen vessel. 


Fil. 


Filtra 


Filter (thou). 


Filt. 


Filtrum, gen. i 


A filter. 


Fistul. arm. 


Fistula armata 


A syringe ready for use. 


Flav. 


Flavus, a, um 


Yellow. 


Flor. 


Flores (pi.) 


Flowers. 


Fluid, vel Fl. 


Fluidus 


Liquid. 


Fol. 


Folia, gen. orum 


Leaves. 


Form. 


Formula, Formentur 


A prescription, Let them be formed. 


Frig. 


Frigor, gen. oris 


Cold. 


Frust. 


Frustillatim 


In small pieces. 


Ft. 


Fiat, Fiant (pi.) 


Let it (or them) be made. 


Ft. cerat. 


Fiat ceratum 


Let a cerate be made. 


Ft. chart, xij 


Fiant chartulae duodecim 


Let 12 powders be made. 


Ft. collyr. 


Fiat collyrium 


Let an eye-wash be made. 


Ft. emuls. 


Fiat emulsum 


Let an emulsion be made. 


Ft. en. 


Fiat enema 


Let an enema be made. 


Ft. inject. 


Fiat injectio 


Let an injection be made. 


Ft. pil. xij 


Fiant pilule duodecim 


Let 12 pills be made. 


Ft. pulv. 


Fiat pulvis 


Let a powder be made. 


Ft. pulv. xij 


Fiant pulveres duodecim 


Let 12 powders be made. 


Ft. sol. 


Fiat solutio 


Let a solution be made. 


Ft. suppos. viij 


Fiant suppositoria octo 


Let 8 suppositories be made. 


Ft. troch. xx 


Fiant trochisci viginti 


Let 20 troches be made. 


Ft. ung. 


Fiat unguentum 


Let an ointment be made. 


Ft. venesec. 


Fiat venesectio 


Let a bleeding be done. 


Fuerit 


Fuerit 


Shall have been. 


Fus. 


Fuscus, a, um 


Brown, dark. 


Garg. 


Gargarisma 


A gargle. 


Gelat. quav. 


Gelatina quavis 


In any kind of jelly. 


Ging. incid. 


Gingivas incide 


Lance (or cut) the gums. 


Gm. 


Gramma 


A gramme. 


g r - 


Granum, Grana 


A grain, Grains. 


gr. vj pond. 


Grana sex pondere 


Six grains by weight. 


Grad. 


Gradatim 


By degrees, gradually. 


Grat. 


Gratus 


Pleasant. 


Gros. 


Grossus, a, um 


Large, coarse. 


Grum. 


Grumus 


A clot (of blood). 


Gtt. 


Gutta, Guttae, Guttas 


A drop, Drops. 


Guttat. 


Guttatim 


By drops. 


Gtt. quibusd. 


Guttis quibusdam 


With a few drops. 


H. 


Hora 


An hour. 


Har. pil. 


Harum pilularum 


Of these pills. 


Haust. 


Haustus, gen. i 


A draught. 


H. p. n. 


Haustus purgans noster 


My own purgative draught. 


Hebdom. 


Hebdomada, Hebdomas 


A week. 


Herb. 


Herba, gen. ae 


An herb. 


Herb, recent. 


Herbarum recentium 


Of fresh herbs. 


Heri 


Heri 


Yesterday. 


Hie, Haec, Hoc 


Hie, Haec, Hoc 


This. 


Hirudo 


Hirudo, gen. inis 


A leech. 


Hirud. app. 


Hirudines appone 


Apply leeches. 


Hor. 


Hora, gen. ae 


An hour. 


Hor. decub. 


Horae decubitus 


At bedtime. 



902 



LIST OF CONTRACTIONS AND LATIN PHRASES. 



Contraction. 


Word or Phrase. 


English Equivalent. 


Hor. j spat. 


Horae unius spatio 


After one hour. 


Hor. interm. 


Horis intermediis 


In the intermediate hours. 


Hor. som. 


Hora somni 


At the hour of sleep. 


Hor. xj matut. 


Hora undecima matutina 


At the eleventh hour of the morning. 


Id. 


Idem 


The same. 


Iden. 


Identidem 


Repeatedly, often. 


Idon. 


Idoneus, a, urn 


Suitable, proper, convenient. 


Idoa. vehic. 


Idoneo vehiculo 


In a suitable vehicle. 


111. 


Illico 


Then, immediately. 


Immit. 


Immitatur 


Let it be placed in. 


Imp. 


Impone 


Lay on, apply. 


Impr. 


Imprimis 


First, chiefly. 


In 


In 


In, within, upon, not. 


Inc. 


Incide, Incisus 


Cut (thou), Being cut. 


Ind. 


In dies 


Daily, or From day to day 


Inde 


Inde 


Therefrom. 


Infun. 


Infunde 


Pour in. 


Infus. 


Infusum 


An infusion. 


Ing. 


Ingere, Ingerendus 


Put into, Putting into. 


Injec. 


Injectio 


An injection. 


Injic. enem. 


Injiciatur enema 


Let a clyster be injected. 


In lag. bene obt 


In lagena bene obturator 


In a well-stoppered bottle. 


In loco frig. 


In loco frigido 


In a cold place. 


In mass. cog. 


In massam cogantur 


Let them be combined in a mass 


In pulm. 


In pulmento 


In gruel. 


Instar 


Instar 


As big as, the size of. 


Int. 


Internus, a. um 


Inner, internal, between. 


Inter 


Inter 


Between. 


Intus 


Intus 


Inwardly. 


Invol. gelat. 


Involve gelatina 


Coat {or cover) with gelatin. 


Irror. 


Irrorentur 


Let them be moistened. 


Ita 


Ita 


In such manner. 


Iter. 


Iteretur, Iterentur 


Let it (them) be repeated 


Jam 


Jam 


Now. 


Jentac. 


Jentaculum, gen. i 


Breakfast. 


Jucund. 


Jucunde 


Pleasantly. 


Jul. 


Julepum 


A julep. 


Juscel. 


Juscellum 


A broth. 


Juscul. 


Jusculum 


Soup. 


Jux. 


Juxta, Juxtim 


Near to, Close by. 


K. 


Kali, Kalium 


Potassa, Potassium. 


Kal. ppt. 


Kali prseparata 


Potassium carbonate. 


Lac, 


Lac, gen. Lactis 


Milk, Of milk. 


Lag. 


Lagena, gen. ae 


A flask, or bottle. 


Lam. 


Lamella 


Plate, leaf, layer, scale. 


Lan. 


Lana, gen. as 


Flannel, wool. 


Lang. 


Languor, gen. oris 


Faintness. 


Lapid. 


Lapideus, a, um 


Stony, made of stone. 


Larg. 


Largus, a, um 


Abundant, plentiful. 


Larid. 


Laridum, gen. i 


Lard. 


Lat. 


Latus, a, um 


Broad, wide. 


Lat. 


Latus, gen. eris 


The side. 


Lat. admov. 


Latere admoveatur 


Let it be applied to the side. 


Lat. dol. 


Lateri dolenti 


To the painful side. 


Lax. 


Laxus, a, um 


Loose, open. 


Lb., It). 


Libra 


A pound. 


Lect. 


Lectus, gen. i 


Abed. 


Len. 


Leniter 


Easily, gently. 


Len. ter. 


Leniter terendo 


By rubbing gently. 


Lev. 


Leviter 


Lightly. 



LIST OF CONTRACTIONS AND LATIN PHRASES. 



903 



Contraction. 


Word or Phrase. 


English Equivalent. 


Lig. 


Ligatura 


A ligature. 


Linct. 


Linctus, gen. i 


A linctus, (taken by licking). 


Linim. 


Linimentum, gen. i 


A liniment. 


Lint. 


Linteum, gen. i 


Lint, linen. 


Liq. 


Liquor, gen. oris 


A solution. 


Lot. 


Lotio 


A lotion. 


Lut. 


Luteus, a, urn 


Yellow, golden yellow. 


M., TTJl 


Minimum, gen. i 


A minim. 


M. 


Misce 


Mix (thou). 


M. 


Manipulus, gen. i 


A handful. 


Macer. 


Macera 


Macerate (thou). 


Mag. 


Magnus, a, um 


Large. 


Man. 


Manipulus, gen. i 


A handful. 


Mane 


Mane (indecl.) 


Morning, in the morning. 


Mane primo 


Mane primo 


Early in the morning. 


Manus 


Manus, gen i 


The hand. 


Mass. 


Massa, gen. ae 


A mass, a pill-mass. 


Mat. 


Matula, gen. ae 


A vessel, a chamber-pot. 


Matut. 


Matutinus 


In the morning. 


Med. 


Medius, a, um 


Middle. 


Mens. 


Mensura 


By measure. 


Mic. pan. 


Mica panis 


A crumb of bread. 


Min. 


Minimum 


A minim. 


Minut. 


Minutum* 


A minute. 


Mis. 


Misce, Miscetur 


Mix (thou), Let it be mixed. 


Mis. bene 


Misce bene 


Mix well. 


Mis. caut. 


Misce caute 


Mix cautiously. 


Mist. 


Mistura 


A mixture. 


Mit. 


Mitte, Mittatur, Mittantur 


Send (thou), Let it be sent, Let them 
be sent. 


Mit. sang, ad uncias 


Mitte sanguinem ad uncias 


Take away blood to 12 ounces at 


xij salt. 


duodecim saltern 


least. 


Mit. tal. 


Mitte tales 


Send of such. 


Mod. diet. 


Modo dictu 


As to be directed. 


Mod. pr. 


Modo praescripto 


In the manner prescribed. 


Modic. 


Modicus, a, um 


Moderate-sized, middling. 


Mol. 


Mollis, Molle 


Soft. 


Mor. 


Mora, gen. ae 


Delay. 


Mor. diet. 


More dictu 


In the manner to be directed. 


Mor. sol. 


More solito 


In the usual manner. 


Mort. 


Mortarium, gen. i 


A mortar. 


Natr. 


Natrium, gen. i 


Sodium. 


Ne tr. s. num 


Ne trade sine nurnmo 


Do not deliver without the money. 


Necn. 


Necnon 


And also, and yet. 


Nig. 


Niger, nigra, nigrum 


Black. 


Nisi 


Nisi 


Unless. 


No. 


Numero, Numerus 


In number, A number. 


Noct. 


Noctis 


Of the night. 


Noct. maneq. 


Nocte maneque 


At night and in the morning. 


Non 


Non 


Not 


Non repetat. 


Non repetatur 


Let it not be repeated. 


Noxa 


Noxa, gen. ae 


An injury. 


Nucha 


Nucha 


The nape of the neck. 


Nunc 


Nunc 


Now. 


Nut. 


Nutricius, a, um 


Nutritious. 


Nutrit. 


Nutritus, gen. us 


Nutriment. 


Nux 


Nux, gen. nucis . 


A nut. 


Nux mosch. 


Nux moschata 


A nutmeg. 


O. 


Octarius 


A pint ( §xvj). 


Obd. 


Obduce 


Cover, conceal, coat. 



♦ This is medical Latin, or " bog-Latin." The proper Latin for a minute of time is Sexagesima pars hero. 



9°4 



LIST OF CONTRACTIONS AND LATIN PHRASES. 



\ 



Contraction. 


Word or Phrase. 


English Equivalent. 


Obduct. 


Obductus, a, um 


Covered, coated. 


Obtrit. 


Obtritus, a, um 


Crushed. 


Occlus. 


Occlusus, a, um 


Enclosed. 


Oct. 


Octo, Octavus 


Eight, Eighth. 


Octup. 


Octuplus 


Eight-fold. 


Ocul. 


■ Oculus, gen. i 


The eye. 


Odor. 


Odora, Odoretur 


Perfume, Let it be perfumed. 


Odorat. 


Odoratus, a, um 


Perfumed, odorous. 


Ol. lini sine ig. 


Oleum lini sine igne 


Cold-drawn linseed oil. 


Ol. O. Opt. 


Oleum olivae optimum 


Best olive oil. 


Olla 


Olla, gen. ae 


A pot, a jar. 


Ollic. 


Ollicula, gen. ae 


A little pot. 


Omn. hor. 


Omni hora 


Every hour. 


Omn. bih. . 


Omni bihorio 


Every two hours. 


Omn. quadr. hor. 


Omni quadrante horae 


Every £ hour. 


Omn. mane 


Omni mane 


Every morning. 


Omn. noct. 


Omni nocte 


Every night. 


Op. 


Opus 


Need, occasion. « 


Opt. 


Optimus, a, um 


Best. 


Oryza 


Oryza, gen. ae 


Rice. 


Os 


Os, gen. oris, ace. os 


The mouth. 


Ov. 


Ovum, gen. ovi 


An egg. 


P. 


Pondere 


By weight. 


P.P. A. 


Phiala prius agitata 


The bottle having been first shaken. 


P. r. n. 


Pro re nata 


Occasionally, as needed. 


Pab. 


Pabulum, gen. i 


Food. 


Pallid. 


Pallidus, a, um 


Pale. 


Pan. 


Panis, Pannus 


Bread, A cloth or rag. 


Par., Pt. 


Pars, gen. Partis 


A part, Of a part. 


Para, Parat. 


Para, Paratus 


Prepare, Prepared. 


Pt. aeq. 


Partes aequales 


Equal parts. 


Pt. affect. 


Parte affecta 


On the affected part. 


Part. vie. 


Partitis vicibus 


In divided doses. 


Parv. 


Parvus, a, um 


Little. 


Parvul. 


Parvulus, a, um 


An infant, a parvule. 


Pastil. 


Pastillus, Pastillum 


A pastille, a lozenge. 


Pauc. 


Paucus, a, um 


Little, few. 


Paul. 


Paulatim 


Little, by little, gradually. 


Pect, 


Pectus, gen. oris 


The breast. 


Pediluv. 


Pediluvium 


A foot-bath. 


Penicil. cam. 


Penicillum camelinum 


A camel's-hair pencil or brush. 


Per 


Per {prep. gov. accus.) 


Through, by means of, very. 


Peract. vom. 


Peracta vomitione 


When the emesis is finished. 


Percalef. 


Percalefactus, a, um 


Thoroughly heated. 


Percol. 


Percola 


Strain through, percolate. 


Per deliq. 


Per deliquium 


By deliquescence. 


Per fistul. vit. 


Per fistulam vitream 


Through a glass tube. 


Perg. 


Perge, Pergetur 


Proceed, Let be continued. 


Perind. 


Perinde 


Just as. 


Permit, vir. 


Permittentibus viribus 


The strength permitting. 


Perpur. 


Perpurus, a, um 


Very clean. 


Pervesp. 


Pervesperi 


Very late in the evening. 


Pes 


Pes, gen. pedis 


The foot. 


Pess. 


Pessarium, Pessulum 


A pessary. 


Ph. 


Phiala, gen. ae 


A vial, a bottle. 


|Pil. 


Pilula, gen. ae 


A pill. 


•Pil. 


Pilus, gen. i 


The hair. 


Ping. 


Pinguis, gen. is 


Fat, grease. 


Pist. 


Pistillum, gen. > 


A pestle. 


Plac. 


Placebo 


I will satisfy (please). 



LIST OF CONTRACTIONS AND LATIN PHRASES. 



905 



Contraction. 


Word or Phrase. 


English Equivalent. 


Plas. 


Plasma, Plasmetur 


Mould, Let it be moulded. 


Plen. 


Plenus, a, um 


Filled. 


Poc. 


Poculum, Pocillum 


A cup, A little cup. 


Pon., P. 


Pondere 


By weight. 


Pon. civ. 


Pondus civile 


Civil weight (avoirdupois). 


Pon. med. 


Pondus medicinale 


Medicinal (apothecaries') weight. 


Pone aur. ■ 


Pone aurem 


Behind the ear. 


Post cib. 


Post cibos 


After meals. 


Post sing. sed. liq. 


Post singulas sedes liquidas 


After every loose stool. 


Postrid. 


Postridie 


On the next day. 


Pot. 


Potus, gen. fis 


A drink. 


Prae 


Prae (prep. gov. abl.) 


Before, very. 


Praep. 


Praeparatus, a, um 


Prepared. 


Prand. 


Prandium, gen. i 


Dinner. 


Prid. 


Pridie 


On the previous day. 


Prim. man. 


Primo mane 


Very early in the morning. 


Primus 


Primus, a, um 


The first. 


Pro 


Pro (adv. and prep. t gov. 
ablative case) 


For, before, according to. 


Prop. 


Proprius, a, um 


Special, particular. 


Pro rat. aet. 


Pro ratione aetatis 


According to the age of the patient. 


Pro r. n. 


Pro re nata 


Occasionally, as needed. 


Prox. , 


Proximo 


Nearest. 


Pug. 


Pugillus 


A pinch. 


Pulm. 


Pulmentum, gen. i 


Gruel. 


Pulv. 


Pulvis, gen. eris 


A powder. 


Pulv. gros. 


Pulvis grossus 


A coarse powder. 


Pulv. subtil. 


Pulvis subtilis 


A smooth powder. 


Pulv. ten. 


Pulvis tenuis 


A fine powder. 


Pulvz. 


Pulverizatus, a, um 


Powdered. 


Pur. 


Purus, a, um 


Pure, clean. 


Purg. 


Purgativus, gen. i 


A purgative, a purging. 


Pyx. 


Pyxis, gen. idis 


A small box, a pill-box. 


Q. 


Quadrans, gen. tis 


A fourth part, a quart. 


Q.lib. 


Quantum libet 


As much as you please. 


Q.p. 


Quantum placet 


« « tt tt « 


Q.q. 


Quoque 


Also. 


Qq. 


Quisque, Quaque 


Each, or Every. 


Qq. hor. 


Quaqua, hora 


Every hour. 


Q.s. 


Quantum sufficiat 


As much as is sufficient. 


Q.s. 


Quantum satis 


tt It tt tt tt 


Q.v. 


Quantum vis 


As much as you please. 


Q. vol. 


Quantum volueris 


tt tt tt tt It 


Quad. 


Quadruplo 


Quadruple, in fourfold. 


Quam 


Quam 


As much as. 


Quart. 


Quartus, gen. i 


Fourth. 


Quat., Quater 


Quatuor, Quater 


Four, Four times. 


Quibus 1 


Quibus 


From which. 


Quinq. 


Quinque 


Five. 


Quint. 


Quintus 


The fifth. 


Quoq. 


Quoque 


Also. 


Quor. 


Quorum 


Of which. 


Quotid. 


Quotidie 


Daily. 


Quoties req. 


Quoties requiritur 


As often as is required 


3 


Recipe 


Take (thou). 


Rar. 


Rarus, a, um 


Loose, thin, rare. 


Rat. 


Ratio, gen. onis 


Relation, proportion. 


Rec. 


Recens, gen. entis 


Fresh, recent, newly. 


Red. in pulv. 


Redactus in pulverem 


Reduced to powder. 


Redig. in pulv. 


Redigatur in pulverem 


Let it be reduced to powder. 



(i 



906 



LIST OF CONTRACTIONS AND LATIN PHRASES. 



I 



Contraction. 


Word or Phrase. 


English Equivalent. 


Reg. umbil. 


Regio umbilici 


The umbilical region. 




Rel. 


Relaxatus, a, um 


Opened, loosened. 




Reliq. 


Reliquus, gen. i 


Remaining, the remainder. 




Renov. 


Renova, Renovetur 


Renew, Let it be renewed. 




Renov. semel 


Renovetur semel 


Let it be renewed once only. 




Rept. 


Repetatur, Repetantur 


Let it (them) be repeated. 




Res 


Res, gen. rei 


A substance, thing, affair. 




Resid. 


Residuus, a, um 


Residual, remaining. 




Respon. 


Responde 


Answer (thou). 




Retin. 


Retinetur 


Let it be withheld. 




Rict. 


Rictus, gen. us 


A wide (distended) opening. 




Rig. 


Rigidus, a, um 


Rigid, hard, inflexible. 




Rub. 


Ruber, Rubra, Rubrum 


Red, ruddy. 




Rudic 


Rudicula, gen. as 


A spatula. 




Rudis 


Rudis, gen. is 


A stirring-rod. 




Rum. 


Rumen, gen. inis 


The throat. 




S. expr. 


Sine expressione 


Without expression. 




S.A. 


Secundum artem 


According to art. 




S.L. 


Secundum legem 


According to law. 




S.N. 


Secundum naturam 


According to nature. 




S. S. S. 


Stratum superstratum 


Layer upon layer. 




S. V. R. 


Spiritus vini rectificatus 


Alcohol. 




S. V. T. 


Spiritus vini tenuis 


Proof spirit. 




Sac. lac. 


Saccharum lactis 


Sugar of milk. 




Sac. sat. 


Saccharum saturni 


Sugar of lead. 




Saep. 


Saspe 


Frequently. 




Sal 


Sal, gen. salis 


Salt. 




Sal am. 


Sal amarum 


Magnesium sulphate. 




Sal mir. 


Sal mirabile 


Sodium sulphate. 




Sal vol. 


Sal volatile 


Ammonium carbonate. 




Saltern 


Saltern 


At least. 




Saltim 


Saltim 


By leaps. 




Sang. 


Sanguis, Sanguineus 


Blood, Bloody. 




Sap. 


Sapor, gen. oris 


A flavor, delicacy. 




Sat. 


Satis 


Enough, sufficient. 




Saturat. 


Saturatus, a, um 


Saturated. 




Scarif. 


Scarifica 


Scarify (thou). 




Scarif. exp]. 


Scarificatione explicata 


Scarification having been effected. 




Scat. 


Scatula, gen. as 


A box. 




Scil. 


Scilicet 


Namely. 




Scrup., 9 


Scrupulum, gen. i 


A scruple (20 grains). 




Scut. pect. 


Scuto pectori 


For protection to the breast 




Sec. 


Secundo, Secundum 


Secondly, According to. 




Secund. 


Secundus 


Second. 




Sed. 


Sedes, gen. is 


The fundament, the feces. 




Semel 


Semel 


Once. 




Semidr. 


Semi-drachma 


Half a drachm. 




Semih. 


Semi-hora 


Half an hour. 




Sensim 


Sensim 


Gently, gradually, slowly. 




Separ. 


Separatim 


Separately. 




Sept. 


Septem 


Seven. 




Septim. 


Septimana 


A week. 




Sero 


Sero 


Late, at a late hour. 




Sesq. 


Sesqui 


One and a half. 




Sesqh. 


Sesquihora 


An hour and a half. 




Sesunc. 


Sesuncia 


An ounce and a half. 




Sev. 


Sevum, gen. i 


Suet, tallow. 




Sex, Sext. 


Sex, Sextus 


Six, Sixth. 




Si 


Si 


If. 




Sic! 


Sic! 


So, thus. 





LIST OF CONTRACTIONS AND LATIN PHRASES. 



907 



Contraction. 


Word or Phrase. 


English Equivalent. 


Sic. 


Sicca, Siccetur 


Dry (thou), Let it be dried. 


Sic. 


Siccus 


Dry, Dried. 


Sig. 


Signa, Signetur 


Write (thou), Let it be marked. 


Sig. nom. prop. 


Signatur nomine proprio 


Let it be written upon (marked) with 
its proper name. 


Sign. 


Signanter 


Clearly, distinctly. 


Sile de hoc. 


Sile de hoc. 


Keep silence concerning this. 


Simp. 


Simplex, gen. simplicis 


Simple, unmixed. 


Simul 


Simul 


Together. 


Sin. 


Sine 


Without. 


Sing. 


Singulorum 


Of each. 


Si non val. 


Si non valeat 


If it does not answer. 


Si op. sit 


Si opus sit 


If necessary. 


Si vir. perm. 


Si vires permittent 


If the strength will permit. 


Sit 


Sit 


Let it be. 


Sit in promp. 


Sit in promptu 


Let it be in readiness. 


Sitis, Siti 


Sitis, Siti 


Thirst, For thirst. 


Sol. 


Solus 


Alone, only. 


Solat. 


Solatium, gen. ii 


A soothing, assuaging. 


Solit. 


Solitus, a, um 


Accustomed, ordinary. 


Solut. 


Solutus, a, um 


Dissolved. 


Solut. 


Solutio, gen. onis 


A solution. 


Solv. 


Solve, Solvetur 


Dissolve, Let it be dissolved. 


Solv. c. calor. 


Solve cum calore 


Dissolve with heat. 


Som. 


Somnus, gen. i 


Sleep. 


Spiss. 


Spissus, a, um 


Dense, hard. 


Spt. 


Spiritus, gen. us 


Spirit. 


Spt. vin. rect. 


Spiritus vini rectificatus 


Rectified spirit of wine (Alcohol). 


Spt. vin. ten. 


Spiritus vini tenuis 


Proof spirit. 


Spt. vinos. 


Spiritus vinosus 


Ardent spirit (of any strength). 


ss 


Semis, Semissis, Semi- 


A half. 


St. 


Stet, Stent 


Let it (or them) stand. 


Stat. 


Statim 


Immediately. 


Stib. 


Stibium, gen. ii 


Antimony. 


Stillat. 


Stillatim 


By drops, drop by drop 


Stom. 


Stomachus, gen. i 


The stomach. 


Strat. 


Stratum, gen. i 


Layer, stratum. 


Strat. superst. 


Stratum superstratum 


Layer upon layer. 


Suav. 


Suavis 


Pleasant, agreeable. 


Sub 


Sub 


Under, somewhat. 


Subact. 


Subactus 


Subdued, sinking. 


Sub fin. coct. 


Sub finem coctionis 


When the boiling is nearly done. 


Subind. 


Subinde 


Frequently. 


Subtil. 


Subtilis 


Fine, smooth, nice. 


Sue. 


Succus, gen. i 


Juice, sap. 


Sugil. 


Sugillationi 


To the bruise. 


Sum. 


Sume, Sumat 


Take (thou), Let him take. 


Sum. 


Sumatur, Sumantur 


Let it (them) be taken. 


Sum. tal. 


Sumat talem 


Let him take one like this. 


Sumend. 


Sumendus 


To be taken. 


Summit. 


Summitates 


The highest points, summits. 


Sum. mane sum. 


Summo mane sumendus 


To be taken very early in the morning. 


Summ. 


Summus, a, um 


Highest, summit. 


Sup. 


Super, Supra 


Above, upon, over. 


Sup. bib. haust. 


Superbibendo haustum 


Drinking afterwards this draught. 


Suppos. 


Suppositoria, gen. ae 


A suppository. 


Suppos. rect. 


Suppositoriae rectales 


Rectal suppositories. 


Suppos. ureth. 


Suppositoriae urethrales 


Urethral suppositories 


Syr. 


Syrupus, gen. i 


Syrup. 


T. d., vel T. i. d. 

. 


Ter die, vel Ter in die 


Thrice daily. 



i 



908 



LIST OF CONTRACTIONS AND LATIN PHRASES. 



} 



Contraction. 


Word or Phrase. 


English Equivalent. 


Tab. 


Tabella, gen. ae 


A lozenge, tablet. 


Tal. 


Talis, gen. is 


Of such, like this. 


Tarn 


Tam 


So far, in so far. 


Tan. 


Tandem 


At last, finally. 


TanU 


Tantum, gen. i 


So much, so many. 


Teg. 


Tegmen, gen. inis 


A cover. 


Temp. 


Tempus, gen. oris 


Time, temple. 


Temp. dext. 


Tempori dextro 


To the right temple. 


Ten. 


Tenuis 


Fine, weak, thin. 


Tep. 


Tepidus, a, urn 


Tepid, lukewarm. 


Ter 


Ter 


Thrice, three times. 


Tere, Teret. 


Tere, Teretur 


Rub (thou), Let it be rubbed. 


Tere sim. 


Tere simul 


Rub (thou) together. 


Teres 


Teres, gen. etis 


Rubbed, smooth, polished. 


Tert. 


Tertius 


Third. 


Test. ov. 


Testa ovi 


An egg-shell. 


Thion. 


Thionas, gen. atis 


Sulphur, sulphate. 


Tinct., vel Tr. 


Tinctura, gen. ae 


Tincture. 


Tinct. herb, recent. 


Tincturae herbarum recen- 
tium 


Tinctures of fresh herbs. 


Tinct. theb. 


Tinctura thebaica 


Laudanum. 


Tr. 


Tres, Tria 


Three. 


Trid. 


Triduum, gen. ui 


The space of three days. 


Trit. 


Tritura, Trituretur 


Triturate, Let it be triturated. 


Troch. 


Trochiscus, Trochisci 


A lozenge, or troche, Lozenges. 


Turn 


Tum i 


Then, next, furthermore. 


Turb. 


Turbidus, a, um 


Turbid, muddy. 


Tus. 


Tussis, gen. is 


A cough. 


Tuto 


Tuto 


Safely. 


Ubi 


Ubi 


Where, wherever, whenever. 


Uln. 


Ulna, gen. ae 


The arm, elbow. 


Ult. 


Ultime, Ultima 


Lastly, at the last. 


Ult. praesc. 


Ultimo praescriptus 


The last ordered. 


Una 


Una 


Together. 


Unc, § 


Uncia, gen. ae 


An ounce. 


Unct. 


Unctus, a, um 


Anointed, besmeared. 


Unctul. 


Unctulus, a, um 


« « 


Ung. 


Unguentum, gen. i 


An ointment, unguent. 


Unguil. 


Unguilla, gen. ae 


An ointment-box. 


Urg. 


Urgens, gen. entis 


Pressing, urgent. 


Ust. 


Ustus, a, um 


Burnt. 


Ut 


Ut, Uti 


That, so that, in order that. 


Ut diet. 


Ut dictum 


As directed. 


Utend. more soL 


Utendus more solito 


To be used in the usual manner. 


Utere 


Utere 


Use (thou), make use of. 


Vas 


Vas, gen. vasis 


A vessel, utensil, bottle. 


Vas vit. 


Vas vitreum 


A glass vessel. 


Vehic. 


Vehiculum, gen. i 


A vehicle, menstruum. 


Vel 


Vel {or Ve as a suffix) 


Or. 


Vensesec. brach. 


Venaesectio brachii 


Bleeding in the arm. 


i Venen. 


Venenum, Venenosus 


A poison, Poisonous. 


, Ver. 


Verus, a, um. 


True, real, genuine. 


1 Vesp. 


Vesper, gen. eris 


The evening. 


i Vesper, 


Vesperma, gen. ae 


Supper. 


j Vic. 


Vicis, Vices 


Change, changes. 


Vin. 


Vinum, gen. i 


Wine. 


IVir. 


Vires {pi. of Vis) 


Strength, vigor, life. 


Virid. 


Viridis, Viride 


Green. 


Vis 


Vis, gen. viris 


Strength, vigor, life. 


Vitel. 


Vitellus, gen. i 


Yolk. 



NUMERALS. 



909 



Contraction. 


Word or Phrase. 


English Equivalent. 


Vitel. ovi 
Vitel. ovi sol. 
Vitr. 
Vol. 
Vom. urg. 


Vitellus ovi 
Vitello ovi solutus 
Vitrum, Vitreus 
Volatilis, Volatile 
Vomitione urgente 


Yolk of egg. 

Dissolved in the yolk of an egg. 

Glass, Of glass, glazed. 

Volatile. 

Vomiting being severe. 



For Dangerous Abbreviations, see page 507, under the title Prescriptions. 



NUMERALS. 



Cardinals. 


Ordinals. 


Unus 


One. 


Primus 


First. 


Duo 


Two. 


Secundus 


Second. 


Tres 


Three. 


Tertius 


Third. 


Quatuor 


Four. 


Quartus 


Fourth. 


Quinque 


Five. 


Quintus 


Fifth. 


Sex 


Six 


Sextus 


Sixth. 


Septem 


Seven. 


Septimus 


Seventh. 


Octo 


Eight. 


Octavus 


Eighth. 


Novem 


Nine. 


Nonus 


Ninth. 


Decern 


Ten. 


Decimus 


Tenth. 


Undecim 


Eleven. 


Undecimus 


Eleventh. 


Duodecim 


Twelve. 


Duodecimus 


Twelfth. 


Tredecim 


Thirteen. 


Tertius decimus 


Thirteenth. 


Quatuordecim 


Fourteen. 


Quartus decimus 


Fourteenth. 


Quindecim 


Fifteen. 


Quintus decimus 


Fifteenth. 


Sexdecim 


Sixteen. 


Sextus decimus 


Sixteenth. 


Septemdecim 


Seventeen. 


Septimus decimus 


Seventeenth. 


Octodecim 


Eighteen. 


Octavus decimus 


Eighteenth. 


Novemdecim 


Nineteen. 


Nonus decimus 


Nineteenth. 


Viginti 


Twenty. 


Vicesimus 


Twentieth. 


Viginti unus, vel ~\ 
Unus et viginti / 


Twenty-one. 


Vicesimus primus 
Vicesimus secundus 


Twenty-first. 
Twenty-second. 


Triginta 


Thirty. 


Tricesimus 


Thirtieth. 


Quadraginta 


Forty. 


Quadragesimus 


Fortieth. 


Quinquaginta 


Fifty. 


Quinquagesimus 


Fiftieth. 


Sexaginta 


Sixty. 


Sexagesimus 


Sixtieth. 


Septuaginta 


Seventy. 


Septuagesimus 


Seventieth. 


Octoginta 


Eighty. 


Octogesimus 


Eightieth. 


Nonaginta 


Ninety. 


Nonagesimus 


Ninetieth. 


Centum 


One hundred. 


Centesimus. 


Hundredth,, 


Ducenti 


Two hundred. 


Ducentesimus 


Two hundredth. 


Trecenti 


Three hundred. 


Trecentesimus 


Three hundredth. 


Quadrigenti 


Four hundred. 


Quadringentesimus 


Four hundredth. 


Quingenti 


Five hundred. 


Quingentesimus 


Five hundredth. 


Sexcenti 


Six hundred. 


Sexcentesimus 


Six hundredth. 


Septingenti 


Seven hundred. 


Septingentesimus 


Seven hundredth. 


Octingenti 


Eight hundred. 


Octingentesimus 


Eight hundredth. 


Nongenti 


Nine hundred. 


Nongentesimus 


Nine hundredth. 


Mille 


One thousand. 


Millesimus 


Thousandth. 


Duo millia 


Two thousand. 


Bis millesimus 


Two thousandth. 



i 



9io 



GENITIVE CASE ENDINGS — VERBS. 

GENITIVE CASE ENDINGS. 



Noif. 


Gen. 


Exceptions. 


a 


as 


Cataplasma, Enema, Physostigma, Theobroma, Aspidosperma and Gargar- 
isma, have the genitive in -atis. Folia is pleural, gen. Foliorum. 


us 

um 

OS 

on 


i 


Rhus, Rhois; Flos, Floris; Bos, Bovis; Limon, Limonis; Erigeron, -ontis. 
Fructus, Cornus, Quercus, Spiritus, Haustus, Potus, do not change, being 
of the 4th declension. 


as 


atis 


Asclepias, -adis; Mas, Maris; Rhceas, Rhoeados. 


is 


idis 


Pulvis, -eris; Arsenis, -itis; Phosphis, -itis; Sulphis, -itis, and all salts 
ending in -is, have the genitive in -itis. 


o 


onis 


Mucilago, -inis; Ustilago, -inis; Solidago, -inis. 


1 


lis 


Fel, Fellis; Mel, Mellis. 


e 

en 

ps 
rs 

r 

X 


es 
inis 
pis 
rtis 
ris 
cis 


Words which do not change in the Genitive. 
Azedarach Cornus Hydrastis Sabal 
Buchu Curare Jaborandi Sago 
Cannabis Digitalis Kino . Sassafras 
Caoutchouc Ethyl* Matico Sinapis 
Catechu Fructus Menthol* Spiritus 
Chloral* Gambir Potus Sumbul 
Cundurango Haustus Quercus Thymol* 



*In the B. P. Chloral, Ethyl, Menthol, and Thymol are Latin nominatives, and do not changejm 
the genitive, (e.g., Syrupus Chloral, Liquor Ethyl Nitritis, Emplastrum Menthol). In the U. S. jP. 
the corresponding nominatives are Chloralum, ^Jthyl, Menthol, and Thymol; but the genitive of 
/Ethyl is iEthylis, and that of Thymol is Thymolis, (e. g., /Ethylis Carbamas, Thymolis Iodidum). 

Pronunciation. 

Attention is particularly directed to the accentuation of words commonly mispronounced; 
as, for example, acetas, angia, chimaphila (kitnaphila), chloridum, conium, enema, i6didum, 
radicis, ricinus, sinapis, syrupus, eczema, umbilicus, abdomen, br6midum, paresis. 



Verbs. 



) 



The Verbs used in prescription writing are nearly all in the imperative mood, giving 
directions to the compounder, and having their objects in the accusative case. Such are — 
Extende, spread. Macera, macerate. Signa, write. 



Adde, add. 
Cola, strain. 
Divide, divide. 



Fac, make. 
Filtra, filter. 



Misce, mix. 
Recipe, take. 



Solve, dissolve. 
Tere, rub. 



A few verbs are found in the subjunctive mood, taking their subject or predicate in the 
nominative case. The most usual are — 

Fiat, let be made. Bulliat, let boil. Drvidatur, let be divided. 

Coletur, let be strained. Capiat, let take. 

Coloretur, let be colored. Detur, let be given. 



Sit, let it be. 
Sumatur, let be taken. 



HYPODERMIC FORMULAE — DIFFERENTIAL DIAGNOSIS. 



911 



Participles. 
Participles or Verbal Adjectives are occasionally used, and should agree with their re- 
spective nouns in gender, number, and case. Such are — 

Adhibendus, a, um, to be administered. Dividendus, a, um, to be divided. 

Sumendus, a, um, to be taken. 

Prepositions. 
Those in the first column require the noun following to be in the accusative case, — ■ 
those in the second column require the ablative case. 

Ad, to, up to. Cum, with. 

In, into. Pro, for. 

Supra, upon. Sine, without. 

Ana, of each, — is usually followed by the genitive case. 



Sundry Words and Phrases, 



Bene, well. 
Bis, twice. 
Dein, thereupon. 
Et, and. 

Gradatim, gradually. 
Guttatim, by drops. 
In dies, daily. 
Da, give. 



Non, not. 
Numerus, number. 
Octarius, a pint. 
Semel, once. 
Simul, together. 
Statim, at once. 
Ter, thrice. 
Quater, four times. 



IN MOST FREQUENT USE. 

Ad saturandum, to saturation. 
Numero, to the number of. 
Quantum sufficiat, as much as necessary. 
Pro re natd, according to need. 
In partes cequales, into equal parts. 
Redactus in pulverem, let be pulverized. 
Secundum artem, according to art. 
Non repetatur, let it not be repeated. 



HYPODERMIC FORMULAE. 

In the previous^ editions of this book formulas were given for hypodermic medication 
In the present edition these are omitted because standardized and readily soluble tablets 
or ampules containing sterile solutions or suspensions of the various drugs which are so 
used are so readily obtainable from the various manufacturing pharmacists and from the 
local druggists that the physician is no longer called upon to write prescriptions for these 
substances. 

TABLES OF DIFFERENTIAL DIAGNOSIS. 



Forms of Renal Disease. 

Compared with Acute Nephritis and with each other. 



Urine Findings. 


Acute 
Diffuse 

Nephritis. 


Chronic 
Diffuse 

Nephritis. 


Chronic 
Interstitial 
Nephritis. 


Amyloid 
Disease. 


Pyelitis. 


Renal 
Calculus. 


Quantity 


Greatly 
decreased. 


Decreased. 


Increased. 


Increased. 


Normal. 


Normal or — 


Reaction 


Acid. 


Acid. 


Acid. 


Acid. 


Acid. 


Acid. 


Color and Tur- 
bidity. 


Dark smoky. 


Cloudy 
(urates) 


Pale, clear. 


Pale, clear. 


Cloudy. 


Cloudy, 
bloody. 


Sp. Gr 


+ 


+ (early). 
- (later). 


- 


- 


Normal or + 


Normal or + 


Urea (Total) . . . 


- 


- 


- 


Normal or — 


Normal. 


Normal. 


Albumin 


Abundant. 


Abundant. 


Scanty or — 


Abundant 
(globulin) . 


Traces (mild). 
Marked 
(severe). 


Traces or 
abundant. 




Blood 

Epithelial 

Hyaline. 


All varieties 
and fatty 
casts. 


Few hyaline. 


Few hyaline 
and waxy. 


— or few. 








Sediment 


Epithelium 
Red blood 
cells. 


Epithelium 
Red blood 

cells. 
Leucocytes. 


Seldom any. 


Seldom any. 


Pus cells in 
abundance, 
epithelial 
cells, red 
cells rarely. 


Red cells, 
Epithelial 
cells, small 
concretions 



Note. — The signs + and — in the line Sp. 
1.024 or less than 1.018. 



Gr., respectively denote a specific gravity greater than 



912 



DIFFERENTIAL DIAGNOSIS. 



CONDENSED DIFFERENTIAL DIAGNOSIS TABLE OF SPINAL DISEASES AND CONDI- 
TIONS WITH WHICH THEY MAY BE CONFOUNDED (DaCosta's Modern Surgery). 



Scoliosis. 



Rachitic 
Spine. 



Pott's 
Disease. 



SHS; Arthritis 
Ipinl" 1 : Gorman, 



Torticollis, 
Congenital. 



Hip 
Disease. 



Age. 8 to 16. 

Onset. Insidious. 

Pain. In back. 



History. None. 

Posture. Free. 

Muscular None, 

rigidity. 

Temperature. j Normal. 
Local tender- None. 



4 to 6. '4 to 6. ji6 to 20. 

Insidious. Insidious. Sudden. 
None. Referred toSevere in 

• I anterior ! spine. 
I # ' abdomen. 

Rachitic. Tuberculous. Trauma. 
Excessively Guarded Guarded. 

! free. i spine. 

'Free. In spine. In spine. 



ness. 
Night cries. 
Tendency 

abscess. 
X-ray. 



Hot-water 
test. 



Absent. 
tOjNone. 

j Character- 
istic defor- 
; mity. 
No tender- 
i ness. 



General [Constant, 

symptoms. I 



Normal. 
jNone. 

Absent. 
iNone. 

Normal. 

None. 

Constant. 



i degree rise. 
In spine. 

Present. 
Probable. 

Focus in 
spine. 

Localised 
in spine. 

Intermittent. 



j After 30. 

Insidious. 
|In spine. 



None. 
Guarded 

spine. 
In spine. 



(Any age. 14 to 6. 
'From birth. Insidious. 
None. In knee. 



Varies. 
Painful all 

over. 
Absent. 
None. 

Normal. 



Sensitive 
all over 
spine. 

Constant. 



Normal. 
All over 

spine. 
Absent. 
None. 



From birth 
Typical. 

In one 

rection 

only. 
Normal. 
None. 

None. 
None. 



I Distortion 
I of cervical 



Tuberculous. 
Guarded 

hip. 
di-In hip in all 

directions. 



1 degree rise. 
In hip. 

Present. 
Probable. 

Spine normal. 



Late 
bridges 
of bone. | spine. 

No necrosed! No tender- No tender- 
sensitive- ness. ness in 
ness. I I spine. 

Constant. Constant. Intermittent. 



CONDENSED DIFFERENTIAL DIAGNOSIS TABLE OF HIP DISEASES AND CONDITIONS 
WITH WHICH THEY MAY BE CONFOUNDED (DaCosta's Modern Surgery). 





Hip 


Infantile 


Congenital 


Psoas i Coxa Vara ' Knee 




Disease. 


Paralysis. 


Dislocation. 


Abscess. or Valga. \ Disease. 


Age. 


Four to six. iFour to six. 


Any age. 


! 
Four to six. ! Any age. Four to six. 


Onset. 


Insidious. Sudden. 


From birth. 


Insidious. Childhood. Insidious. 


Pain. 


Referred to, None. 


None. 


Referred to. None. Referred from 




knee. 




abdomen. knee. 


History. 


Tuberculous. Inflammatory 


Limp from 


Tuberculous. Limp. Tuberculous. 






disease. 


birth. 






Posture. 


Flexion, 


Uncontrolled. 


Shortening 


Flexion, Great 


Knee flexed. 




abduction, 




and adduc- 


adduction, j trochanter 






external ro- 




tion. 


external ro- higher in 




tation. 






tation. vara and 










lower in 
valga. 
In one direc-JNone. 




Muscular rigidity. 


Present in all, Absent. 


Absent. 


About knee. 




directions, j 




tion. 


Temperature. 


1 degree high. Normal. 


Normal. 


r degree. Normal. 1 degree. 


Local tenderness. 


In hip. None. 


None. 


In spine. None. In knee. 


Night cries. 


Present. 


Absent. 


Absent. 


Present. Absent. Present. 


Tendency to ab- 


Yes. 


No. 


No. 


Yes. No. ■ Yes. 


X-ray. 


Diseased 


Atrophy. 


Alteration in 


Normal hip. Alteration in Normal hip, 




focus in hip. 




joint. 


neck angle, focus in knee. 



} 



Carditis, Endo 

Endocarditis. 
Blowing sound. Excited heart action. 
Slight if any increase of percussion dullness. 
Impulse strong. 

Sounds normal or more distinct except at 
site, where a murmur is heard. 

Cerebral. 

Concussion. 
Patient can be roused; pupils react. 
Breathing seldom stertorous. 
Urinary action normal. 
Symptoms appear soon after accident. 
Transient. 



and Peri-. 

Pericarditis. 
Friction sound. Excited heart action. 
Marked increase in effusion stage. 
Wavy and feeble. 
Feeble and muffled; no blowing sounds. 



Compression. 
Complete insensibility; motionless pupils. 
Breathing usually stertorous. 
May be either retention or incontinence. 
Frequently do not. 
(Persisting.) 



DIFFERENTIAL DIAGNOSIS. 



913 



Chancre and 

Chancre. 
Commences about 3d week after inoculation 

(never before 10 days). 
First as a papule, abrasion, or crack. 

Generally indurated (rarely not). 
Develops slowly and is painless. 
Discharge slight, unless irritated. 
Is soon limited and seldom phagedenic. 

Edges sloping, not undermined. 

Scanty serous secretion. 

Sore remains solitary, and cannot be multi- 
plied; is multiple in 18 per cent, of the 
cases (Fournier), in 25 per cent. (Gail- 
lard), in 33 per cent. (Julien). 

Followed by numerous buboes, rarely sup- 
purating, never furnish inoculable pus. 

Followed by secondary constitutional 
symptoms. 

Scrapings from the sore reveal the spiro- 
chaeta pallida. After a few days the 
Wassermann reaction becomes positive. 



Chancroid. 

Chancroid. 
In 2-5 days (always within 10 days). 

First as a red spot, then a pustule, then a 
suppurating sore. 

Not on an indurated base. 

Develops rapidly and is painful. 

Suppurates profusely. 

Tends to invade surrounding tissues, or be- 
come phagedenic. 

Edges undermined. 

Discharge is purulent and copious. 

May be transplanted at will, and is seldom 
single. 



A single bubo may appear and suppurate. 

Followed by no constitutional symptoms. 
The cases reported in which chancroid was 
followed by manifestations of syphilis are 
probable instances of mixed infection in 
which "induration was overlooked because 
a papular initial lesion was beneath the 
chancroid ulcer" (Da Costa). 



Cholera. 



Asiatic. 
Preceded by painless diarrhea. 
Not directly from error in diet. 
First pain shooting down thighs. 
Prostration rapid and overwhelming, and 

out of ratio to evacuations. 
Rapid reduction of surface temperature; 

high temperature in cavities. 
Evacuations like rice-water from the first. 

Cramps commence in extremities. 

Veins congested; tongue, lips and extremi- 
ties livid purple. 

Urine albuminous. 

Bacteriological examination of the stools re- 
veals the cholera spirilla. 



the 



Simple. 
Seizure sudden. 

Generally is from error in diet. 
First pain is abdominal (colic). 
Prostration gradual, less marked than 

vomiting and purging. 
Gradual reduction of surface temperature; 

internal temperature normal. 
Discharges bilious, causing burning and 

smarting pain; colorless only at very last. 
Cramps commence in abdomen. 
Not so. 

Not so. 
Not so. 



Croup and Diphtheria. 



Croup. 

Premonitory hoarse, metallic cough, with- 
out illness. 

A child's disease. 

Tenacious mucus covering the swollen mem- 
brane. 

A local disease. 



Diphtheria. 
Premonitory illness, marked by chills, fever 

and sore throat, without cough. 
Attacks adults as well. 
Distinguished by a false membrane, and 

the Klebs-Loeffler bacillus. 
A blood poison; great general depression. 



Epilepsy 

Loss of consciousness is sudden, complete. 

Livid face, frothy saliva escapes, eyelids 
half open, eyeballs rolling, teeth grind- 
ing, tongue biting; more or less insensi- 
bility of pupils to light. 

Countenance is distorted. 

Patient shows no feeling. 

Aura epileptica may precede attack. 

58 



Epilepsy and Hysteria. 

Hysteria. 

Gradual and partial or apparent. 

Face flushed, or complexion unaltered, no 
froth on lips, eyelids closed, eyeballs 
fixed, no grinding of teeth, or biting of 
tongue; pupils react readily. 

Is not. 

Sighs, or laughs, or sobs. 

Globus hystericus. 



9i4 



DIFFERENTIAL DIAGNOSIS. 



Epilepsy 

Short paroxysm, followed by heavy coma- 
tose sleep and dull intellect. 

Frequently occurs at night. 

Not necessarily of uterine connection, 
though a paroxysm often occurs at the 
menstrual period. 



Hysteria 

Longer paroxysm; patient not sleepy, usu- 
ally wakeful and depressed in spirits. 

Rarely occurs at night. 

Often connected with uterine or menstrual 
disorders. 



Iritis, Conjunctivitis and GJaucoma (Mays). 



Acute Iritis. 
i. Iris swollen, dull, and dis- 
colored. 

2. Pupil small, gray, slug- 
gish, irregular after use of 
atropine. 

3. Anterior chamber of nor- 
mal depth (deeper in se- 
rous form) and presents 
exudation. 

4. Cornea transparent (may 
present deposits on pos- 
terior surface) and sensi- 
tive. 

5. Ciliary (circumcorneal) in- 
jection; pink zone of fine 
vessels surrounding cor- 
nea and fading toward 
fornix. 

6. Conjunctiva usually trans- 
parent. 

7. Lacrymation but no dis- 
charge. 

8. Tension usually normal 
(occasionally increased) . 

9. Some ciliary tenderness. 

0. Pain radiating to fore- 
head and temple, worse 
at night. 

1. Dimness of vision. 



Acute Conjunctivitis. 
No change in iris. 



2. Pupil normal. 



Anterior chamber 
mal. 



4. Cornea transparent. 



5. Conjunctival injection, 
coarse meshes, most pro- 
nounced in fornix and 
fading toward the cornea. 

6. Conjunctiva reddened 
and opaque. 

7. Mucous or muco-purulent 
discharge. 

8. Tension normal. 



) 



Pleurisy. 

No herpes. 

Sharp pain, friction sound, dry cough, im- 
paired chest motion. 

In stage of effusion, obliteration of inter- 
costal spaces, enlargement of the side, 
viscera displaced. 

Flatness, with enfeebled or absent respira- 
tion, voice, and fremitus. 

Sputa absent or frothy, rarely any rales. 
Febrile symptoms slight usually. 
Temperature irregular, rarely high. 

Slight or moderate leucocytosis. 



9. No ciliary tenderness. 

10. Discomfort, hot gritty 
feeling, but no real 
pain. 

n. No interference with 1 
vision, except blurring 
caused by the discharge 
smeared over the sur- 
face of the cornea. 

Pleurisy and Pneumonia. 



Acute Glaucoma. 
Iris congested, discolored, 
dull, periphery pushed 
forward. 

Pupil dilated, oval, im- 
mobile. 

Anterior chamber shallow 
and aqueous, sometimes 
turbid. 

Cornea steamy and in- 
sensitive. 



Ciliary and episcleral in- 
jection (also conjunctival 
congestion). 



6. Conjunctiva congested 
and chemotic. 

7. Lacrymation but no dis- 
charge. 

8. Tension increased. 

9. Ciliary tenderness. 
10. Severe pain in and about 

eye, with headache. 



Marked 
sion. 



dimness of vi- 



Pneumonia. 
Herpes labialis. 
Dull pain, crepitant rale, cough followed 

by expectoration. 
In stage of hepatization none of these signs 

are present. 

Dulness, with marked bronchial respira- 
tion, distinct thoracic voice, increase4 
vocal fremitus. 

Sputa thick, viscid, rusty color, rales common. 

Febrile symptoms severe. 

Sudden elevations and falls, high tempera- 
ture not uncommon. 

Marked leucocytosis. 



It is well to remember that while the physical signs of the two diseases are theoretically 
different, one finds in practice instances of pleural effusion in which breath sounds, vocal 
fremitus and vocal resonance are present or only slightly modified. The use of exploratory 
puncture may be necessary. 



DIFFERENTIAL DIAGNOSIS. 



915 



Pleurisy and Intercostal Neuralgia. 



Pleurisy (Dry). 
Pain somewhat diffused, not limited to a 

certain area. 
Slight fever and cough. 
Herpes absent. 
Friction sounds. 



Intercostal Neuralgia. 
Pain localized to the exit of the intercostal 

nerves. 
No fever, no cough. 
Herpes common, in the affected area. 
No friction sounds. 



Pleurisy and Hydrothorax 

Pleurisy with Effusion. 
Disease is unilateral. 
Pain and cough. 
Often a primary affection. 
Friction sounds present. 
Organs often displaced. 
Slight fever. 



Hydrothorax. 
Disease is bilateral. 
No pain; cough slight. 
Secondary to other diseases. 
Friction sounds absent. 
Organs not displaced. 
No fever. 



Pneumonia. 



Lobular (Broncho-pneumonia). 

Is bilateral. 

Begins gradually, and is secondary to bron- 
chitis. 

Temperature is not typical. 

Affects lobules in both lungs. 

Sputum not characteristic. 

No herpes. 

Subcrepitant rales; broncho- vesicular breath- 
ing. 

A prolonged disease, ending by lysis. 



_ Lobar (Croupous). 
Usually unilateral. 
Begins suddenly, often with a chill, and is a 

primary disease. 
Temperature is typical. 
Affects one or more lobes of the lung. 
Sputum rusty. 
Herpes common. 
Crepitant rales, then bronchial breathing, 

followed by crepitus redux. 
A short disease, ending by crisis. 



Scarlet 

Scarlet Fever. 
Incubation, 1 to 7 days. 

Fever, great heat of skin, 
and frequent pulse, un- 
abated during eruption. 

Brilliant stare. 

Sore throat, rarely coryza or 
bronchitis. 

"Raspberry" tongue, red. 

Temperature may be 105 - 
106 to 10th day, subsides 
gradually, falls on 5th, 
10th, and 15th days. 

No secondary fever. 

Eruption on second day, 
not rough, first on neck 
and chest, spreads rapidly, 
white streak on pressure 
with nail. 

Eruption uniform, or in large 
patches, interspersed raised 
spots and some vesicles; 
rash scarlet, on its seventh 
day very complete desqua- 
mation in large patches. 

Cerebral symptoms are fre- 
quent and grave. 

Pneumonia rare, pleurisy 
more frequent. 



Fever, Measles and Smallpox. 



Measles. 
Incubation, 7 to 14 days. 

Same fever rather increased 
by eruption. 



Liquid, watery eye. 

Coryza and bronchitis very 
constant, sore throat 
rarely. 

Tongue coated, may be red 
at edges. 

i03°-io6° before eruption, 
remains high for 1 to 2 
days thereafter, then falls 
suddenly. 

No secondary fever. 

Eruption on fourth day, on 
face, rough, spreads grad- 
ually, the streak lasts 
only a short time. 

Eruption in crescentic 
patches, lasts about 5 
days, then partial des- 
quamation, scales very 
fine. 

Not so. 

Pneumonia a frequent com- 
plication. 



Smallpox. 

Incubation, 6 to 20 days, 
average, 10. 

Fever often violent, bound- 
ing pulse, pain in loins; 
all are greatly relieved by 
eruption. 

Eyes injected, face red. 

Sore throat often, also a dry 
cough. 

Tongue coated, and swollen, 
may be red at edges. 

Before eruption often 106 , 
then rapidly sinks to ioo° 
in 36 hours; rises during 
the secondary fever. 

Secondary fever always. 

Eruption usually on third 
day, at first on lips, fore- 
head and hands, spreads 
rapidly. 

Eruption is first papular, 
then vesicular, finally 
pustular; pustules matu- 
rate on 8th day of erup- 
tion. 

Cerebral symptoms are fre- 
quently seen. 

Pneumonia not a very fre- 
quent complication. 



( 



916 



DIFFERENTIAL DIAGNOSIS. 



Scarlet Fever. 
Sequelae: Bright's disease, 
dropsy, deafness, conjunc- 
t i v i t i s, phthisis, chronic 
diarrhea; glandular enlarge- 
ments. 



Measles. 
Sequelae: chronic bronchi- 
tis, phthisis, conjunctivi- 
tis. 



Small pox. 
Sequelae: chronic diarrhea 
glandular enlargements, 
various eye diseases. 



Typhus Fever. 
Attacks quickly, incubation 8-12 days. 

Occurs at any age. 



Rare among the higher classes, except those 

exposed. 
Mulberry Eruption on 4th and 5th day, on 

abdomen spreading to extremities, lasts 

until the close. 

Nervous system chiefly affected; bowels 
often but little so; abdomen natural, 
evacuations dark, but never bloody (these 
are occasionally reversed). 

Contracted pupils, dusky face. 

Pulse and temperature rise to 120 and 105 
until 3d day, high for 1-2 weeks, then fall. 

Lasts 2 to 3 weeks. 
Widal reaction negative. 

Leucocytosis. 
Relapses rare. 

Death from coma or congestion of the lungs, 
in 1st or 2d week. 

Arises from destitution, over-crowding, bad 
ventilation, is highly contagious and gen- 
erally epidemic. Infection carried by 
lice. 

Post-mortem: changes not constant, the 
most frequent are dark blood, enlarged 
spleen, soft heart, parenchymatous 
changes in various organs. 



Typhus and Typhoid. 

Typhoid (Enteric) Fever. 
Commences slowly, incubation 3-23 (about 

14) days. 
Most common in youth and childhood, rare 

after the age of 40. 
As common among the rich as the poor. 



Rose Eruption on 7th to 10th day, isolated, 
flattened papules, few, on abdomen and 
back, in successive crops which fade and 
disappear. 

Bowels chiefly affected, constipation or 
diarrhea, evacuations ochre-color and 
watery, sometimes hemorrhage or per- 
foration, abdomen tumid. 

Dilated pupils, cheeks flushed. 

Pulse and temperature rise and fall inde- 
pendently, and without uniformity, but 
both are usually high to the 15th day. 

Lasts 4 to 6 or more weeks. 

Widal reaction positive in 95 per cent, of 
the cases. 

Leucopenia. 

Relapses frequent. 

Death from asthenia, pneumonia, hemor- 
rhage or perforation of intestine, in or 
after 3d week. 

From contaminated drinking water, in- 
fected food, flies, contact with patients and 
lack of personal cleanliness. Eberth's 
bacillus present in the intestinal lesions, 
the spleen, liver, blood, etc. 

Post-mortem: morbid Peyer's patches, en- 
larged mesenteric glands, ulcerated mu- 
cous coat of intestines; enlarged and soft 
spleen, parenchymatous changes in vari- 
ous organs. 



Varicella and Varioloid. 



Varicella. 
Incubation, 14 days; may extend to the 27th 

day (Trousseau). 
Prodromes, none or slight; no initial rashes. 



Eruption, on the first day, on trunk and 
arms, slightly on forehead, rapidly be- 
comes vesicular; is irregular, sometimes 
numerous, distributed universally in suc- 
cessive crops; lasts 5 to 8 days. 

Vesicles, not umbilicated, differ in size, uni- 
locular, when pricked collapse entirely. 

Crusts, yellowish-brown, slight. 



Varioloid. 
Incubation, 7 to 14 days. 

Prodromes, active for 2 days; headache often 
severe, backache slight or absent; initial 
rashes frequently occur. 

Eruption, usually within 36 hours, on fore- 
head and arms, then over body; regular, 
few, definitely localized; macular, papular, 
and then vesicular, rarely pustular; lasts 
about 14 days. 

Vesicles, umbilicated, of uniform size, mul- 
tilocular, when pricked they collapse 
partially. 

Crust-formation positive. 



DIFFERENTIAL DIAGNOSIS. 



917 



Varicella. 

Pustules, ordinarily absent, may occur from 
irritation or infection, or in poorly-nour- 
ished children. 

Temperature, irregular, to io2°F., no 
secondary fever. 

Duration, 7 to 10 days. 



Varioloid. 
Pustules, usually few in number. 



Temperature, rises suddenly, to io3°F., no 

secondary fever if pustules few. 
Duration, 2 to 3 weeks. 



Blackwater, Yellow and Bilious Remittent Fevers (Stitt). 




Blackwater Fever. 


Yellow Fever. 


Bilious Remittent. 


Onset 


Sudden but asthenic 
with marked vigor. 


Sudden but asthenic for 
2 or 3 days. 


Comes on more slowly. 


Urine 


Hemoglobinuria. Pink 
foam to urine. Al- 
buminuria from first 
day. 


No blood in urine before 
3d or 4th day and then 
hematuria. Albumin 
from 2d day. 


Bile in urine. Yellow 
froth on shaking urine. 
Albuminuria slight_and 
not common. 


Icterus 


Early and intense. 
Comes on in a few 
hours. 


Does not appear before 
3d day and gradually 
intensifies. 


Jaundice develops 
slowly about 2d day. 


Spleen 


Somewhat enlarged and 
tender. 


No enlargement of 
spleen. 


Splenic enlargement I is 
marked; may have 
ague cake. 


Pulse 


Rapid from start and 
becoming more so as 
disease progresses. 


Stationary pulse with 
rising temperature or 
falling pulse with sta- 
tionary temperature. 
(Faget's law.) 


Pulse not so rapid as in 
blackwater. 


Vomit 


Early marked bilious 
vomiting. 


Mucus-like followed by 
black vomit about 4th 
day. 


Bilious vomiting and 
gastric distress less 
than in blackwater. 


Evidences of 
Malaria. 


Usually present as para- 
sites or melaniferous 
leucocytes or increased 
large mononuclear per- 
centage. 


Negative unless yellow 
fever occurs in a mala- 
rial case. 


Some evidence at some 
time almost always 
obtainable. 



< 



9l8 DROPS IN A FLUIDRACHM. 

TABLE SHOWING THE 
NUMBER OF DROPS IN A FLUIDRACHM 

OF VARIOUS LIQUIDS, ALSO THE WEIGHT OF ONE FLUIDRACHM IN GRAINS. 



Liquid. 



Acetuta Opii, 

Acetum Sailae, 

Acid, Acetic, ^ 

Ac. Acetic, Dil., ... 

Ac. Hydrochloric, 

Ac. Hydrocyanic, 

Acid, Lactic, 

Acid, Nitric, 

Ac. Nitro-hydrochloric, . . 

Ac. Phosphoric Dil., 

Ac. Sulphuric, 

Ac. Sulph. Aromat., 

Ac. Sulph. Dil., 

Ac. Sulphurosum, 

.Ether,... 

Alcohol, 

Aqua, 

Aqua Destillata, 

Balsam of Peru, 

Bromine 

Chloroform, 

Copaiba, 

Creosote, 

Fluidextr. Belladon. Rad 

Fluidextr. Buchu, 

Fluidextr. Digitalis, 

Fluidextr. Ergots, 

Fluidextr. Ipecac, 

Fluidextr Rhei, 

Fluidextr. Senegse, 

Fluidextr. Valerianae, 

Fluidextr. Zingib., 

Glycerin, 

Hydrargyrum, 

Liq. Acidi Arsenosi, 

Liq. Ferri Chloridi, 



Drops 
in f3j. 
(Illlx.) 



90 

68 

108 

68 

70 

60 

in 

102 

76 

59 

128 

146 

60 

59 

I7 6 

146 

60 

60 

101 

250 

250 

no 

122 
156 
I50 
134 
133 
I20 
158 
137 
I50 
142 
67 
I50 

57 
7i 



Weight 
of f5j in 
grains. 



61 
57 
58 
55 
65 
54 
66 
77 
66 
57 
101 
53 , 
58} 
55 
39 
44 

& 

60 

165 

80 

5i, 
56i- 

S7 x 
47i 
62 
60 
60 
61 
62 
49 
48 
68 
760 
55 
72 



Liquid. 



Liq. Iodi Compos, 

Liq. Potassii Hydroxidi 

Liq. Zinci Chloridi, 

Oleores. Apsidii, 

Oleores. Capsici, 

Oleores. Cubebae, 

Oleum Anisi, 

Oleum Cari, 

Oleum Juniperi 

Oleum Limonis 

Oleum Ricini 

Oleum Rosae, 

Oleum Terebinthinss,.. 

Oleum Tiglii, 

Phenol 

Spt. ^Etheris Comp.,... 
Spt. Athens Nitrosi, .. 

Spt. Camphorae 

Syrupus, 

Syrupus Acaciae 

Syrupus Ferri Iodidi,.., 

Syrupus Scillae 

Syr. Scillae Comp., 

Syrupus Senegae, 

Tinctura Aconiti, 

Tinct. Belladonnas Fol. 
Tinct. Benzoini Comp., 

Tinct. Cantharidis, 

Tinct. Digitalis 

Tinct. Ferri Chlor., 

Tinct. Iodi 

Tinct. Opii, 

Tinct. Opii Camph.,... 
Tinct. Opii Deodor.,... 

Vin. Colchici Sem., 

Vinum Opii, 



Drops 
in f3j. 

(mix.) 



63 
62 
89 

130 

120 

123 
119 
132 
148 
129 

77 
132 
136 
104 
in 
148 
146 
143 
65 
44 
65 
75 
102 
106 
146 
137 
148 
131 
128 
150 
148 
130 
130 
no 



Weight 
of f 5j in 
grains. 



59 
58 
88 
52 
5i 
52 
54 
50 
49 

5i* 

45$ 

5° 

59 

45 

47 

47 

72 

73 

77 

74 

70 

70 

46 

58 

48 

5i 

53 

53 

47 

53 

52 

54 

54 

55 



WEIGHTS AND MEASURES. 



apothecaries' or troy weight. 



Pound. Ounces. Drachms. 

lb 5 3 

1 = 12 = 96 = 

1=8 = 

1 = 



Scruples. 

288 = 
24 = 

3 ■ 
1 = 



Grains. 

gr- 

5760 

480 

60 

20 



metric weights (approximate). 



I Milligramme, . . 0.001 

1 Centigramme . 0.01 

1 Decigramme, ... 0.1 

1 Gramme, 1. 

I Kilogramme, . . . 1000. 



: gr. <5T 
gr-* 
gr- i-h 
gr. 15.432 



_ I lb 2.7 Troy. 



lb 2.2 Av. 



APOTHECARIES' or wine measure. 
Gallon. Pints. FV ounces. FV dr'ms. Minims. 

c. o. f § f 5 m 

1 = 8 = 128 = 1024 = 61440 

= x = 16 = 128 = 7680 

T = 8 = 480 

1 = 60 

APPROXIMATE EQUIVALENTS. 

ttjjj or gr. j, = .06 gramme. 

f 5 j or 3 j, = 4- grammes. 

f 5j, = 3°- 

5j, -3i- 

f o j of Glycerin, = 37- 

f o j of Syrups, = 40. 



METRIC CONVERSIONS. 



919 



TABLE FOR CONVERTING 
APOTHECARIES' WEIGHTS AND MEASURES INTO METRIC. 

(Adapted from Maisch.) 

[Multiply all grains, or fractions of a grain, by 6479 (or 648) for the metric equivalent in 

milligrammes. — Potter.] 



Troy Weight. 


■ Metric. 


Apothecaries' 
Measure. 


Fluid Grammes or Milliliters. 


Grains. 


Grammes. 


liquids 

Lighter than 

Water.* 


Liquids of 
Specific 

Gravity of 
Water.f 


Liquids Heavier 
than Water. J 




Milligramme 


1$ 1 


•055 


.06 


.08 


■h 


.OOI 


2 


.10 


.12 


•15 


A 


.0015 


3 


.16 


.18 


.24 


A 


.002 


4 


.22 


.24 


•32 


A 


.003 


5 


.28 


•3° 


.40 


tV 


.004 


6 


•32 


.36 


.48 


A 


.005 


7 


.38 


.42 


•55 


1 

i 

i 

h 

1 


.006 

.008 
Centigramme 


8 

9 
10 


•45 
•5o 
•55 


•5o 

•55 
.60 


.65 
•73 
.80 


•OI 

.016 
.02 

.03 

•05 
.065 

Decigramme 


12 

i5 
16 


•65 
.80 
.90 


.72 

.90 

1. 00 


.96 
1.20 
1.32 


20 


1. 12 


1.25 


1.60 


25 


1.40 


i-55 


2.00 




3° 


1.70 


1.90 


2.50 


2 


•*3 


35 


2.00 


2.20 


2.90 


3 


.20 


40 


2.25 


2.50 


3-3° 


4 


.26 


48 


2.70 


3.00 


4.00 


5 
6 


.32 


50 


2.80 


3.12 


4-i5 


•39 


6o(f3j) 


3-4o 


3-75 


5.00 


7 


•45 


65 


3.60 


4.00 


5-3o 


8 


•52 
•59 
•65 


72 


4.00 


4-5° 


6.00 


9 
10 


80 

90 (f 3jss) 


4-5° 

5.10 


5.00 
5.60 


6.65 
7-5o 




Gramme 


96 


5-4o 


6.00 


8.00 


IS 


I. OO 


IOO 


5.60 


6.25 


8.30 


20 oj) 


I.30 


i2o(f5ij) 


6-75 


7-5° 


10.00 


24 


I.50 


150 (f 5ijss) 


8.50 


9-5° 


12.50 


26 


I.62 


160 


9.00 


10.00 


13-3° 


30 ( oss) 


: i-95 


180 (f 5Uj) 


10.10 


11.25 


15.00 


40 


: 2 -6o 


210 (f 3iijss) 


11.80 


13.00 


i7-5o 


50 


3.20 


240 (f 3iv) 


i3-5o 


15.00 


20.00 


60 ( 5j) 


3-90 


300 (f 3v) 


16.90 


18.75 


25.00 


IOO 


6.48 


330 (f 3vss) 


18.60 


20.75 


27.50 


120 ( 5ij) 


7.80 


360 (f 3vj) 


20.25 


22.50 


30.00 


180 


11.65 


420 (f 3vij) 


23.60 


26.25 


35 -oo 


240 ( oss) 


i5-5o 


480 (f gj) 


27.00 


30.00 


40.00 


300 


19.40 


540 (f 3ix) 


30.40 


33-75 


45.00 


360 


2 3-5° 


600 (f 3 x) 


33-75 


37-5o 


50.00 


420 


27.20 


720 (f 3xij) 


40.50 


45.00 


60.00 


480 (Sj) 


31.10 


840 (f 3xiv) 


47-25 


52-50 


70.00 


960 ( gij) 


62.20 


960 (f gij) 


54.00 


60.00 


80.00 


1000 


64.79 


1000 


56.00 


62.50 


83.00 



i 



* Lighter than water are tinctures, spirits, compound spirit of ether, sweet spirit of nitre, fixed and volatile oils. 
.<Ether, f5j = grammes 2.80. 

tSame as water are waters, liquids, decoctions, infusions, most fluidextracts, and tinctures made with dilute 
alcohol. 

% Heavier than water are syrups, glycerin, a few fluidextracts, and chloroform. Of the latter f5j = grammes 5.50. 



920 



PERCENTAGE SOLUTIONS. 



TABLE OF PERCENTAGE SOLUTIONS 

SHOWING THE REQUIRED QUANTITIES IN GRAINS. 

[Based on 456 grains as the weight of one fluid-ounce of Water.] 

Dissolve the quantity of ingredient in less water than the required volume of solution, and then 
add sufficient water to bring the solution up to the required volume. 



Solution. 


oj 


oij 


oiv 


5vj 


Pint 


Quart 


Gallon 


lU P-C, 


1:10,000 


fa 


fa 


* 


fa 


! 


ii 


6 


fa P-c, 


1:5,000 


fa 


1 


& 


i 


A 


3 


12 


15V P-c, 


1:3,000 


1 


& 


T 6 o 


A 


2 


5 


19! 


fa P- c -, 


i;2,000 


1 


1 
2 


9 
10 


ii 


3i 


7i 


29 


fa P-c, 


i:i,000 


1 


T 9 o 


2 


3 


7i 


I4§ 


58 


1 p-c., 


1:800 


fa 


I 


2* 


3i 


9 


18 


73 


1 P-c, 


1:500 


_9_ 
10 


2 


3} 


5i 


14? 


29 


117 


i p.c, 


1:400 


I 


H 


4* 


7* 


18 


36 


146 


1 P-c, 


1:300 


ii 


3 


6 


9 


24 


49 


195 


\ P-c, 


1:200 


H 


4* 


9 


14 


36 


73 


292 


t P.c, 


'1:150 


3 


6 


12 


18 


47 


95 


379 


fa P-c,* 


1:111 


4 


8 


16 


2 5 


65 


131 


525 


1 p.c, 


1:100 


4i 


9 


18 


27 


73 


146 


584 


2 p.C, 


1:50 


9 


18 


36 


55 


146 


292 


1167 


3 P.c, 


1:33-3- 


14 


27 


55 


82 


219 


438 


i75i 


4 P-c, 


1:25 


18 


36 


73 


no 


292 


584 


• 2335 


5 P-c, 


1:20 


23 


46 


9i 


137 


365 


73o 


2918 


7 P-c, 


1:14.28 


3 2 


64 


128 


192 


5" 


1021 


4086 


10 p.c, 


1:10 


46 


9i 


182 


274 


73o 


1459 


5837 


12 p.C, 


I'M 


55 


109 


219 


328 


876 


i75i 


7004 


15 p.c, 


i:6| 


68 


137 


274 


410 


1094 


2189 


8755 


20 p.c, 


*'* 


9i 


182 


365 


547 


1459 


2918 


11673 


30 p.c, 


l!3l 


137 


274 


547 


821 


2189 


4378 


17510 


40 p.c, 


i:»i 


182 


365 


73° 


1094 


2918 


5837 


23345 


50 p.c, 


1:2 


228 


45 6 


912 


1368 


3648 


7296 


29184 



* The strength of the normal salt solution. 



INTERNAL REVENUE REGULATIONS NO. 35, REVISED MAY, 1916. 



LAW AND REGULATIONS 

RELATING TO THE 

Production, Importation, Manufacture, Compounding, Sale, Dispensing, 
or Giving Away of Opium or Coca Leaves, their Salts, Derivatives, or 
Preparations. 



THE LAW. 



By an act of Congress approved December 17, 1914, it is provided: 

That on and. after the first day of March, nineteen hundred and fifteen, every person 
who^ produces, imports, manufactures, compounds, deals in, dispenses, sells, distributes, 
or gives away opium or coca leaves or any compound, manufacture, salt, derivative, or 
preparation thereof, shall register with the collector of internal revenue of the district his 
name or style, place of business, and place or places where such business is to be carried on : 
Provided, That the office, or if none, then the residence of any person shall be considered 
for the purpose of this Act to be his place of business. At the time of such registry and on or 
before the first day of July, annually thereafter, every person who produces, imports, manu- 
factures, compounds, deals in, dispenses, sells, distributes, or gives away any of the afore- 
said drugs shall pay to the said collector a special tax at the rate of $1 per annum: Provided, 
That no employee of any person who produces, imports, manufactures, compounds, deals 
in, dispenses, sells, distributes, or gives away any of the aforesaid drugs, acting within the 
scope of his employment, shall be required to register or to pay the special tax provided by 
this section: Provided further, That the person who employs him shall have registered and 
paid the special tax as required by this section: Provided further, That officers of the United 
States Government who are lawfully engaged in making purchases of the above-named 
drugs for the various departments of the Army and Navy, the Public Health Service, and 
for Government hospitals and prisons, and officers of any State government, or of any 
county or municipality therein, who are lawfully engaged in making purchases of the above- 
named drugs for State, county, or municipal hospitals or prisons, and officials of any Terri- 
tory or insular possession or the District of Columbia or of the United States who are law- 
fully engaged in making purchases of the above-named drugs for hospitals or prisons therein 
shall not be required to register and pay the special tax as herein required. 

It shall be unlawful for any person required to register under the terms of this Act to 
produce, import, manufacture, compound, deal in, dispense, sell, distribute, or give away 
any of the aforesaid drugs without having registered and paid the special tax provided for 
in this section. 

That the word "person" as used in this Act shall be construed to mean and include a 
partnership, association, company, or corporation, as well as a natural person; and all pro- 
visions^ existing law relating to special taxes, so far as applicable, including the provisions 
of section thirty-two hundred and forty of the Revised Statutes of the United States are 
hereby extended to the special tax herein imposed. 

That the Commissioner of Internal Revenue, with the approval of the Secretary of the 
Treasury, shall make all needful rules and regulations for carrying the provisions of this 
Act into effect. 

Sec. 2. That it shall be unlawful for any person to sell, barter, exchange, or give away 
any of the aforesaid drugs except in pursuance of a written order of the person to whom 
such article is sold, bartered, exchanged, or given, on a form to be issued in blank for that 
purpose by the Commissioner of Internal Revenue. Every person who shall accept any 
such order, and in pursuance thereof shall sell, barter, exchange, or give away any of the 
aforesaid drugs, shall preserve such order for a period of two years in such a way as to be 
readily accessible to inspection by any officer, agent, or employee of the Treasury Depart- 
ment duly authorized for that purpose, and the State, Territorial, District, municipal, and 

921 



i 



92 2 LAW AND REGULATIONS 

insular officials named in section five of this Act. Every person who shall give an order 
as herein provided to any other person for any of the aforesaid drugs shall, at or before the 
time of giving such order, make or cause to be made a duplicate thereof on a form to be 
issued in blank for that purpose by the Commissioner of Internal Revenue, and in case of 
the acceptance of such order, shall preserve such duplicate for said period of two years in 
such a way as to be readily accessible to inspection by the officers, agents, employees, and 
officials hereinbefore mentioned. Nothing contained in this section shall apply — 

(a) To the dispensing or distribution of any of the aforesaid drugs to a patient by a 
physician, dentist, or veterinary surgeon registered under this Act in the course of his pro- 
fessional practice only: Provided, That such physician, dentist, or veterinary surgeon shall 
keepa record of all such drugs dispensed or distributed, showing the amount dispensed or 
distributed, the date, and the name and address of the patient to whom such drugs are dis- 
pensed or distributed, except such as. may be dispensed or distributed to a patient upon 
whom such physician, dentist or veterinary surgeon shall personally attend; and such 
record shall be kept for a period of two years from the date of dispensing or distributing 
such drugs, subject to inspection, as provided in this Act. 

(b) To the sale, dispensing, or distribution of any of the aforesaid drugs by a dealer 
to a consumer under and in pursuance of a written prescription issued by a physician, den- 
tist, or veterinary surgeon registered under this Act : Provided, however, That such prescrip- 
tion shall be dated as of the day on which signed and shall be signed by the physician, den- 
tist, or veterinary surgeon who shall have issued the same: And provided further, That such 
dealer shall preserve such prescription for a period of two years from the day on which 
such prescription is filled in such a way as to be readily accessible to inspection by the offi- 
cers, agents, employees, and officials hereinbefore mentioned. 

(c) To the sale, exportation, shipment or delivery of any of the aforesaid drugs by any 
person within the United States or any Territory or the District of Columbia or any of the 
insular possessions of the United States to any person in any foreign country, regulating 
their entry in accordance with such regulations for importation thereof into such foreign 
country as are prescribed by said country, such regulations to be promulgated from time 
to time by the Secretary of State of the United States. 

(d) To the sale, barter, exchange, or giving away of any of the aforesaid drugs to any 
officer of the United States Government or of any State, territorial district, county, or 
municipal or insular government lawfully engaged in making purchases thereof for the 
various departments of the Army and Navy, the Public Health Service, and for Govern- 
ment, State, territorial district, county, or municipal or insular hospitals or prisons. 

The Commissioner of Internal Revenue, with the approval of the Secretary of the Treas- 
ury, shall cause suitable forms to be prepared for the purposes above mentioned, and shall 
cause the same to be distributed to collectors of internal revenue for sale by them to those 
persons who shall have registered and paid the special tax as required by section one of 
this Act in their districts, respectively; and no collector shall sell any of such forms to any 
persons other than a person who has registered and paid the special tax as required by sec- 
tion one of this Act in his district. The price at which such forms shall be sold by said 
collectors shall be fixed by the Commissioner of Internal Revenue, with the approval of 
the Secretary of the Treasury, but shall not exceed the sum of $i per hundred. Every 
collector shall keep an account of the number of such forms sold by him, the names of the 
purchasers, and the number of such forms sold to each of such purchasers. Whenever any 
collector shall sell any of such forms, he shall cause the name of the purchaser thereof to 
be plainly written or stamped thereon before delivering the same, and no person other than 
such purchaser shall use any of said forms bearing the name of such purchaser for the pur- 
pose of procuring any of the aforesaid drugs, or furnish any of the forms bearing the name 
of such purchaser to any person with intent thereby to procure the shipment or delivery 
of any of the aforesaid drugs. It shall be unlawful for any person to obtain by means of 
said order forms any of the aforesaid drugs for any purpose other than the use, sale, or dis- 
tribution thereof by him in the conduct of a lawful business in said drugs or in the legiti- 
mate practice of his profession. 

The provisions of this Act shall apply to the United States, the District of Columbia, 
the Territory of Alaska, the Territory of Hawaii, the insular possessions of the United States, 
and the Canal Zone. In Porto Rico and the Philippine Islands the administration of this 
Act, the collection of the said special tax, and the issuance of the order forms specified in 
section two shall be performed by the appropriate internal-revenue officers of those govern- 
ments, and all revenues collected hereunder in Porto Rico and the Philippine Islands shall 
accrue intact to the general governments thereof, respectively. The courts of first instance 
in the Philippine Islands shall possess and exercise jurisdiction in all cases arising under 
this Act in said islands. The President is authorized and directed to issue such Executive 



LAW AND REGULATIONS 923 

orders as will carry into effect in the Canal Zone the intent and purpose of this Act by pro- 
viding for the registration and the imposition of a special tax upon all persons in the Canal 
Zone who produce, import, compound, deal in, dispense, sell, distribute, or give away opium 
or coca leaves, their salts, derivatives, or preparations. 

Sec. 3. That any person who shall be registered in any internal-revenue district 
under the provisions of section one of this Act, shall whenever required so to do by the 
collector of the district, render to the said collector a true and correct statement or return, 
verified by affidavit, setting forth the quantity of the aforesaid drugs received by him in 
said internal-revenue district during such period immediately preceding the demand of the 
collector, not exceeding three months, as the said collector may fix and determine; the names 
of the persons from whom the said drugs were received; the quantity in each instance 
received from each of such persons, and the date when received. 

Sec. 4. That it shall be unlawful for any person who shall not have registered and 
paid the special tax as required by section one of this Act to send, ship, carry, or deliver 
any of the aforesaid drugs from any State or Territory or the District of Columbia, or any 
insular possession of the United States, to any person in any other State or Territory or 
the District of Columbia or any insular possession of the United States: Provided, That 
nothing contained in this section shall apply to common carriers engaged in transporting 
the aforesaid drugs, or to any employee acting within the scope of his employment, of any 
person who shall have registered and paid the special tax as required by section one of this 
Act, or to any person who shall deliver any such drug which has been prescribed or dis- 
pensed by a physician, dentist, or veterinarian required to register under the terms of this 
Act, who has been employed to prescribe for the particular patient receiving such drug, or 
to any United States, State, county, municipal. District, Territorial, or insular officer or 
official acting within the scope of his official duties. 

Sec. 5. That the duplicate-order forms and the prescriptions required to be preserved 
under the provisions of section two of this Act, and the statements or returns filed in the 
office of the collector of the district, under the provisions of section three of this Act, shall 
be open to inspection by officers, agents, and employees of the Treasury Department duly 
authorized for that purpose; and such officials of any State or Territory, or of any organized 
municipality therein, or of the District of Columbia, or any insular possession of the United 
States, as shall be charged with the enforcement of any law or municipal ordinance regu- 
lating the sale, prescribing, dispensing, dealing in, or distribution of the aforesaid drugs. 
Each collector of internal revenue is hereby authorized to furnish, upon written request, 
certified copies of any of the said statements or returns filed in his^ office to any of_ such 
officials of any State or Territory or organized municipality therein, or the District of 
Columbia, or any insular possession of the United States, as shall be entitled to inspect 
the said statements or returns filed in the office of the said collector, upon the payment of 
a fee of $1 for each one hundred words or fraction thereof in the copy or copies so requested. 
Any person who shall disclose the information contained in the said statements or returns 
or in the said duplicate-order forms, except as herein expressly provided, and except for 
the purpose of enforcing the provisions of this Act, or for the purpose of enforcing any law 
of any State or Territory or the District of Columbia, or any insular possession of the 
United States, or ordinance of any organized municipality therein, regulating the sale, 
prescribing, dispensing, dealing in, or distribution of the aforesaid drugs, shall, on convic- 
tion, be fined or imprisoned as provided by section nine of this Act. And collectors of in- 
ternal revenue are hereby authorized to furnish upon written request, to any person, a 
certified copy of the names of any or all persons who may be listed in their respective collec- 
tion districts as special-tax payers under the provisions of this Act, upon payment of a 
fee of $1 for each one hundred names or fraction thereof in the copy so requested. 

Sec. 6. That the provisions of this Act shall not be construed to apply to the sale, 
distribution, giving away, dispensing, or possession of preparations and remedies which do 
not contain more than two grains of opium, or more than one-fourth of a grain of morphine, 
or more than one-eighth of a grain of heroin, or more than one grain of codeine, or any salt 
or derivative of any of them in one fluid ounce, or, if a solid or semisolid preparation, in 
one avoirdupois ounce; or to liniments, ointments, or other preparations which are prepared 
for external use only, except liniments, ointments, and other preparations which contain 
cocaine or any of its salts or alpha or beta eucaine or any of their salts or any synthetic sub- 
stitute for them: Provided, That such remedies and preparations are sold, distributed, 
given away, dispensed, or possessed as medicines and not for the purpose of evading the 
intentions and provisions of this Act. The provisions of this Act shall not apply to de- 
cocainized coca leaves or preparations made therefrom, or to other preparations of coca 
leaves which do not contain cocaine. 

Sec. 7. That all laws relating to the assessment, collection, remission, and refund of 



i 



924 



LAW AND REGULATIONS 



internal-revenue taxes including section thirty-two hundred and twenty-nine of the Re- 
vised Statutes of the United States, so far as applicable to and not inconsistent with the 
provisions of this Act, are hereby extended and made applicable to the special taxes imposed 
by this Act. 

Sec. 8. That it shall be unlawful for any person not registered under the provisions of 
this Act, and who has not paid the special tax provided for by this Act, to have in his pos- 
session or under his control any of the aforesaid drugs; and such possession or control 
shall be presumptive evidence of a violation of this section, and also of a violation of the 
provisions of section one of this Act: Provided, That this section shall not apply to any 
employee of a registered person, or to a nurse under the supervision of a physician, dentist, 
or veterinary surgeon registered under this Act, having such possession or control by virtue 
of his employment or occupation and not on his own account; or to the possession of any 
of the aforesaid drugs which has or have been prescribed in good faith by a physician, 
dentist, or veterinary surgeon registered under this Act; or to any United States, State, 
county, municipal, District, Territorial, or insular officer or official who has possession of 
any said drugs, by reason of his official duties, or to a warehouseman holding possession 
for a person registered and who has paid the taxes under this Act; or to common carriers 
engaged in transporting such drugs : Provided further, That it shall not be necessary to 
negative any of the aforesaid exemptions in any complaint, information, indictment, or 
other writ or proceeding laid or brought under this Act; and the burden of proof of any such 
exemption shall be upon the defendant. 

Sec. 9. That any person who violates or fails to comply with any of the requirements 
of this Act shall, on conviction, be fined not more than $2,000 or be imprisoned not more 
than five years, or both, in the discretion of the court. 

Sec. 10. That the Commissioner of Internal Revenue, with the approval of the Secre- 
tary of the Treasury, is authorized to appoint such agents, deputy collectors, inspectors, 
chemists, assistant chemists, clerks, and messengers in the field and in the Bureau of Internal 
Revenue in the District of Columbia as may be necessary to enforce the provisions of this 
Act. 

Sec. 11. That the sum of $150,000, or so much thereof as may be necessary, be, and 
hereby is, appropriated, out of any moneys in the Treasury not otherwise appropriated, 
for the purpose of carrying into effect the provisions of this Act. 

Sec. 12. That nothing contained in this Act shall be construed to impair, alter, amend, 
or repeal any of the provisions of the Act of Congress approved June thirtieth, nineteen 
hundred and six, entitled "An Act for preventing the manufacture, sale, or transportation 
of adulterated or misbranded, or poisonous, or deleterious foods, drugs, medicines, and 
liquors, and for regulating traffic therein, and for other purposes," and any amendment 
thereof, or of the Act approved February ninth, nineteen hundred and nine, entitled "An 
Act to prohibit the importation and use of opium for other than medicinal purposes," and 
any amendment thereof. 



\ 



INDEX 



When English and Latin names are nearly alike, the former are given in the index and 
the latter are omitted; but when they are dissimilar both names are indexed. Salts of the 
metals are usually described in the book under the titles of their metalic constituents; 
some few (the Arsenates, Phosphates, etc.)? also the salts of the alkaloids and those of 
active elementary substances (the Bromides, Iodides, etc.) are placed under the titles of 
their most active constituents. Salts and Preparations are therefore not mentioned in- 
dividually in the Index except when their places in the text are exceptional and do not 
come within either of the above rules. 



Abbreviations, their use, 506 

Table of, 502, 897 
Abies, 379 

balsamea, 473 

excelsa, 380 
Abortion, 566 
Abrin, 53, 442 
Abrus, 53 
Abscess, — See Furunculosis, 567 

of the Liver, 702 

Mammary, 567 
Absinthe, 53 
Absinthium, 53 
Absolute Alcohol, — See Alcohol Dehydra- 

tum, 97 
Absorption by various channels, 46 
Acacia, 54 

Catechu, 206 
Accommodation of the Eye, 46 
Aceta, 523 
Acetamide, 54 
Acetanilide, 54 

Ammoniated, 55 

Antidotes and Antagonists, 789 
Acetates, — See the titles of their basic con- 
stituents. 
Acetone, 98 

Chloroform, 215 

Preparations, 523 

in Urine, Test for, 870 
Acetous Preparations, 523 
Acetozone, 353 
Acetphenetidin, 58 

Antidotes and Antagonists, 800 
Acetum, 60 
Acid, Abie tic, 475 

Abric, 53 

Acetic, 60 

Antidotes, etc., 789 

Acetyl-salicylic, 411 

Aconitic, 77 

Agaricic, 88 

Aloetic, 108 

Amido-acetic, 59 



Acid, Anemonic, 391 
Angelic, 470 
Arabic, 53 
Arsenous, 152 

Antidotes and Antagonists, 792 
Artanthic, 339 
Benzoic, 171 
Boracic, 61 
Boric, 61 
Brassic, 454 
Butyric, 329 
Caffeic, 182 
Calumbic, 192 
Camphoric, 193, 195 
Camphretic, 193 
Capronic, 151 
Caprylic, 151 
Carbolic, — See Phenol, 362 

Antidotes and Antagonists, 800 
Carbonic, 200 

Antidotes and Antagonists, 789 
Carminic, 238 
Caryophyllic, 205 
Caryophyllinic, 205 
Catechuic, 206 
Catechu-tannic, 206 
Cathartic, 424 
Cerotic, 207 
Cetraric, 119 
Chelidonic, 208 
Chloric, 221 
Chromic, 221 
Chrysammic, 108 
Chrysophanic, 222, 401, 406, 424 
Cinnamic, 164, 171, 463 
Citric, 315 
Copaibic, 243 
Cresylic, 245 
Crotonic, 479 
Cubebic, 248 
Daturic, 298 
Diacetic, Test for, 870 
Dibromo-gallic, 64 
Diethyl-barbaturic, 464 
Erucic, 453 



i 



925 



926 



INDEX. 



Acid, Eugenic, 331 
Euonic, 266 
Filicic, 160 
Formic, 329 
Gallic, 63 
Gallotannic, 63 
Gambogic, 193 
Gentesic, 278 
Gentianic, 278 
Glycero-phosphoric, 372 
Glycyrrhizic, 281 
Guaiacic, 284 
Guaiaconic, 284 
Guaiaretic, 284 
Gurjunic, 285 
Hydriodic, 303, 307 
Hydrobromic, 175 
Hydrochloric, 66 
Hydrocyanic, 68 

Antidotes and Antagonists, 789 
Hypophosphorous, 369 
Hypopicrotoxic, 374 
Igasuric, 335 
Ipecacuanhic, 308 
Juglandic, 312 
Kinic, 224 

Kinotannic, 224, 313 
Kino vie, 224 
Kinovo-tannic, 224 
Kolatannic, 185 
Lactic, 71 
Lactucic, 314 
Laricic, 88 
Linoleic, 316 
Lobelic, 318 
Lupulinic, 287 
Maizenic, 487 
Mastichic, 325 
Meconic, 342 
Mezereinic, 328 
Morrhuic, 329 
Muriatic, 66 
Nitric, 71 

Nitrohydrochloric, 72 
Nitromuriatic, 72 
Nitrous, 73 
Nucleinic, 131 
Oleic, 73 
Ophelic, 209 
Opianic, 295 

Ortho-phenol-sulphonic, 363' 
Orthophosphoric, 368 
Osmic, 749 
Oxalic, 74 

Antidotes and Antagonists, 790 
Palmaric, 475 
Phenol-sulphonic, 363 
Phosphoric, 368 
Phytolaccic, 374 
Picric, 363 
Picrotoxic, 374 
Pinic, 475 
Piperonylic, 244 
Podophyllinic, 384 
Polygonic, 385 



Acid, Protocatechuic, 384 

Prussic, 68, 789 

Pyrogallic, 64 

Pyroligneous, 380 

Quercitannic, 63 

Rhatania-tannic, 63, 313 

Ricinoleic, 404 

Robustic, 383 

Rosolic, 363 

Salicylic, 410 

Salicyluric, 412 

Santoninic, 418 

Scheele's, 68 

Silvic, 475 

Sphacelinic, 260 

Stearic, 81 

Strychnic, 335 

Succinic, no 

Sulphuric, 74 

Aromatic, 74 

Sulphurous, 75 

Sumbulic, 470 

Tannic, 63, 285 

as an Antidote, 788 

Tartaric, 76 

Toxicodendric, 403 

Trichloracetic, 61 

Tropic, 166 

Uric, Test for, 874 

Valeric, 470, 481 

Vanillic, 483 

Viburnic, 486 
Acidifiers, Urinary, 44 
Acidity, Gastric, 674 
Acids, — their action, 13, 67 

as Antidotes, 785 

Antidotes and Antagonists, 790 

Mineral, 67, 790 

Organic, 8 

Vegetable, 60 
Acne, 567 

Rosacea, 769 
Acocanthera Ouabaio, 473 
Aconine, 77 
Aconite, 76 

iVntidotes and Antagonists, 790 
Aconitine, 77 
Acorin, 188 
Acorus Calamus, 188 
Acrinyl, Sulpho-cyanate, 453 
Acrolein, 279 
Actinomycosis, 569 
Actol, 144 
Adalin, 176 
Addison's disease, 569 
Adenitis, — See Glandular Affections, 677 
Adeps, 81 

Benzoinatus, 81 

Lanae, 80 

Lanae Hydrosus, 81 
Administration of Medicines, 46 
Adonidin, 255 
Adonis, 255, 258 
Adrenal Extract, 125 
Adrenalin, 126 



INDEX. 



927 



Adrenalin, Chloride, 127 
Adynamia, 570 
iEther, 82 

Acetic, 82 
yEthylis Carbamas, 464 
After-pains, 570 
Agalactia, 571 
Agar-agar, 87 
Agaric, 88 
Agaricin, 88 
Agathin, 55 

Agropyrum repens, 480 
Ague, — See Intermittent Fever, 712 
Ailanthus, 89 
Airol, 173 
Albargin, 145 
Alabastrine, 333 
Albaspidin, 160 
Albau, 260 
Albumen, 89 

Ovi, 91, 96 
Albumin, 89 

as an Antidote, 785 

in Urine, Test for, 870 
Albuminates, 11 
Albuminoids, 11, 89 
Albuminuria, 571 
Albumoses, 95 
Alcohol, 97 

Absolute, 97 

Amyl, 98 

Antidotes and Antagonists, 790 

Caustic, 456 

Dehydrated, 97 

Ethyl, 97 

Methyl, 97, 98 

Phenyl, 97 

Propenyl, 279 
Alcoholic Preparations, 523 
Alcoholism, 104, 571 
Aldehyde, 98 

Acetic, 98 

Cinnamic, 230 

Ethyl, 98 

Formic, 98, 273 
Alder Bark, 64 

Buckthorn, 276 
Ale, 99 
Aletris, 108 
Alexins, 429 
Alkalies, their action, 13 

Antidotes and Antagonists, 791 
Alkalinizer's, Urinary, 44 
Alkalithia, 317 
Alkaloids, 5 

Antidotes and Antagonists, 791 

Liquid, 6 
Allium, 108 
Allspice, 377 
Allyl Sulphide, 159 

Sulpho-carbamide, 454 

Sulpho-cyanide, 455 
Almond, 68, 114 
Alnus, 64 
Aloes, 109 



Aloin, 109 
Alopecia, 573 

Areata, 573 
Alphozone, 354 
Alstonia constricta, 259 

scholaris, 259 
Alstonine, 259 
Alteratives, 15 
Althaea, 109 
Alum, no 

Antidotes and Antagonists, 791 
Curd, 96 
Alumen, no 

Exsiccatum, no 
Aluminum, no 
Alumnol, no 
Alum-root, 64 
Alypin, 232 
Amanita Muscaria, 88 
Amaroids, 8 
Amber, 463 
Amblyopia, 46, 574 
Amboceptor, 429 
Ambrine, 263 
Amenorrhea, 574 
Ammonia, 111 

as an Antidote, 785 
Antidotes and Antagonists, 791 
Ammonium, 111 
Benzoate, 171 

Carbonate, as an Antidote, 785 
Sulpho-ichthyolate, 467 
Ammonol, 55 
Amorphous Bodies, 516 
Ampho tropin, 274 
Amygdala, 68, 114 
Amygdalin, 68, 114, 390 
Amyl Alcohol, 98 
Chloride, 85 
Hydroxide, 98 
Hydride, 85 
Nitrite, 116 

Antidotes and Antagonists, 791 
Amylamine, 329 
Amylene, 85 

Chloral, 210 
Hydrate, 210, 214 
Amyloid Substances, 5, 11 
Amylopsin, 359 
Amylum, 118 
Anacyclus Pyrethrum, 393 
Analgen, 55 
Analgesics, 15 
Analgesine, 55 
Anamirta paniculata, 374 
Anaphrodisiacs, 16 
Anarcotine, 348 
Anasarca, — See Dropsy, 644 
Anemia, 575 

Cerebral, 607 
Anemone, 391 
Anemonin, 391, 392 
Anesthesia, 84, 576 

Brownlee's Method, 86 
Hewitt's Method, 86 



928 



INDEX. 



Anesthesia, Intrathoracic Insufflation, 86 

Intravenous, 86 

Local, 16, 577 

Sayre's Method, 219 

Schleich's Methods, 86, 231, 237 

Scopolamine-Morphine, 301 

Spinal, 237 

Therapeutics, 576 
Anesthesin, 232 
Anesthetics, 16, 86, 215 

Antidotes and Antagonists, 791 

Local, 16, 235 

Mixtures, 83 
Anesthol, 83 
Anethol, 11, 132 
Aneurism, 584 

Angina, — See Croup, Laryngitis, Pharyn- 
gitis, Throat, Tonsillitis, etc. 
Angina Pectoris, 578 
Anhalonium, 180 
Anhidrotics, 17 
Aniline, 398 
Animal Extracts, 121 

Starch, 119 
Anise, 132 

Star, 302 
Ankylostomiasis, — See Worms, 887 
Anodynes, 15 

Dental, 28 

Hoffman's, 83 

Local, 16 
Ant-acids, 14 
Antagonism of Drugs, 18 

Toxicological, 18 
Antagonists, 17, 785 

Table of, 19 
Anthelmintics, 19 
Anthemis, 132 
Anthrax, 579 
Antiabrin, 428 
Antibilious Pills, 546 
Antidote, Arsenic, 268, 792 

Bouchardat's, 787 

JeaunePs, 789 
Antidote-bag, 788 
Antidotes, 20, 795 

General, 789 
Anti-emetics, 32 
Anti-fat, 374 
Antifebrin, 54 

Antigalactagogues, — See Galactophyga, 34 
Antigens, 426 
Antilupin, 56 
Antimony, 133 

Antidotes and Antagonists, 792 
Anti-narcotic Law, Federal, 921 
Antinervin, 55 
Antinosin, 303 
Antiperiodics, 20 
Antiphlogistics, 21 
Antipyretics, 21 
Antipyrine, 134 

Antidotes and Antagonists, 792 

Salicylate, 135, 411 
Antiricin, 428 



Antiseptic Fluid, 478 

Solutions, 62, 295 
Antiseptics, 21 
Antisialics, 42 
Antispasmodics, 23 
Antitoxin, 428 

Diphtheria, 431' 

Plague, 449 

Rabies, 449 

Streptococcus, 444 

Syphilis, 450 

Tetanus, 437 

Tuberculosis, 441 

Typhoid, 447 
Antitoxins, 428 
Antivenene, 451 
Antizymotics, 23 
Antrum Disease, 579 
Anuria, — See Urinary Disorders, 870 
Anus, Fissured, 579 

Prolapse of, 805 
Aperients, 26 
Aphonia, 580 
Aphrodisiacs, 24 
Aphthae, 580 
Apiin, 138 
Apinol, 380 
Apiol, 138 

Apis mellifera, 207, 325 
Apnea, 584 
Apocynin, 139 
Apocynum, 139 
Apomorphine, 344, 348, 350 
Apoplexy, 581 
Apotheme, 531 
Appendicitis, 581 
Appetite, 582 
Approximate Measures, 497, 918 

Weights, 918 
Aqua, 139 

Carbonata, 201 

Regia, 72 
Aquae, 523 

Aqueous Preparations, 523 
Arabin, 5, 54, 480 
Arbor Vitae, 477 
Arbutin, 398, 481 
Arctium Lappa, 314 
Arctostaphylos glauca, 481 

Uva-ursi, 481 
Argentamin, 145 
Argentum, 144 

Antidotes and Antagonists, 803 

Compounds, 145 
Argol, 385 
Argonin, 145 
Argyria, 146 
Argyrol, 145 
Aristochin, 225 
Aristol, 302, 308 
Aristolochia, 452 
Aristolochine, 452 
Arnica, 151 
Arnicine, 151 
Aromatic Fluidextract, 230 



INDEX. 



929 



Aromatic Powder, 230 

Sulphuric Acid, 75 

Wine, 99 
Arrow-root, 120 

Arsenates and Arsenites, 152, 162 
Arsenauro, 153, 162 
Arsenic, 152 

Antidote, 268, 792 

Antidotes and Antagonists, 792 

Trioxide, 152 
Arsenobenzol, 159 
Artemisia Absinthium, 53 

pauciflora, 418 
Arteriosclerosis, 582 
Arthritis Deformans, 582 
Asafcetida, 159 
Asagrsea officinalis, 483 
Ascarides, — See Worms, 887 
Ascites, 583 
Asclepias, 160 
Aselline, 328 
Ash, Flowering, 325 

Prickly, 487 
Asparagin, 109, 266, 281 
Asphyxia, 202, 584 
Aspidium, 160 
Aspirin, 411 
Assay, 521 

Asthenia, — See Adynamia, Convalescence. 
Asthenopia, 586 
Asthma, 586 

Astragalus gummifer, 480 
Astringents, 24 

Intestinal, 34 

Pill, 546 

Powder, 548 

Urinary, 45 

Vegetable, 63 
Atheroma, — See Arteriosclerosis, 582 
Atoxyl, 147 

Atropa Belladonna, 166 
Atrophy, 588 
Atropine, 166, 297, 298 

and Morphine, 353 

Antidotes and Antagonists, 790 
Aurantiin, 161 
Aurantium, 161 
Aurin, 363 
Aurum, 162 

Authorities, List of, 565 
Autocondensation, 560 
Ava-kava, 313 

Azoturia, — See Urinary Disorders, 866 
Azulen, 325 

Bacillary Milk, 71 

Tablets, 71 
Bacillus Cultures, 71 
Bacterins, 430 
Bacteriolysins, 429 
Bacteriotropins, 429 
Balanitis, 589 

Baldness, — See Alopecia, 573 
Balm of Gilead, 474 
Balnea, 524 

59 



Balsam of Copaiba, 243 

of Fir, 474 

Friar's, 171, 463 

Gurjun, 285 

of Peru, 165 

of Tolu, 164 
Balsamum Dipterocarpi, 285 

Peruvianum, 164 

Tolutanum, 165 
Bandoline, 252 
Banting Dietary, 753 
Baptisia, 165 
Baptisin, 165 
Barberry, 172 
Barium, 166 

Chloride, 166 

Salts, Antidotes, etc., 792 
Bark, Alder, 64 

Blackberry, 406 

Casca, 255 

Chittem, 400 

Coto, 244 

Cramp, 486 

Cuprea, 224 

Dita, 259 

Elm, 480 

Honduras, 206 

Huxham's Tincture of, 225 

Oak, 64 

Ordeal, 255 

Peruvian, 223 

Pitaya, 224 

Sacred, 411 

Sassy, 255 

Soap, 394 

Willow, 410 
Barley, 118, 120 
Barosma, 180 
Barosmin, 180 
Basham's Mixture, 268 
Basilicon Ointment, 475 
Bassorin, 5, 480 
Baths, 524 

Formulae, 524 
Battley's Sedative, 344 
Bay-berry, 331 
Bay Rum, 331 
Beans, 120 
Bear-berry, 481 
Bed-sores, 589 
Beech, 244 

Bee-venom, Antidotes, etc., 792 
Beef, 91 

Peptonoids, 92 

Raw, 95 

-tea, 95 
Beer, 99 

Ginger, 491 
Beet, Sugar, 408 
Behring's Law, 428 
Belladonna, 166 

Antidotes and Antagonists, 792 
Benzaconine, 77 
Benzaldehyde, 115 
Benzanilid, 55 



93° 



INDEX. 



Benzoates, 171 
Benzoin, 171 
Benzoinated Lard, 81 
Benzosol, 245, 247 
Benzosulphinide, 408, 410 
Benzoyl-acetyl Peroxide, 353 
Benzoyl Guaiacol, 245 

Monochloride, 239 

Pseudotropine, 232 
Benzyl Cinnamate, 164 
Berberine, 172, 193, 295 
Berberis, 172 
Beriberi, 589 
Betanaphthol, 173, 333 
Beta vulgaris, 408 
Betol, 333 
Betula lenta, 410 
Bhang, 196 

Bibliography and References, 565 
Bile, Agents affecting, 26, 35 

Pigment in Urine, Test, 871 
Biliousness, 590 
Bilious Remittent Fever, 917 
Bind-weed, 287 
Birch, Sweet, 410 
Bird-lime, 487 
Bismuth, 173 

Mixture for Children, 540 

Salts, 173 

Subgallate, 173 

Subiodide, 173, 303 

Tannate, 64 
Bites and Stings, 838 
Bitters, Action of, 192 
Bittersweet, 259 
Blackberry, 64, 406 
Black Draught, 423 

Drop, 343 

Haw, 486 

Wash, 289 
Black water Fever, Diagnosis of r 917 
Bladder, inflammation of, 629 

Irritable, 590 

Paralysis of, 591 
Blancard's Pills, 268 
Blastomycosis, 591 
Blaud's PiUs, 267 
Bleaching Powder, Antidotes, 796 
Blende, 488 
Blepharitis, 591 
Blistering Cerate, 197 

Collodion, 197, 282 
Blisters, 37, 528 
Blood-root, 416 
Blood-stains, 837 
Blue Cohosh, 207 

Flag, 310 

Gum, 264 

Mass, 288 

Methyl, 327 

Methylene, 327 

Ointment, 288 
t Pill, 288 
Boiling, 522 
Bolus, 541 



Bone Diseases, 592 

Marrow Extract, 128 
Boneset, 266 
Borax, 61 
Borism, 62 
Borneo!, n, 406 
Boroglyceride, 62, 63 
Boroglycerin, 62 
Bos Taurus, 266, 357 
Bouchardat's Antidote, 787 
Bougies, 550 
Bovinine, 91 
Bovril, 91 
Boxwood, 356 

Brain Disorders, — See Cerebral Anemia, 
Cerebral Concussion, etc. 

Extract, 127 

Fever,' — See Meningitis, Cerebrospi- 
nal Meningitis, Typhoid Fever, Ty- 
phus Fever. 
Brandy, 99 
Brassica nigra, 454 
Brayera, 252 
Breasts, — See Abscess, Lactation, Mastitis, 

Nipples. 
Breath, Fetid, 592 
Bright's Disease, Acute, 592 

Chronic, 593 
Brometone, 176 
Bromides, 175 

Antidotes and Antagonists, 793 

Formulae for, 661 
Bromidethyl-acetylcarbamide, 176 
Bromidrosis, — See Feet, 668 
Bromine, 175 

Antidotes and Antagonists, 793 
Bromipin, 176, 180 
Bromism, 176 
Bromoform, 176, 180 
Bromo-seltzer, 55 
Bromural, 176 
Bronchiectasis, 594 
Bronchitis, Acute, 595 

Capillary, 596 

Chronic, 597 
Bronchocele, — See Goitre, 679 
Bronchorrhea, 598 
Broom, 422 
Brovalol, 482 
Brown Mixture, 281 
Brownlee's Method of Anesthesia, 86 
Brucine, 299, 335, 341 
Bruises, 598 
Bryonia, 180 
Bryonin, 180 
Bubo, 598 
Buchu, 180 
Buckthorn, 276, 400 
Buhach, 839 
Bulgara Tablets, 71 
Bulgarian Cultures, 71 
Bunion, 599 
Burdock, 314 

Burnett's Disinfectant, 488 
Burns, 599 



INDEX. 



931 



Bursitis, 600 
Buttermilk, 92, 97 
Butternut, 312 
Butyl Angelate, 132 

Chloral Hydrate, 210 

Chloride, 86 

Hydride, 86 

Valerate, 132 
Butylamine, 329 
Buxine, 356 
Buxus sempervirens, 356 



Cacao-butter, 182, 477 
Cachets, 547 
Cactine, 181 
Cactus grandiflorus, 181 
Cadmium, 181 
Caffeine, 182 

Citrated, 182 
Caffeol, 182 
Caffeone, 182 
Cajuput, Oil of, 187 
Calabar Bean, 372 
Calabarine, 372 
Calamine, 488 

Ointment, 491 
Calamus, 188 
Calcauro, 163 
Calcination, 518 
Calcium, 188 

Chloride, Antidotes, etc., 793 

Hydroxide, as an Antidote, 785 

Salts, 188 

Sulphide, 467 
Calciumichthyol, 467 
Calculi, Biliary, — See Gall-stones, 672 

Renal, 600 

Vesical, 600 
Calendula, 192 
Callosity, 601 
Calomel, 289 
Calumba, 192 
Calumbin, 192 
Calx, 188 

Chlorinata, 220 

Sulphurata, 467 
Cambogia, 193 
Cameroon Tree, 487 
Camp Fever, — See Typhus, 860 
Campho-phenique, 363 
Camphor, 193 

Antidotes and Antagonists, 793 

Baldrian, 180, 485 

Barosma, 180 

Carbolated, 194 

-chloral, 194 

-cymol, 193 

Monobromated, 193 

Peppermint, — See Menthol, 326 

Pulsatilla, 391 

Salicylated, 194 

Tar, 333 
Camphors, 10 
Camphylene, 333 



Canadian Hemp, 139 
Canadine, 295 
Cancer, 601 

of Uterus, 876 
Cancrum Oris, 602 
Cannabene, 195 
Cannabin, 195 
Cannabis, 195 

Antidotes and Antagonists, 793 
Cantharides, 197 
Cantharidin, 197 
Cantharis, 197 

Antidotes and Antagonists, 793 
Caoutchouc, 259 
Capsicin, 199 
Capsicum, 199 
Capsules, 524 
Caraway, 205 
Carbinol, 98 
Carbo Animalis, 200 

Ligni, 200 
Carbohydrates, 5, 119 
Carbon, 200 

Acids, 8 

Dioxide, 200, 202, 471 

Antidotes and Antagonists, 796 

Disulphide, 204, 797 

Monoxide, 200, 202, 471 

Tetrachloride, 215 
Carbonated Mineral Waters, 141 
Carbonates, as Antidotes, 785 
Carboneum, 200 
Carbonization, 515 
Carbuncle, 603 
Carcinoma, — See Cancer, 601 
Cardamom, 204 
Cardiac Disorders, — See Heart, 688 

Sedatives, 24 

Stimulants, 25, 41, 43 

Tonics, 25 
Cardialgia, — See Pyrosis, 815 
Carditis, Diagnosis of, 912 
Carduus, 204 
Carica Papaya, 358 
Caries, 604 

Carlsbad Salt, 140, 701 
Carminative, Dalby's, 344 

Dewee's, 159, 320 
Carminatives, 25 
Carmine, 238 
Caroval, 251 
Carragheen, 90 

Carrel Wound Sterilization, 891 
Carron Oil, 189 
Carthamus tinctorius, 248 
Carum, 205 
Carvene, 205 
Carvol, 205 
Caryophyllin, 205 
Caryophyllus, 205 
Casca Bark, 255 
Cascara Amarga, 206 

Sagrada, 400 
Cascarilla, 206 
Cascarillin, 206 



932 



INDEX. 



Casein, 89, 91 
Cassia acutifolia, 424 

angustifolia, 424 

Cinnamon, 230 

Fistula, 206 

Purging, 206 
Castanea, 64 
Castor Oil, 404 

Emulsion; Formula, 623 
Catalepsy, 604 
Cataplasmata, 524 
Cataract, 604 
Catarrh, Acute Nasal, 605 

Broncho-pulmonary, — See Bronchitis, 
Bronchorrhea. 

Chronic Nasal, 606 

Duodenal, 646 

Epidemic, — See Influenza, 709 

Gastric, — See Gastritis, Chronic, 676 

Genito-urinary, — See Bladder, Catarrh 
of, Cystitis, Endometritis, Gonor- 
rhea, Leucorrhea, etc. 

Intestinal, — See Dysentery, Jaundice. 

Summer, — See Hay Fever, 685 
Catechol, 398 
Catechu, 64, 206 
Cathartics, 26 

in Poisoning, 786 
Catharto-mannit, 424 
Caulophyllin, 207 
Caulophyllum, 207 
Caustic, Lunar, 144 

Potash, 386 

Soda, 456 
Caustics, 33 
Cedar, Oil of, 417 

Red, 407 

White, 477 
Celandine, 208 
Cellulose, 119, 281 
Centaurea benedicta, 205 
Cephaeline, 308 
Cephaelis Ipecacuanha, 308 
Cephalalgia, — See Headache, 686 
Cera, 215 
Cerata, 525 
Cerate, 207 

Blistering, 197 

Cantharides, 197 

Rosin, 475 

Theobroma, 477 
Cerates, 525 

Compounding of, 555 
Ceratum, 207 

Cerebellum, Agents affecting, 27 
Cerebral Anemia, 607 

Compression, Diagnosis, 912 
Concussion, 607 

Diagnosis, 912 

Congestion, 608 

Depressants, 27 

Excitants, 27 
Cerebro-spinal Fever, 447, 738 
Cereus, Night-blooming, 181 
Cerium Oxalate, 207 



Cerolein, 207 
Cetaceum, 81 
Cetin, 81 

Cetraria, 119, 121 
Cetyl Palmitate, 81 
Cevadilla, 483 
Cevadilline, 483 
Cevadine, 483 
Chafing, 665 
Chalk, 188 

Chalybeate Waters, 140 
Chamomile, 133 

German, 133, 325 
Chamomilla, 133, 325 
Champagne, 99 
Chancre, 608 

Diagnosis of, 913 
Chancroid, 608 

Diagnosis of, 913 
Change of Life,' — See Climacteric, 616 
Chapped Hands and Feet, 609 
Charcoal, 201 

as an Antidote, 786 
Chartae (Papers), 526 
Chartulae, 545 
Chaulmoogra Oil, 208 
Cheese, 92 
Chekan, 333 
Chekanine, 333 
Chelerythrine, 208, 416 
Chelidonine, 208 
Chelidonium, 208 
Chelidoxanthin, 208 
Chelsea Pensioner, 526 
Chemical Incompatibility, 508 
Chenopodium, 208 
Cherry-laurel, 68 
Cherry, Wild, 390 
Chestnut, 64 
Chest-pains, 609 
Chian Turpentine, 474 
Chicken-pox — See Varicella, 880 
Chicory, 185 
Chilblains, 609 
Children, Dosage for, 52, 352 
Chimaphila, 208 
Chimaphilin, 208 
Chinoidin, 226 
Chirata, 209 
Chiratin, 209 
Chiretta, 209 
Chittem Bark, 400 
Chloasma, 610 
Chloral, 209 

Analogues, 210 

Antidotes and Antagonists, 794 

Butyl, 210 

Hydrated, 209 
Chloralamide, 209, 214 
Chloralformamide, 209, 214 
Chloral-habit, 211 
Chloralose, 209, 214 
Chlorates, — See the titles of their metallic 

constituents. 
Chloretone, 215, 219 



INDEX. 



933 



Chlorides, — See the titles of their metallic 
constituents. 

in Urine, Tests, 871 
Chlorinated Waters, 140 
Chlorine, 219 

Antidotes and Antagonists, 794 
Chlorine-water, 220 
Chlorodyne, 214 
Chloroform, 79, 83, 214 

Antidotes and Antagonists, 794 

Sayre's method of using, 219 
Chlorosis, 610 
Chocolate, 185, 477 
Choking, 611 
Cholagogues, 35 
Cholagogue Pills, 546 

Purgatives, 26 
Cholera Asiatica, 611 

Diagnosis of, 913 

Infantum, 613 

Mixture (Squibb), 344, 612 

Simplex, 614 

Toxin, 448 
Chondodendron tomentosum, 356 
Chondrus, 90 
Chordee, 614 
Chorea, 615 
Choroiditis, 616 
Chromic Trioxide, 222 

Sulphate, 222 
Chrysarobin, 222 
Chrysophan, 401 

Churchill's Tincture of Iodine, 302 
Churrus, 196 
Chyluria, 616 
Ciconium, 185 

Cigarettes, Formulae for, 587 
Ciliary Excitants, 27 
Cimicifuga, 223 
Cimicifugin, 223 
Cinchona, 223 

Red, 224 

Yellow, 224 
Cinchonidine, 224, 226 
Cinchonine, 224, 226 
Cinchonism, 227 
Cineol, 187, 332 
Cinnaldehydum, 230 
Cinnamein, 164 
Cinnamomum, 230 

Camphora, 193 
Cinnamon, 230 

Circulation, Agents affecting, 24, 25, 45 
Cissampeline, 356 
Citrates, 315, — See also the titles of their 

basic constituents. 
Citrine Ointment, 289 
Citron,- 315 
Citrophen, 58 
Citrullus Colocynthis, 240 
Citrus acris, 315 

Aurantium, 161, 315 

Limonum, 315 

medica, 315 

vulgaris, 161, 315 



Clarification, 515 
Classification of Medicines, 12 
Claviceps purpurea, 260 
Clavus, — See Headache, 686 
Clemen's Solution, 153 
Climacteric Disorders, 616 
Cloves, 205 
Club-moss, 319 
Clysters,. 533 
Cnicin, 205 

Cnicus benedictus, 205 
Coal-gas, Antidotes, etc., 796 
Coal-oil Poisoning, 794 
Coca, 185, 231 
Cocaine, 231 

Antidotes and Antagonists, 794 
Cocaine-habit, 235 
Cocamine, 231 
Cocculus Indicus, 374 
Coccus, 238 
Coccygodynia, 617 
Cochineal, 238 
Cocoa, 185 
Codamine, 342 
Codeine, 342, 345, 348, 350 
Codol, 475 
Codfish, 328 
Cod-liver Oil, 328 

Emulsion, 529 
Coffea, 182 
Coffee, 182 
Cohosh, Black, 223 

Blue, 207 
Cola acuminata, 185 
Colation, 516 
Colchiceme, 239 
Colchicine, 239 

Salicylate, 239 
Colchicum, 239 

Antidotes and Antagonists, 794 
Cold Cream, 81, 405 
Coldness, 617 
Colic, Hepatic, 618 

Intestinal, 617 

Lead, 617 

Renal, 618 
Colic-root, 108, 259, 503 
Collagen, 90 

Collagenes and Mucilaginous Bodies, 12 
Collapse, 619, — See also Exhaustion, Shock, 

Syncope. 
Collargol, 145 
Collidine, 471 
Collodia, 526 
Collodion, 282 

Blistering, 197, 282 

Cantharidal, 197, 282 

Flexible, 282 

Styptic, 64, 282 
Colloids, 517 
Colloxylin, 282 
Collunarium, 534 
Collyrium, 535 

Formulas for, 536 
Colocynth, 240 



934 



INDEX. 



Colocynthein, 240 
Colocynthin, 240 
Colocynthitin, 240 
Cologne-water, 99 
Coloring Matters, 8 
Columbo, 192 
Coma, 619 

Alcoholic, 105 

Opium, 346 
Combination, Principles of, 504 
Combustibles, 510 
Comminution, 516 
Commiphora Myrrha, 332 
Compounding Medicines, 513 

a Mixture, 538 

an Ointment, 555 
Compounds, Explosive, 510- 

Miscellaneous, n 

Poisonous, 510 
Condurango, 249 
Condylomata, 620 
Condy's Fluid, 23, 322 
Confectio Damocratis, 526 
Confections, 526 
Conhydrine, 241 
Conime, 241 
Conium, 241 

Antidotes and Antagonists, 794 
Conjunctivitis, Catarrhal, 620 

Diagnosis of, 914 

Diphtheritic, 620 

Gonorrheal, 621 

Granular, 621 

Phlyctenular, 622 
Conspergatives, 543 
Constipation, 622 
Constituents of Organic Drugs, 4 
Contractions, List of, 503, 897 
Contractors, Vascular, 45 
Convalescence, 623 
Convallamarin, 242 
Convallaria, 242 
Convallarin, 242 
Convolvulin, 311 
Convolvulus Scammonia, 421 
Convulsions, 623 

Infantile, 624 

Puerperal, 811 
Copaiba, 243, 811 

Emulsion, 529 

Mixture, 243 
Copper, 249 

Carbonate, as Antidote, 786 

Salts, Antidotes, etc., 794 
Copperas, 268 
Coral, 189 
Cordial, Aletris, 108 

Cascara, 400 

Godfrey's, 344 
Coriander, 244 
Corn, Indian, 118 
Corn-silk, 487 
Corneal Opacities, 624 
Corneitis, — See Keratitis, 716 
Cornin, 244 



Corns, 625 

Cornus, 244 

Cornutine, 260 

Cornutol, 262 

Corpulence, — See Obesity, 753 

Corrosive Sublimate, 288 

Antidotes and Antagonists, 795 
Coryza,' — See Catarrh, Acute. 
Corson's Paint, 479 
Cosmoline, 360 
Cotarnine, 344, 348 
Coto Bark, 244 
Cotoin, 244 
Cotton, 281 

Gun, 119, 281 
Cotton-seed Oil, 282 
Couch-grass, 480 
Cough, 625 

Mixtures, 627 
Counter-irritants, 37 
Counter-irritation, 198 
Court Plaster, 96 
Coxalgia, 627 
Coxe's Hive Mixture, 133 
Crab Lice, — see Pediculosis, 766 
Crabs'-eyes, 189 
Cramp Bark, 486 
Cramps, — See Colic, Spasmodic Affections, 

Trismus. 
Cranesbill, 64, 279 
Cream, Cold, 81, 405 

of Tartar, 386 
Crede's Ointment, 145 
Creolin, 368 
Creosol, 244 
Creosotal, 245 
Creosote, 244 

Antidotes and Antagonists, 795 
Cresol, 364 
Creta, 189 

Creuse's Iron Solution, 267 
Crocus, 248 
Croton-chloral, 210 
Croton Eleuteria, 206 

Oil, 479 

Tiglium, 479 
Croup, Catarrhal, 628 

Membranous, 628 
Diagnosis, 913 
Cryoscopy, 871 
Cryptopine,_ 343 
Crystallization, 516 
Cubeb, 248 
Cubeben, 248 
Cubebene, 248 
Cubebin, 248 
Cuca, 185 

Cucumber, Squirting, 260 
Cucurbita Pepo, 356 
Cucurbitine, 357 
Cultures, Bacillus, 71 
Culver's Root, 315 
Cundurango, 249 
Cuprea Bark, 224 
Cuprum, 249 






INDEX. 



935 



Cuprum, Ammoniatum, 249 

Curare, 251 

Curarine, 251 

Curd, Alum, 96 

Cure, Keeley's Gold, 164 

Cusso, 252 

Cutaneous Irritants, 43 

Cuttle-fish Bone, 189 

Cyanide of Potassium — Antidotes, etc., 795 

Cyanides, — See the titles of their metallic 

constituents. 
Cyanosis, 629 
Cycloform, 232 
Cydonin, 252 
Cydonium, 252 
Cymene, 478 
Cynips tinctoria, 63 
Cypripedin, 252 
Cypripedium, 252 
Cystitis, Acute, 629 

Chronic, 630 
Cysts, 631 
Cytisine, 151 
Cytisus laburnum, 151 

Scoparius, 422 

Dakin's Solution, 23 
Dalby's Carminative, 344 
Damiana, 252 
Dandelion, 473 

Blue, 185 
Dandruff, — See Pityriasis, 777 
Dangers of Incompatibility, 511 
Daphne Mezereum, 328 
Daphnin, 328 
Datura Stramonium, 298 

Tatula, 298 
Daturine, 298 
Deafness, 631 

Death, Signs of, — See Asphyxia, 586 
Debility, — See Adynamia, Anemia, Conva- 
lescence. 
Decantation, 517 
Decimal Weights, etc., 496, 918 
Decocta (Decoctions), 527 
Decoloration, 517 
Deflagration, 517 
Deliquescence, 516 
Deliquescent Salts, List of, 544 
Deliriants, 27 
Delirium, 632 

Tremens, 104, 632 
Delphinine, 77, 467 
Delphinium Staphisagria, 77, 459 
Dementia Paralytica, 633 
Demulcents, 28 
Dengue, 633 
Dental Anodynes, 28 
Dentifrices, 28 
Dentition, 634 
Deodorants, 28 
Deposits in Urine, 874 
Depressants, Cerebral, 17 

Renal, 31 

Respiratory, 40 



Depressants, Uterine, 45 

Dermatol, 173 

Dermatitis herpetiformis, 634 

Medicamentosa, 635 

Occupational, 635 

Seborrheica, 635 

Solare, 636 

Venanata, 636 
Desiccation, 517 
Destructive Metamorphosis, 29 
Dewees' Carminative, 159, 320 
Dextrin, 118 
Dhobie Itch, 637 
Diabetes Insipidus, 637 

Mellitus, 637 
Diabetin, 409 
Diacetyl-morphine, 345 
Diacetyl-tannin, 64 
Diachylon Ointment, 382 
Diagnosis, Differential, 912 
Dialysis, 517 
Dialyzed Iron, 517 
Diaphoretics, 29 
Diarrhea, 642 
Diatase, 118 
Diathermy, 559 
Diazo-reaction, 872 
Diazyme Essence, 358 

Glycerole, 358 
Dichloro-me thane, 215. 
Didymin, 127 
Diet, — See Albumin and Amylum. 

Table, 639 
Diethylene-diamine, 378 
Diethyl-malonyl-urea, 464 
Diethylsulphon-diethyl-methane, 464 
Diethylsulphon-dimethyl-methane, 464 
Diethylsulphon-methyl-ethyl-methane, 464 
Diffusate, 517 

Digestive System, Agents affecting, 13 
Digipoten, 254 
Digipuratum, 254 
Digitalein, 254 
Digitalin, 254 
Digitalis, 253 

Antidotes and Antagonists, 796 
Digitin, 254 
Digitol, 254 
Digitonin, .254 
Digitoxin, 253 _ 
Dihydro-toluidine, 329 
Dilators, Vascular, 45 
Diluents, 29, 544 
Dime thy- amido-antipyrine, 135 
Dimethyl-ethyl-carbinol, 210 
Dimethyl-piperazin Tartrate, 378 
Dimethyl-xanthin, 182 
Dionin, 345 
Dioscorea, 259 
Dioscorem, 259 
Diosphenol, 180 
Diospyros, 64 
Diphtheria, 644 

Antitoxin, 435 

Diagnosis, 913 



936 



INDEX. 



Diphtheria, Laryngeal, 628 

Temperature in, 847 
Diplosal, 411 
Dipsomania, — See Alcoholism, Delirium 

Tremens. 
Discs, 534 
Discutients, 29 
Disinfectants, 22 

Burnett's, 22 

Condy's, 22 

Labarraque's, 22 
Disinfecting Fluid, 488 
Dislocations, 672 
Dispensatories, 493 
Dispensing, 513 

by Physicians, 507 
Displacement, 519 
Distillation, 517 
Dita Bark, 259 
Ditaine, 259 
Ditamine, 259 
Dithymol-Iodide, 303 
Diuretics, 30 

Formulae for, 645 

List of, 30 
Diuretin, 187 

Dizziness, — See Vertigo, 883 
Dobell's Nasal Wash, 534 
Dock, Yellow, 406 
Dog-bane, 139 
Dog-wood, 244 

Jamaica, 379 
Domestic Measures, 497 
Donovan's Solution, 153' 
Dormiol, 210 
Dosage of Medicines, 51, 52 

Young's Rule for, 52 

Table of, — See inside of cover. 
Dover's Powder, 308, 343 
Drastic Purgatives, 26 
Draught, 532 

Black, 423, 532 

Effervescing, 532' 
Drink, 546 

Imperial, Formula, 546 
Drops, 497 

to a Drachm, 497, 918 

Knock-out, 375 
Dropsy, 644 
Drosera, 259 

Drowning, — See Asphyxia, 585 
Drug-eruptions, 635, 663 
Drug-experimentation, 3 
Drugs, 1 

Active principles, 5 

Antagonism of, 17, 19 

Constituents of, 4 

Inorganic, 4 

Neutral principles, 8 

Organic, 4 
Dryopteris Filix-mas, 160 

Marginalis, 160 
Duboisia, 167 
Duboisine, 167, 170 
Dulcamara, 259 



Dulcamarin, 259 
Duodenal Catarrh, 646 
Duotal, 245 
Durande's Remedy, 86 
Dutch Liquid, 215 
Dysentery, 646 
Dysentery, Tropical, 646, 647 
Dysidrosis, pompholyx, 647 
Dysmenorrhea, 648 
Dyspepsia, 649 
Dysphagia, 651 
Dyspnea, 651 
Dysuria, 651 

Ear Affections, 652 

Earache, — See Otalgia, 757 

Eau Sedative, 116, 193 

Ebullition, 522 

Ecballium Elaterium, 260 

Ecbolics, 38 

Ecchymosis, 652 

Ecgonine, 231 

Eclampsia,— See Puerp. Convulsions, 811 

Ecthyma, 652 

Ectropion, 653 

Eczema, 653 

Efflorescence, 516 

Efflorescent Salts, List of, 545 

Egg-albumen, 91 

Egg-shell, 189 

Egg, Yolk of, 91, 96 

Eggs as food, 95 

Ehrlich's Theory, 428 

Elastica, 259 

Elaterin, 260 

Elaterium, 260 

Elder, 416 

Electricity, 556 

Electrotherapeutics, 556 

Electuaries, 526 

Electuary for Piles, 520 

Elettaria repens, 204 

Elixir Ad ju vans, 281 

Aromatic, 162 
Elixir, Simple, 161 

of Vitriol, 75 

Yvon's Hypnotic, 712 
Elixiria, 527 
Elm, Slippery, 480 
Elutriation, 522 
Emaciation, 656 
Embrocation, 531 
Emetics, 31 

in Poisoning, 786 
Emetine, 308 
Emissions, 656 
Emmenagogues, 32 

Formulae for, 575 

Pills, 546 
Emodin, 401 
Emollients, 28, 33 
Emphysema of Lungs, 657 
Emplastra, 527 
Empyema, 657 
Empyroform, 274 






INDEX. 



937 



Emulsa, 528 
Emulsification, 529 
Emulsin, 68, 114, 390 
Emulsions, 528 
Encephaoma, — See Cancer, 601 

Diagnosis of, 912 
Endermic Method, 50 
Endocarditis, 657 

Diagnosis of, 912 
Endometritis, 658 
Enema, Nutrient, 658 
Enemata, 533, 658 

Formulae for, 534 
Enepidermic Method, 50 
Entralgia, — See Colic, Intestinal, 617 
Enteric Fever, — See Typhoid, 858 
Enteritis, 658 
Enteroclysis, 143 
Entropion, 653 
Enuresis, 659 
Enzymes, 24 

Elixir of, 357 
Enzymol, 357 
Epidermic Method, 50 
Epididymitis, 660 

Epilation, — See Tinea Circinata, 851 
Epilepsy, 660 

Diagnosis of, 913 
Epinephrin, 125 
Epispastics, 37 
Epistaxis, 662 
Epsom Salt, 320 
Epulis, — See Teeth, 845 
Equinia, — See Glanders, 677 
Erections, 656 
Ergot, 260 

Antidotes and Antagonists, 796 
Ergo tin, 261 

Bon jean's, 261 

Merck's, 261 
Ergotinine, 261 
Ergotism, 263 
Ergotoxine, 261 
Ericolin, 481 
Erigeron, 264 
Eriodictyon, 264 
Errhines, 33 

Eruptions caused by Drugs, etc., 663 
Erysipelas, 664 

Intertrigo, 665 

Multiforme, 666 
Erythrol Tetranitrate, 116 
Erythrophlcein, 255 
Erythrophlceum Guinense, 255 
Erythroxylon Coca, 182, 249 
Escharotics, 33 
Eseridine, 372 
Eserine, 372 

Eosophageal Affections, 666 
Essential Oils, 10 
Ethene, 85 

Chloride, 85 

Dichloride, 85 
Ether, 82 

Acetic, 82 



Ether, Chloric, 215 

Chlorinated Muriatic, 215 

Hydriodic, 82 

Hydrobromic, 82 

Methylene-di-methyl, 210 

Methylic, 85 

Nitrous, 82, 84, 85 

Spirit of, 82 

Sulphuric, 82 

Preparations, 523 

Acetate, 82 

Alcohol, 97 

Aldehyde, 98 

Bromide, 82 

Carbamate, 464, 465 

Chloride, 215, 219 

Hydride, 85 

Hydroxide, 97 

Iodide, 82 

Nitrite, 82, 116 

Oxide, 82 
Ethylene Bichloride, 215 
Ethylidene Chloride, 215 

Oxide, 98 
Ethylirtes Chloral-ure thane, 210 
Eucalypetene, 265 
Eucalyptol, 265 
Eucalyptolen, 265 
Eucalyptus, 265 
Euchinin, 225 
Eudoxin, 173 
Eugenia aromatica, 205 
Eugenol, 205, 377 
Eugenol-acetamide, 205 
Euonymin, 266 
Euonymus, 266 
Eupatorin, 266 
Eupatorium, 266 
Euphorin, 55 
Euphthalmin, 232 
Euquinine, 225 
Europhen, 303, 308 
Eurotium oryzae, 359 
Evaporation, 522 

Spontaneous, 522 
Exalgin, 55 

Exanthemata, Diagnosis of, 915 
Excipients, 528, 538, 542 
Excitants, Cerebral, 27 

Ciliary, 27 
Excoriation, — See Intertrigo, 713 
Exhaustion, 666 
Exodyne, 55 
Exogonium Purga, 311 
Exostosis, 667 
Expectorants, 34 
Explosive Compounds, 510 
Expression, 518 
Exsication, 516, 518 
Extemporaneous Pharmacy, 513 
Extract, Adrenal, 125 

Bone Marrow, 128 

Brain, 127 

Goulard's, 381 

Lymphatic, 132 



93§ 



INDEX. 



Extract, Malt, 118, 121 

Mammary Gland, 130 

Meat, 91 

Orchitic, 127 

Ovarian, 130 

Parotid, 130 

Pituitary, 130 

Pond's, 286 

Splenic, 128 

Supra-renal, 126 

Testicular, 127 

Thyroid, 123 
Extracta, 530 
Extractive, 531 
Extracts, 530 

Animal, 121 

Distilled, 285 

of Meat, 91 
Eye, Agents affecting, 12, 15, 40, 49 

Ointments, Formulas for, 620 

Sensibility, Agents affecting, 15 

Water, Formulae for, 620 
Eye-bright, 267 

Fabiana imbricata, 374 

Face, 667 

Face-ache, — See Neuralgia, Tic Douloureux 

Fagara Clava-Herculis, 487 

Fainting, — See Syncope, 841 

False Pains, 667 

Farcy, 677 

Fast Days, 641 

Fat, — See Obesity, 753 

Hog, 81 

Wool, 81 
Fatigue,' — See Exhaustion, 666 
Fats and Oils, 9 

as Antidotes, 787 
Favus, — See Tinea Favosa, 667, 851 

Sylvatica, 244 
Febricula, — See Fever, Simple, 670 
Febrifuge, 226 
Febrinol, 55 
Feet, 609, 668 

Federal Anti-narcotic Law, 921 
Fehling's Solution, 249, 872 
Fel Bovis, 266 

Tauri, 266 
Felon, — See Onychia, 755 
Fennel, 273 
Fermentation, 23 

Lactic, 409 
Ferments, 12, 24 

Agents affecting, 23 
Fern, Male, 160 

Marginal Shield, 160 
Ferratin, 269 
Ferrichthyol, 467 
Ferrier's Snuff, Formula, 606 
Ferrocyanide of Potassium, 69 
Ferrocyanide of Potassium as an" Antidote, 

787 
Ferro-mangin, 269 
Ferropyrin, 135 
Ferrum, 267 



Ferrum, Dialysatum, 517 

Reductum, 267 
Ferula fcetida, 159 

galbaniflua, 276 
Fever, 669 

Bilious Remittent, Diagnosis, 917 

Cerebro-spinal, 446, 738 

Enteric, — See Typhoid, 858, 916 

Hay, 685 

Hemoglobinuric, 694 

Intermittent, 712 

Malta, 734 

Miliary, 743 

Milk, — See Lactation, 718 

Pernicious, — See Intermittent Fever, 
Remittent Fever. 

Puerperal, 813 

Relapsing, 817 

Diagnosis of, 917 

Rheumatic, 818 

Scarlet, 823 

Diagnosis of, 915 

Simple, 670 

Spotted, — See Typhus Fever; also 
Meningitis, Cerebro-spinal. 

Typhoid, 447, 858 
Diagnosis of, 914 

Typho-malarial, — See Typhoid, 858 

Typhus, 860 

Diagnosis of, 916 

Yellow, 894 

Diagnosis of, 907 
Fibrin, n, 89, 90 
Fibrolysin, 454 
Ficus, 273 
Fig, 273 

Filariasis, — See Worms, 887 
Filix Mas, 160 
Filmaron, 160 
Filtering paper, 518 
Filtration, 518 
Fir, Balsam of, 474 

Scotch, 380 

Silver, 474 
Firs, 379 
Fish-berries, 374 
Fish-poison, Antidotes, etc., 796 
Fistula, 672 
Fits, — See Apoplexy, Convulsions, Epilepsy, 

Hysteria, Syncope. 
Flatulence, 671 
Flavoring Agents, 538 
Flaxseed, 316 
Flea-bane, 264 
Flooding, — See Hemorrhage, Post-partum, 

Menorrhagia, Metrorrhagia. 
Fluavil, 259 
Fluid, Antiseptic, 478 

Burnett's, 488 

Condy's, 322 

Disinfecting, 488 

Extract, Aromatic, 230 

Extracts, 531 
Fluorine, 41 
Flushing-heats, 671 






INDEX. 



939 



Fly-agaric, 88 
Fceniculum, 273 
Fomentation, 535 
Food, Horlick's, 119 

Mellin's, 119 

Parrish's Chemical, 370 

Producing Eruptions, 663 
Foods, — also Albumin, Amylum, 40, 94 
Foreign Bodies, 584, 671 
Formaldehyde, 273 

Antidotes and Antagonists, 796 
Formalin, 273 

Poisoning by, 796 
Formicin, 274 
Formulae Hypodermic, 911 
Formyl, 273 

Iodide, 302 
Fotus, 53 s 

Fowler's Solution, 152 
Fox-glove, 252 
Fractures, 672 
Franciscea uniflora, 322 
Frangula, 276 
Frangulin, 276 
Frankincense, 474 
Franklinite, 488 
Fraxin, 325 
Fraxinus Ornus, 325 
Freckles, 672, 722 
Friar's Balsam, 171 
Fungi, Antidotes, etc., 796 

Kefir, 71 
Fusel Oil, 98 
Fusion, 518 

Gadus Morrhua, 328 
Galactagogues, 34 
Galactophyga, 34 
Galbanum, 276 
Galena, 381 
Galla, 63, 64 
Gallipots, 555 
Gallobromol, 64 
Galls, 63 
Gall-stones, 672 
Gambir, 206 
Gamboge, 193 

Antidotes and Antagonists, 796 
Gangrene, 673 

of Lungs, 728 
Garcinia Hanburii, 193 

mangostana, 324 
Gargarisma, 532 

Garbles, Formulae for, 532, 644, 771, 850 
Garlic, 108 
Gas, Illuminating, — Antidotes, etc., 796 

Laughing, 334 
Gases, Agents affecting, 28 

Antidotes and Antagonists, 796, 798 
Gasoline Poisoning, 794 
Gastralgia, 673 
Gastric Acidity, 674 

Dilatation, 675 

Fever, — See Fever Simple, Gastritis, 
Remittent Fever, Typhoid Fever. 



Gastric Pain, 673 

Sedatives, 32 

Tonics, 43 

Ulcer, 675 
Gastritis, 676 
Gastrodynia, 673 
Gaultheria, 411 
Gaultherilene, 411 
Gelatin, 90, 95, 96 

as an Antidote, 786 

Glycerinated, 279 
Gelsemine, 277 
Gelsemium, 277 

Antidotes and Antagonists, 797 
Generative System, Agents affecting, 16, 

24, 41 
Genitive Case-endings, 910 
Gentian, 277 
Gentianin, 277 
Gentopicrin, 277 
Geoform, 245 
Geranium, 64, 277 
Germicides, — See Disinfectants, 22 
Gin, 99 
Ginger, 491 
Glanders, 677 
Glandulae Thyroideae, 126 
Glandular Affections, 677 

Extracts, 121 
Glass, Antidotes for, 796 

Soluble, 386, 453 
Glauber's Salt, 456 
Glaucoma, 678 

Diagnosis of, 914 
Gleet, 678 
Globulins, 11 
Glonoin, 116 
Glossitis, 679 
Gluco-chloral, 210 
Glucose, 408 

in Urine, Test for, 872 
Glucosides, 7 
Glusidum, 408 
Gluten, 91 

as an Antidote, 786 
Glutol, 274 
Glycerin, 279 
Glycerines, 523 
Glycerites, 93, 532 
Glycerol, 279 
Glyceryl Trinitrate, 116 
Glycocoll, 60 
Glyco-formalin, 274 
Glycogen, 119 

Agents affecting its production, 35 
Glyconin, 91 

Glycosuria, Temporary, 872 
Glycyrrhetin, 281 
Glycyrrhiza, 280 
Glycyrrhizin, 281 

Glycyrrhizinum Ammoniatum, 281 
Gnoscopine, 343 
Godfrey's Cordial, 344 
Gold, 162 

Antidotes and Antagonists, 796 



94Q 



INDEX. 



Gold. "Bichloride," 164 

Bromide, 162 

Chloride, 162 

Cure, Keeley's, 164 
Golden Seal, 295 
Gonobulus Condurango, 249 
Gonococcus Infections, 445 
Gonorrhea, 680 
Gossypium, 281 
Goulard's Extract, 381 
Gout, 682 

Diagnosis of, 913 
Granatum, 64, 283 

Granular Lids, — See Conjunctivitis, Oph- 
thalmia. 
Granulation, 518 
Granule, 541 
Grape, Oregon, 172 
Grass, Ribbed, 381 

Worm, 459 
Gray Oil, 295 

Powder, 288 
Griffith's Mixture, 267 
Grindelia, 283 
Grindeline, 283 
Grippe, — See Influenza, 709 
Guaiac, 284 
Guaiacol, 245, 247, 284 
Guaiacose, 245 
Guaiaform, 245 
Guaialin, 245 
Guaiamar, 245 
Guarana, 183, 186, 187 
Guaranine, 185 
Gum Arabic, 54 

as an Antidote, 786 

Kauri, 463 

Sweet, 463 
Gumboil, — See Gums, 684 
Gum-resins, 9 
Gums, 5, 684 
Gum-tree, Blue, 264 
Gun-cotton, 119, 282 
Gunjah, 196 
Gurjun Balsam, 285 
Gutta, 259 
Guttae (Drops), 497 
Gutta-percha, 259 
Gynocardia odorata, 208 
Gypsum, 188 

Haematoxylin, 285 
Hsematoxylon, 64, 285 
Hagenia abyssinica, 252 
Hager's Tincture, 225 
Hair, 573, 685 

Superfluous, 704 

Tonic, 573 

Washes, 574 
Haller's Dictum, 3 
Halogen Elements, 41 
Haloid Salts, 41 
Hamamelin, 285 
Hamamelis, 64, 285 
Hands, — See Chapped Hands, 609 



Haptophores, 428 

Hashish, 196 

Haustus, 532 

Haw, Black, 486 

Hayden's Viburnum Compound, 486 

Hay-fever, 685 

Head-ache, Bilious Sick, 686 

Congestive, 686 

Nervous, 687 
Hearing, 34 
Heart Affections, 688 

Dilated, 688 

Disorders, 689 

Fibroid, 688 

Hyper trophied, 880 

Palpitation, 690 

Valvular Disease, 691 
Heartburn, — See Pyrosis, 815 
Heart's ease, 486 
Heat-stroke, — See Insolation, 710 
Hedeoma, 286 
Hellebore, 286 

American, 483 

White, 483 
Helleborein, 286 
Helleborin, 286 
Helleborus, 286 
Helmitol, 274 
Hemaboloids, 269 
Hematemesis, 691 
Hematics, 40 
Hematocele, Pelvic, 692 
Hematuria, 692 
Hemicrania, 692 
Hemiplegia, 694 
Hemlock, 241 

Spruce, 380 
Hemogallol, 269 
Hemoglobinuric Fever, 694 
Hemol, 269 
Hemoptysis, 695 
Hemorrhage, 697 

Intestinal, 699 

Post-partum, 699 
Hemorrhagic Diathesis, 697 
Hemorrhoids, 699 
Hemostatics, 44 
Hemp, Canadian, 139 
Henbane, 297 
Hepar Sulphuris, 467 
Hepatalgia, 701 
Hepatic Abscess, 702 

Cirrhosis, 701 

Congestion, 701 

Diseases, 701 

Stimulants, 35, 43 
Hepatitis, 702 
Hernia, 703 
Herpes, 703 

Zoster, 703 
Hesperidin, 161 
Hetol, 171 
Heuchera, 64 
Hevea, 259 
Hewitt's Method of Anesthesia, 86 



INDEX. 



941 



Hexamethylenamine, 273 

Hexamethylene-Tetramine-Tannin, 64 

Hexylamine, 329 

Hiccough, 704 

Hip- joint Disease, — See Coxalgia, 627 

Hirsutes, 704 

Histamine, 261 

Hive Mixture, 133 

Syrup, 133 i 
Hives, — See Urticaria, 875 
Hoang Nan, 287 
Hoarseness, — See Aphonia, 580 
Hodgkin's Disease, 730 
Hoffmann's Anodyne, 83 
Hoff's Malt Extract, 119 
Hog, 80 
Holadin, 358 
Holocaine, 232 
Homatropine, 167 
Homochelidonine, 416 
Honey, 325 
Honeys (Mellita), 536 
Hooper's Female Pills, 546 
Hope's Mixture, 643 
Hops, 287 

Hordeum distichum, 118 
Horehound, 325 
Horlick's Food, 119 
Housemaid's Knee, — See Bursitis, 600 
Humulus, 287 

Hunger,- — See Appetite, 582 
Hunyadi Water, 140, 623 
Huxham's Tincture of Bark, 225 
Hwang-Nao, 287 
Hydragogue Diuretics, 30 

Purgatives, 26 
Hydrangea, 288 
Hydrargyrism, 292 
Hydrargyrum, 288 

Ammoniatum, 289 

Antidotes and Antagonists, 795, 797 

cum Creta, 288 

Succinidum, 290 
Hydrastin, 172, 295^ 
Hydrastine, 295 
Hydrastinine, 295 
Hydrastis, 295 
Hydrides, — See the titles of their metallic 

constituents. 
Hydrobromides, — See the titles of their 

basic constituents. 
Hydrocele, 705 
Hydrocephalus, 705 

Acute, — See Meningitis, Tuberculous. 
Hydrochlorides, — See the titles of their 

basic constituents. 
Hydrocotarnine, 343 
Hydrocotyle, 297 
Hydrogen Carbonate, 200 

Dioxide, 353, 354 

Peroxide, 353, 354 

Sulphide, 467 

Sulphuretted, 467 
Hydronaphthol, 333 
Hydrophobia, 705 



Hydrophobia Toxin, 449 
Hydroquinone, 398 
Hydrothorax, 706 

Diagnosis of, 915 
Hydroxides, — See the titles of their metallic 

bases. 
Hydroxybenzene, 362 
Hydroxy methane, 98 
Hygroscopic Bodies, 516 
Hyoscine, 167 
Hyoscyamine, 167 
Hyoscyamus, 167 

Antidotes and Antagonists, 796 
Hyperidrosis, — See Perspiration, 706, 769 
Hypertrichiasis, 704 
Hypnal, 210 
Hypnotics, 35, 712 
Hypochlorites, Antidotes, etc., 796 
Hypochondriasis, 707 
Hypodermic Formulae, 911 

Injections, 51, 295 

Method, 48 

Solutions, 49 

Tablets, 50 
Hypodermoclysis, 143 
Hypophosphites, 369, — See also the titles of 

their basic constituents. 
Hypophysis, Liquor, 130 

Sicca, 130 
Hyposulphites, 75, — See also the titles of 

their basic constituents. 
Hysteria, 707 

Diagnosis of, 913 

Ice, 142 

Iceland Moss, 119 
Ichthalbin, 467 
Ichthargan, 145 
Ichthoform, 467, 470 
Ichthyocolla, 90 
Ichthyol, 467, 469 

Albuminate, 467 ] 
Ichthyosis, 708 
Icterus, — See Jaundice, 715 
Ignatia, 335, 341 
Ignition, 519 

Ileus, — See Intestinal Obstruction, 713 
Ilex Paraguayensis, 182, 186 
Illicium, 302 
Immunity, 425 

Illuminating-gas, Antidotes, etc., 796 
Impetigo Contagiosa, 708 
Impotence, 7.09 
Incineration, 519 
Incompatibility, 508 • 

Chemical, 508 

Dangers of, 511 

Pharmaceutical, 510 

Rules for avoiding, 511 

Therapeutical, 511 
Incompatible Substances, 511 
Indian Corn, 487 

Tobacco, 318 
Indican in Urine, Test for, 872 
Indigestion, — See Dyspepsia, 649 



942 



INDEX. 



Indigo, Wild, 165 
Influenza, 709 
Infusa (Infusions), 533 
Infusion, 143 
Inhalations, 533 
Injection Brou, 534 
Injections, 533 

Antiseptic, 62, 295 

Formulae, 534 

Hypodermic, 51, 295, 911 

Nasal, 534 

Parenchymatous, 50 

Urethral, 534 

Yaginal, 534 
Injuries, — See Bruises, Burns, Ecchymosis, 

Fractures, Sprains, Wounds. 
Inoculation, 51 
Inosit, 408 

Insect-venom, Antidotes, etc., 792 
Insolation, 710 
Insoluble Salts, 510 
Insomnia, 711 

Integument, Absorption by, 50 
Intemperance, — See Alcoholism, Delirium 

Tremens, Opium Habit. 
Intermittent Fever, 712 
Intertrigo, 712 
Intestinal Astringents, 36 

Diseases, — See Appendicitis, Colic, 
Constipation, Diarrhea, Dysentery, 
Duodenal Catarrh, Enteritis, Hemor- 
rhoids, Hernia, Intestinal Obstruc- 
tion, Intussusception, Typhlitis, 
Tabes Mesenterica, Worms. 

Obstruction, 713 

Parasites, — See Worms, 887 

Stimulants, 43 
Intraocular Tension, 46 
Intussusception, 713 
Inulin, 151 
Inunctiqn, 50 
Iodides, 303 
Iodine, 302 

as an Antidote, 786 

Antidotes and Antagonists, 797 

Carbolated, 303 

Disulphide, 467 
Iodipin, 303 
Iodism, 304 

Phenol, 303 
Iodoalbin, 304 
Iodo-Casein, 304 
Iodoform, 303, 307 
Iodoformogen, 303 
Iodol, 303, 308 
Iodo-Mangan, 304 
Iodophen, 303 
Iodothyrin, 125 
Iodum, 302 
Ipecacuanha, 308 

Antidotes and Antagonists, 797 
Iris, 310 
Irish Moss, 90 
Iritis, 713 

Diagnosis of, 914 



Iron, 267 

as an Antidote, 787 

Antidotes for, 797 

Content of Foods, 271 

Dialyzed, 517 

and Manganese, 322 

Mixtures, 267 

Pills, 546 

Syrup of, 269 
Irritability, 714 
Irritants, Cutaneous, 37 
Ischuria, — See Urinary Disorders, 866 
Isinglass, 90 

Isobutyl-orthocresol Iodide, 303 
Isonandra Gutta, 259 
Isopilocarpine, 375 
Itch, — See Scabies, 822 

Dhobie, 637 
Itching, — See Lichen, Prurigo, Pruritus, 

Pediculosis, Scabies, Urticaria, etc. 
Ivy, Poison, 402 

Jaborandi, 375, 801 

Jaborine, 375 

Jalap, 311 

Jalapin, 311, 435 

Jambul, 310 

Jamestown Weed, 298 

Japaconitine, 77 

Jasmine, Yellow, 277 

Jateorhiza palmata, 192 

Jaundice, 714 

Javelle Water, Antidotes, etc., 796. 

Jeaunel's Antidote, 789 

Jequirity, 58 

Jervine, 483 

Jimson Weed, 298 

Joint Affections, 715 

Joslin's Diet Table, 639 

Juglans, 312 

Juices, 549 

Juniper, 312 

Juniperin, 312 

Juniperus communis, 312 

Oxycedrus, 312 

Sabina, 407 

Virginiana, 407 

Kalium, 385 
Kalmia latifolia, 326 
Kamala, 313 
Kaolin, no, 280 
Kaputin, 56 
Kauri Gum, 463 
Kavahin, 313 
Kava-kava, 313 
Kawin, 313 

Keeley Gold Cure, 164 
Kefir, 922 

Fungi, 71 
Kelene, 215 
Keloid, 716 
Keratitis, 716 
Keratosis Senilis, 716 



INDEX. 



943 



Kerosene poisoning, 794 

Ketone, 98 

Kidneys, Diseases of, — See Albuminuria, 
Bright's Disease, Calculi, Colic Renal, 
Diabetes, Dropsy, Gout, Hematuria, 
Pyelitis. 

Kino, 64, 313 

Kinoin, 313 

Kino-red, 313 

Kinovin, 224 

Koch's Lymph, 438 

Kola, 182, 185 

Kolanin, 185 

Kombe-poison, 461 

Koomiss, 92 

Kosin, 887 

Kousso, 252 

Krameria, 64, 313 

Kumysgen, 92 

Kumyss, 92, 94, 100 

Kurung Oil, 385 

Labarraque's Solution, 22, 220 

Antidotes, etc., 796 
Labor, 717 
Laburnum, 151 
Lac Sulphuris, 466 
Lactation, 718 
Lactocin, 314 
Lactone, 96 
Lactophenin, 58 
Lactopicrin, 314 
Lactose, 408 
Lactuca virosa, 314 
Lactucarium, 314 
Lactucerin, 314 
Lactucin, 314 
Lactyl-para-phenetidin, 58 
Ladies' Slipper, 252 
La Fayette's Mixture, 243 
Lallemand's Specific, 684 
Lamellae, 534 
Lanolin, 81 
Lanthopine, 343 
Lapathin, 406 
Lappa, 314 
Larch, 474 
Lard, 80 

Benzoinated, 81 

Oil, 81 
Larix Europaea, 474 
Laryngismus Stridulus, 719 
Laryngitis, Acute, 719 

Catarrhal, 719 

Chronic, 720 

Edematous, 721 

Tuberculous, 721 
Latin in Prescriptions, 502 

Genitive Case-endings, 910 

Numerals, 909 

Participles, 911 

Phrases and Terms, 897, 911 

Prepositions, 911 

Pronunciation, 910 



Latin in Prescriptions, Verbs, 910 
Laudanine, 343 
Laudanosine, 343 
Laudanum, 343 
Laurel, Cherry, 68 

Mountain, 326 
Laurocerasus, 68 
Lavandula, 314 
Lavender, 314 

Law, Federal Anti-narcotic, 921 
Laxatives, 26, 560, 562 
Lead, 381 

Colic, 618 
Lead, Plaster, 382 

Salts, — Antidotes, etc., 797 

Sugar of, 381 

Water, 382 

and Laudanum, 383, 536 
Leek, 108 
Lemon, 74, 315 

Lentigo, — See Freckles, 672, 722 
Leopard's Bane, 151 
Leprosy, 722 
Leptandra, 315 
Leptandrin, 315 
Lettuce, 314 
Leucocythemia, 723 
Leucoma, — See Corneal Opacities, 624 
Leucomames, 6 
Leucorrhea, 723 
Leukemia, 723 
Leukodermia, 883 
Levigation, 522 
Levulose, 408 
Libradol, 318 

Lice, — See Pediculosis, 766 
Lichen, 724 
Lichenin, 119 

Licoperdon giganteum, 315 
Licorice Root, 280 

Wild, 54 
Lignum vitae, 284 
Lily-of-the-Valley, 242 
Lily, Pond, 64 
Lime, 188, 315 

Antidotes and Antagonists, 797 

Chlorinated, 220 

Kinovate, 224 

Sulphurated, 467 

Water, 189 
Limon, 315 
Linimenta, 534 
Liniments, Formulae, 535 
Linseed, 316 
Linum, 316 

Lips, — See Chapped Lips, 609 
Lip-salve, Red, 477 
Liquid-ambar orientalis, 463 
Liquor hypophysis, 130 
Liquores, 535 
Listerine, 62 
Litharge, 381 
Lithemia, 725 
Lithium, 317 

Benzoate, 171 



944 



INDEX. 



Liver, — See Hepatalgia, etc., 701 

Spots, 610 
Liver of Sulphur, 467 
Lixiviation, 519 
Lobelacrin, 318 
Lobelia, 318 

Antidotes and Antagonists, 797 
Lobelin, 318 
Lobeline, 318 
Lochia, — See Labor, 717 
Lock-jaw, — See Tetanus, 436, 847 
Locomotor Ataxia, 726 
LoefSer's Solution, 644 
Loganin, 335 
Logwood, 64, 285 
Lotion, 535 

Black, of Mercury, 289 

Yellow, of Mercury, 289 
Lozenges, 554 
Lugol's Solution, 302 
Lumbago, 727 
Lumbrici, — See Worms, 887 
Lung, Emphysema of, 657 

Gangrene of, 728 
Lupulin, 287 
Lupuline, 287 
Lupus, Erythematosus, 729 

Vulgaris, 728 
Lycetol, 378 
Lycoctonine, 77 
Lycopodium, 319 
Lyctonine, 77 
Lymphadenoma, 730 
Lymphangitis, 731 
Lymphatic Extract, 132 
Lysidin, 378 
Lysol, Poisoning by, 799 



Mace, 331 
Maceration, 519 
Macis, 331 
Macro tin, 223 
Magendie's Solution, 344 
Magma, 520 
Magnesia, 319 

as an Antidote, 787 
Magnesium, 319 

Silicate, 453 
Maize, 118, 408, 487 
Malaria, chronic, 733 

Fever, 731 
Male Fern, 160 
Mallein, 451 

Mallotus philippinensis, 313 
Malt, 118 

Extract, 118, 121 
Hoff's, 119 
Malta Fever, 734 
Mammary Abscess, 567 

Gland Extract, 130 
Manaca, 322 
Mandragora, 298 
Mandragorine, 298 
Mandrake, 384, 503 



Manganauro, 163, 164 
Manganese, 322 
Manganum, 322 
Mangifera indica, 324 
Mango, 324 
Mango-fruit, 324 
Mangosteen, 324 
Mania, 734 

Puerperal, 813 
Manna, 325 
Mannit, 325 
Mannite, 283 
Manzanita, 481 
Marasmus, — See Atrophy, Emaciation, 

Tabes Mesenterica. 
Margarin, 80 

Marginal Shield Fern, 160 
Marigold, 192 
Marrubiin, 325 
Marrubium, 325 
Marsh's Test, 153 
Marsh-mallow, 109 
Marsh Rosemary, 64 
Mass, Blue, 288 

of Ferrous Carbonate, 267 

of Mercury, 288 

Pill, 54i 
Mass, Vallet's, 267 
Massae, 536 
Massolin, 71 
Mastic, 325 
Mastiche, 325 
Mastichin, 325 
Mastitis, 735 

Masturbation, — See Emissions, 656; Sper- 
matorrhea, 833 
Mate, 182, 186 
Materia Medica, 53 
Matico, 325 
Matricaria, 325 
May Apple, 384 
Meadow Anemone, 392 

Saffron, 239 
Measles, 736 

Diagnosis of, 915 

False, — See Roseola, 822 

Temperature in, 847 
Measures, Antagonistic, 785 

Antidotal, 785 

Apothecaries', 495, 918 

Approximate, 497 

British, 495 

Domestic, 509 

Metric, 496, 918 

and Weights, 494, 918 

Wine, 918 
Meal Diet, 95 

Extracts, 91 

-juices, 91 
Meconidine, 343 
Meconin, 343 
Meconoiasin, 343 
Medicines, Administration of, 46 

Classification of, 12 

Dosage of, 51, 52 



INDEX. 



945 



Medinal, 464, 466 

Meerschaum, 453 

Mel, 325 

Melachol, 370 

Melaleuca Leucadendron, 187 

Melancholia, 737 

Puerperal, 813 
Mellin's Food, 119 
Mellita, 536 

Meniere's Disease, — See Vertigo, 883 
Meningitis, Cerebral, 738 

Cerebro-spinal, 446, 738 

Spinal, 739 

Tuberculous, 740 
Menispermin, 374 
Menispermum Cocculus, 374 
Menopause, — See Climacteric, 616 
Menorrhagia, 740 
Menstrual Disorders, 741 
Menstruum, 519 
Mentagra, — See Sycosis, 841 
Mentha piperita, 326 

spicata, 326 

viridis, 327 
Menthol, n, 326 
Mercauro, 163 
Mercurio-vegetal, 332 
Mercurol, 289 
Mercury, 797 

Antidotes and Antagonists, 795, 797 

Vegetable, 322 
Mergal, 843 
Mesenteric Disease, — See Tabes Mesen- 

terica, 844 
Mesotan, 411 

Metabolism, Agents affecting, 15 
Metadioxybenzene, 398 
Metallic Salts, Antidotes, etc., 798 
Metamorphosis, Destructive, 29 
Methacetin, 56, 58 
Methanal, 273 
Methane, 85 
Methene Chloride, 85 
Methol, 98 

Methyl-acetanilide, 55 
Methyl-aldehyde, 273 
Methyl Alcohol, 98 

Blue, 327 

Bromide, 85 

Chloride, 215 

Coniine, 241 

Hydroxide, 98 

Salicylate, 411 
Methylal, 210, 214 
Methylated Spirit, 98 
Methylene Bichloride, 215 

Blue, 327 
Methylene-dimethyl Ether, 210 

Ditannin 64 
Methyl thionine, 327 
Methysticin, 313 
Metric Prescriptions, 505 

System of Weights, etc., 496, 918 

Table for Conversions, 919 
Metritis, 742 
60 



Metrorrhagia, 742 

Meyer's Mixture, 85 

Mezcaline, 181 

Mezereon, 328 

Mezereum, 328 

Mica Panis, 543 

Microbes, Agents affecting, 21 

in Water, 141 
Migraine, — See Hemicrania, 693 
Miliaria, 743 
Miliary Fever, 743 
Milk as an antidote, 787 

as a food, 92, 94, 96; See also Agalactia 
and Lactation. 

of Asafetida, 159 

Bacillary, 71 

Condensed, 92 

Desiccated, 92 

Papaw, 358 

Peptonized, 92 

Sugar of, 408 

of Sulphur, 466 

Substances excreted in, 718 
Milk-fever, — See Lactation, 718 
Mindererus, Spirit of, in 
Mineral Green, 153 

Waters, 139, 143, 201 
Mint, 327 

Miscarriage, — See Abortion, 566 
Mistletoe, 487 
Misturae, 536 
Mixture, A. C. E., 83 

Basham's, 268 

Bismuth, for Children, 540 

Brown, 281 

Chalk, 189 

Cholera, 344, 613 

Copaiba, Compound, 243 

Cough, 613, 627 

Coxe's Hive, 133, 421 

Diarrhea, 344 

Griffith's, 267 

Hive, 133, 421 

Hope's, 643 

Iron, Compound, 268 

Lafayette's, 243 

Licorice, Compound, 281 

M. S, 83 

Magnesia and Asafetida, 159 

Meyer's, 83 

Narcotic, 215 

Neutral, 386 

Nussbaum's, 83 

Quinine, 540, 712 

Rhubarb and Soda, 401 

Schleich's, 215 

Scudamore's, 684 

Squibb's, 344, 613 

Vienna, 83 
Mixtures, 536 

Anesthetic, 83 

Compounding of, 538 

Substances suitable to, 538 
Moccasin-plant, 252 
Modality, 558 



946 



INDEX. 



Molasses, 408 
Mole, — See Nevus, 752 
Mollities Ossium, — See Bone Disease, Ra- 
chitis. 
Monatol, 245 
Monk's-hood, 76 

Monobrom-isovaleryl bromide, 1 76 
Monochlorethane, 215 
Monsel's Solution, 268 

Salt, 268 
Morbilli, — See Measles, 736 
Morphine, 342, 343 

and Atropine, 353 

Antidotes and Antagonists, 799 

Habit, 756 

Tests for, 345 
Morrhuae Oleum, 328 
Morrhuine, 328 
Morrhuol, 329 
Morrison's Pills, 193 
Moschus, 330 
Mosquitoes, 838 
Mouth, Absorption by, 46 

Diseases, — See Aphthae, Cancrum Oris, 
Gums, Parotitis, Ptyalism, Stoma- 
titis, Toothache, Tongue. 

Washes, Formulae, 685 
Mucilages, 540 
Mucilagines, 540 
Mucilaginous Bodies, 12 
Mucus in Urine, Test for, 873 
Mulene, 362 
Mullein, 486 

Mumps, — See Parotitis, 765 
Muscae Volitantes, 744 
Muscarine, 88 

Antidotes and Antagonists, 798 
Muscular Disorders,' — See Atrophy, Chorea, 
Hydrophobia, Laryngismus, Lumbago, 
Myalgia, Pleurodynia, Rheumatism, 
Tetanus, Torticollis. 
Mushrooms, Antidotes, etc., 798 
Musk, 330 
Mustard, 453 
Myalgia, 744 
Mydriasis, 37 
Mydriatics, 37 
Myelitis, 744 
Myotics, 37 
Myrcia, 331 
Myrica, 64 

cerifera, 205 
Myricin, 207 
Myristica, 331 
Myristicol, 331 
Myronate, Potassium, 454 
Myrosin, 453, 454 
Myrrh, 332 
Myrrhin, 332 
Myrrhol, 332 
Myrtle, 64, 332 
Myrtol, 332 
Myrtus communis, 332 

Chekan, 333 
Myxedema, 123, 745 



Nails, Ingrowing, 745 
Napelline, 77 
Naphthalene, 333 
Naphthalin, 333 
Naphthol, 333 
Narceine, 343, 348 
Narco-hypnotics, 36 
Narcosis, 38, 346 
Narcotic Mixture, 215 
Narcotics, 38 

Antidotes and Antagonists, 789 
Narcotine, 343, 345, 348 
Natrium, 455 
Nausea, 745 
Nectandra, 356 
Nepenthe, 344 
Nephritis, Diagnosis of, 912, — See also 

Bright's Disease, 592 
Nervous Affections, 746 

Exhaustion, — See Neurasthenia, 750 
Nervousness, 747 
Neuralgia, 748 

Intercostal, Diagnosis, 915 

Ovarian, 759 
Neurasthenia, 750 
Neuritis, 752 
Neurodin, 56 
Nevus, 752 

Nicotiana Tabacum, 471 
Nicotianin, 471 
Nicotine, 471 

Antidotes and Antagonists, 803 

Bitartrate, 471 
Niemeyer's Pill, 777 
Nightmare, 753 
Nightshade, Deadly, 166 

Woody, 259 
Night Sweats, — See Hectic Fever, Perspira- 
tion, Phthisis. 
Nioform, 303 

Nitrates, — See the titles of their metallic 
constituents. 

Antidotes and Antagonists, 798 
Nitre, 386 

Chili, 456 . 

Sweet Spirit of, 82 
Nitrites, 116, 798, — See also the titles of 

their metallic constituents. 
Nitro-benzol, 115 

Antidotes, etc., 798 

-glycerin, 116 

Antidotes, etc., 798 
Nitrogen Monoxide, 334 
Nitrous Ether, 82 

Oxide, 334 

Antidotes, etc., 798 
Nodes, 753 

Normal Salt Solution, 457, 458 
Norway Spruce, 380 
Norwood's Tincture, 483 . 
Nose-bleed, — See Epis taxis, 662 
Nosophen, 303 
Novargan, 145 
Novaspirin, 411 
Novocaine, 232 



INDEX. 



947 



Nucin, 312 
Nuclein, 131 
Numerals, Latin, 909 
Nutgall, 63, 64 
Nutmeg, 331 
Nux Vomica, 335 

Antidotes and Antagonists, 798 
Nymphaea, 64 
Nymphomania, 753 

Oak-bark, 63, 64 
Oak, Poison, 402 

White, 63 
Oat, 120 
Obesity, 753 
Ocular Sensibility, 46 
Odontalgia, 754 
Official Operations, 515 

Preparations, 523 
Oil of Allspice, 377 

of Almond, Bitter, 115 
Expressed, 115 

of Amber, 463, 475 

of Anise, 132 

of Anthemis, 132 

of Aurantium Cortex, 161 

of Bay, 331 

of Betula, 441 

of Birch, 441 

of Cade, 312 

of Cadinum, 312 

of Cajuput, 187 

Camphor, 194 

Camphorated, 194 

of Caraway, 205 

Carron, 189, 316 

of Carum, 205 

of Cassia, 230 

Castor, 404, 623 

of Caryophyllus, 205 

of Cedar, 417 

Chamomile, 132 

Chaulmoogra, 208 

of Chenopodium, 208 

of Cinnamon, 230 

of Cloves, 205 

Cod-liver, 328 

of Coriander, 244 

of Cotton-seed, 282 

Croton, 479 

of Cubeb, 248 

of Erigeron, 264 

Essential, 10 

of Eucalyptus, 265 

of Fennel, 273 

of Fleabane, 264 

Fusel, 98 

of Gaultheria, 411 

of Garlic, 108 

of Gossypium-seed, 282 

Gray, 205 

of Hedeoma, 286 

of Hemlock Spruce, 281 

Jecoris Aselli, 328 

of Juniper, 312 



Oil, Kurung, 385 

Lard, 80 

of Lavender flowers, 314 

of Lemon, 315 

of Linseed, 316 

of Linum, 316 

of Mentha Piperita, 326 

of Mentha Viridis, 327 

of Mirbane, 115 
Poisoning by, 798 

of Morrhua, 328 

of Mustard, Volatile, 454 

of Myrcia, 331 

of Myristica, 331 

of Myrtle, 332 

of Nutmeg, 331 

Olive, 341 

of Orange flowers, 161 

of Orange-peel, 161 

of Pennyroyal, 286 

of Peppermint, 326 

of Pimenta, 377 

of Pine Needles, 380 

of Pinus Silvestris, 380 

of Pix Liquida, 380 

of Pongamia, 385 

of Ricinus, 404, 623 

of Rose, 405 

of Rosemary, 406 

of Rue, 406 

of Ruta, 406 

of Sabina, 408 

Salad, 341 

of Sandalwood, 417 

of Santal, 417 

of Sassafras, 420 

of Savin, 407 

of Scotch Fir, 480 

of Sinapis, Volatile, 454 

of Spearmint, 327 

of Spruce, 381 

St. Jacob s, 77 

Sweet, 341 

of Succinum, 463, 475 

of Tabacum, 473 

of Tanacetum, 473 

of Tansy, 473 

of Tar, 380 

of Terebinthina, 474 

of Theobroma, 185, 477 

of Thuja, 475 

of Thyme, 478 

of Tiglium, 479 

of Tobacco, 471 

of Turpentine, 474 

of Valerian, 482 

of Vitriol, 74 

Volatile, 10 

of Wintergreen, 411 

Wood, 485 
Oils^as Antidotes, 787 

and Fats, 9 

Essential, 10 

Expressed, 518 

Fixed, 9, 518 



948 



INDEX. 



Oils. Hydrocarbon, 10 

Nitrogenous, 10 

Oxygenated, 10 

Sulphuretted, 10 

Volatile, 10 
Ointment, 207 

Antipruritic, 555 

Basilicon, 475 

Blue, 288 

Calamine, 491 

Chrysarobin, 222 

Citrine, 289 

Diachylon, 382 

of Iodine, 555 

Mercurial, 289 

Nutgall, 64 

of Phenol, 363- 

of Rose Water, 81 

Spermaceti, 81 

of Tannic Acid, 64 

Tar, 380 . 

Unna's, 724 

White Precipitate, 289 
Ointments, 554 

Compounding, 555 

Dispensing of, 555 

Formulae for, 555 
Olea Europaea, 341 
Oleaginous Preparations, 523 
Oleata, 540 
Oleates, 73, 540 
Olein, 80 
Oleoresina, 540 
Oleoresins, 9, 540 
Olive, 341 
Onion, 108 
Onychia, 755 

Operations, Pharmaceutical, 515 
Ophthalmia, Neonatorum, 755 
Opisthotonos, — See Tetanus, 436 
Opium, 342 

Alkaloids, 342 

Antidotes and Antagonists, 799 

Denarcotized, 343 

Deodorized, 343 

Habit, 756 
Opodeldoc, 419 
Opsonins, 429 
Orange, 161, 315 
Orchitic Extract, 127 
Orchitis, 757 
Ordeal Bark, 255 
Oregon Grape, 172 
Orphol, 173 

Ortho-dihydroxy-benzene, 398 
Orthoform, 233 
Oryza sativa, 119 
Ossein, 90 
Otalgia, 757 
Otitis, 758 
Otorrhea, 758 
Ouabain, 461 
Ourouparia Gambir, 206 
Ovaralgia, 759 
Ovarian Extract, 130 



Ovarian Neuralgia, 760 

Substance, 130 

Tumors, — See Cysts, 631 
Ovaritis, 760 
Ovis Aries, 81 
Ovoferrin, 269 
Ox, 266, 357 
Oxalates, 74 

Antidotes and Antagonists, 790 
Oxaluria, 760 
Ox-gall, 266 
Oxides, 353, — See also the titles of their 

metallic constituents. 
Oxidizers, 510 
Oxygen, 353 
Oxymel, 326 

Oxymethyl-acetanilide, 58 
Oxymethylene, 273 
Oxynarcotine, 343 
Oxytocics, 38 
Oxyuris Vermicularis, 20 
Oyster-shell, 188 
Ozena, 761 
Ozone, 368 

Pain, 761 

Gastric, 673 

Remedies relieving, 15, 761 
Pains, After-, 570 

Chest, 609 

False, 667 
Paint, Corson's, 479 

Unna's, 280 
Paints, 540 
Palmitate of Cetyl, 81 
Panase, 358 
Pancreas, Agents affecting, 39 

Ferments, 358 
Pancreatin, 357 
Pancreopepsine, 357 
Pankreon, 358 

Pannus, — See Corneal Opacities, 624 
Panopepton, 92 
Pansy, 486 
Papain, 358, 359 
Papaiva, 358 
Papaver somniferum, 342 
Papaveramine, 343 
Papaverine, 342 
Papaw Milk, 358 
Papayotin, 358 
Paper, Filtering, 518 
Papers (Chartae), 526 
Papoid, 358 
Para Rubber, 259 
Paraconiine, 241 
Paracoto Bark, 244 
Paracotoin, 244 
Para-dihydrosy-benzene, 398 
Paraffin, 361 
Paraform, 273 
Paraldehyde, 98, 210, 213 
Paralysis, 764 

Agitans, 764 

Bladder, 591 






INDEX. 



949 



Paralysis, Spinal, 834 

Paramenispermin, 374 

Paramorphine, 343 

Paraphimosis, — See Phimosis, 772 

Paraplegia, — See Paralysis, 125, 763 

Parasiticides, 39 

Parathyroid Gland, 125 

Paregoric, 343 

Pareira, 356 

Parenchymatous Injection, 50 

Paresis, — See Paralysis, 763, 764 

Parillin, 420 

Paris Green, 153 

Paronchia, 755 

Parotid Extract, 130 

Parotitis, 765 

Parresine, 362 

Parrish's Chemical Food, 370 

Parsley, 138 

Participles, Latin, 911 

Parvoline, 471 

Parvule, 541 

Pasque-flower, 391 

Pasteur's Inoculation, 449 

Pastilles, 554 

Paullinia Cupana, 182, 186 

curare, 251 

sorbilis, 182 
Pearson's Solution, 152 
Peas, 120 
Pectin, 63 
Pediculosis, 766 
Pellagra, 766 
Pelletierine, 283 
Pellitory, 393 
Pellotine, 181 
Pelosine, 356 
Pemphigus, 767 
Pencils, 550 
Penis, — See Chancre,' Chancroid, Chordee, 

Gleet, Gonorrhea, Phimosis, Urethra. 
Pennyroyal, 286 
Pennywort, 297 
Pepo, 356 
Pepper, Black, 377 

Cayenne, 199 

Water, 384 
Peppermint, 326 
Pepper-vine, 376 
Pepsin, 357 
Peptic Ferments, 357 s 
Peptogenic Milk Powder, 92 
Peptones, 11*, 93 
Peptonoids, 92 
Percentage Solutions, 918 
Percolation, 519 
Pericarditis, 768 

Diagnosis of, 912 
Periostitis, 768 
Peritonitis, 769 

Tuberculous, 769 
Permanganate of Potassium, 322, 324, 787 

as an Antidote, 324, 787 
Pernicious Fever, — See Intermittent Fever, 
Remittent Fever. 



Peronin, 360 
Peroxides, 354 
Persimmon, 64 
Perspiration. 769 
Pertussin, 384 
Pertussis, 769 
Peruvian Bark, 223 
Petrolatum, 360 
Petroleum Benzin, 361 

Poisoning by, 794 

Ointment, 360 
Petroselinum sativum, 138 
Phagedena, — See Chancre, Chancroid, Gan- 
grene, Ulcers. 
Pharmaceutical Incompatibility, 510 

Operations, 515 

Preparations, 52.3 

Rules, 515 
Pharmaceutists, — Their objectionable prac- 
tices, 507, 532,. 573 
Pharmacodynamics, 1 
Pharmacology, 1 
Pharmacopoeias, List of, 493 
Pharmacy, 1, 493 

Extemporaneous, 513 

Magistral, 513 

Official, 515 

Rules for neophytes, 515 
Pharyngitis, 771 
Phenacetin, 58 

Antidotes and Antagonists, 800 
Phenatol, 56 
Phenazone, 139 
Phenetidin, 56, 58 
Phenocoll, 56, 59 

Salicylate, 59 
Phenol, 362 

Antidotes and Antagonists, 800 

Camphor, 368 

Iodized, 303 

Sodique, 363 
Phenolid, 56 
Phenolphthalein, 363 
Phenols, 363 

Phenolsulphonates, 363, 368 
Phenoresorcin, 363 
Phenosalyl, 363 
Phenyl Alcohol, 97 

Salicylate, 411, 413 
Phenyl-acetamide, 55 

Ammoniated, 56 
Phenyl-dimethyl-pyrazolon, 134 
Phenyl-methyl-acetone, 98 
Phenyl-urethane, 55 
Phimosis, 772 
Phlebitis, 772 

Phlegmasia Alba Dolens, 773 
Phlegmon, 773 
Phloridzin, 390 
Phosgene, 218 
Phosphates, 369 

Test for, 873 
Phosphaturia, 873 
Phosphites, 369 
Phosphorus, 368 



95° 



INDEX. 



Phosphorus, Antidotes and Antagonists, 800 
Phthisis, 773 

Temperature in, 847 
Physiological Antagonism, 18 
Physostigma, 372 

Antidotes and Antagonists, 800 
Physostigmine, 373 
Phytolacca, 373 
Phytolaccin, 373 
Phytoline, 374 
Pichi, 374 
Picraconitine, 77 
Picrasma excelsa, 410 
Picroglycion, 269 
Picropodophyllin, 384 
Picrotoxin, 374 

Antidotes and Antagonists, 804 
Pigmenta, 541 
Piles, 699 , 
Pill, Anaphrodisiac, 546 

Anti-bilious, 546 

Aperient, 546 

Astringent, 546 

Blancard's, 267 

Blaud's, 267 

Blue, 288 

Cathartic, Compound, 240 
Vegetable, 240 

Chalybeate, 267 

Cholagogue, 546 

Emmenagogue, 546 

Ferruginous, 267 

Goodell's, 747 

Hooper's, 546 

Morrison's, 193 

Niemeyer's, 777 

Tanjore, 838 

Tonic, 561 
Pill-making, 541 
Pill-mass, 541 
Pills, 541 

Coated, 545 

Excipients for, 542 

Formulae for, 546 

Official, 541 

Process of making, 541 

Substances suitable for, 541 
Pilocarpene, 376 
Pilocarpine, 375 

Antidotes and Antagonists, 801 
Pilocarpus, 375 
Pilulae, 541 
Pimenta, 377 
Pimpinella Anisum, 132 
Pimples, — See Acne, 567 
Pine, Prince's, 208 

Yellow, 473 
Pineal Extract, 129 

Gland, 129 
Pinene, 332 
Pines, 379 
Pinipicrin, 477 
Pinites succinifer, 463 
Pink, Carolina, 459 
Pink-root, 459 



Pink-root, Demarara, 459 
Pinus, 379 

australis, 474 

palustris, 379, 473 

sylvestris, 380 

Taeda, 474 
Piper, 377 

angustifolium, 325 

cubeba, 248 

methysticum, 313 

nigrum, 377 
Piperazin, 378 
Piperidin, 378 
Piperine, 377 
Pipsissewa, 208 
Piscidia, 379 
Piscidin, 379 
Pissenlit, 474 
Pistacia Lentiscus, 325 

Terebinthus, 474 
Pitch, 379 

Burgundy, 380 
Pituitary Extract, 129 

Gland, 129 
Piturine, 167 
Pityriasis Rosea, 777 
Pix, 379 

Liquida, 379 
Plague, 449, 778 
Planat's Tincture, 374 
Plantago, 381 
Plantain, 381 

Anodyne, 528 

Cantharidal, 197 

Capsicum, 199 

Counterirritant, 528 

Court, 90 

Isinglass, 90 

Lead, 382 

Pitch, 197 

Rosin, 475 

Rubber, 260 

Soap, 433 

Vesicating, 542 

Warming, 197 
Plasters, 527 

Formulae for, 528 
Plethora, 779 
Pleurisy, 779 

Diagnosis of, 915 
Pleurisy-root, 160 
Pleuritis, 779 
Pleurodynia, 780 
Plum, 390 
Plumbism, 382 
Plumbum, 381 

Pneumococcus Infections, 449 
Pneumonia, 780 

Diagnosis of, 915 

Lobular, 596 
Pneumothorax, 784 
Podophyllitoxin, 384 
Podophyllum, 384 
Poison Ivy, 402 

Nut, 335 



INDEX. 



951 



Poison Oak, 402 

Antidotes and Antagonists, 801 

Sumach, 402 
Poisoning, 784, — See also the several poisons 
under their titles in Part I. 

Antidotes and Antagonists, 17, 20, 785 

Treatment of, — Indications for, 784 
General Principles of, 784 
Poisonous Compounds, 510 
Poisons, Energetic, 784 
Poke-root, 374 
Polygala Senega, 423 
Polygonum, 384 
Polyporus fomentarius, 88 

officinalis, 88 
Polypus, 804 

Polyuria, — See Diabetes Insipidus, 637 
Pomade de Bareges, 804 
Pomegranate, 64, 283 
Pond Lily, 64 
Pond's Extract, 285 
Pongamia, 385 
Poplar, 410 

Poppy, White, 342, 416 
Populus, 410 
Porphyrization, 522 
Porphyroxin, 343 
Porter, 99 
Port Wine, 99 
Potash, 385 

Antidotes, etc., 801 
Potassa, 385 

cum Cake, 385 

Sulphurata, 468 
Potassium, 385 

Alum, no 

Cyanide, 68, 795, 801 

Dichromate, 801 

Ferrocyanide, 69, 787 

Myronate, 455 

Nitrate, 386, 801 

Nitrite, 116 

Permanganate, 322, 324, 787 

Salts, 385 

Silicate, 386 
Potato, 124 

Spirit, 98 
Potus, 546 
Poultices, 524 
Powder, Antipruritic, 548 

Aromatic, 524 

Astringent, 548 

Bismuth and Soda, 548 

Bleaching, Antidotes, etc., 796 

Catarrh, 548 

Dover's, 308, 343 

Effervescing, 386 

Gastric Sedative, 548 

Gray, 288 

Laxative, 548 

Licorice, 281 

Purgative, 311 

Seidlitz, 386 
Powders, 546 

Formulae for, 547 



Powders, Substances suitable to, 547 
Precipitant Solutions, Table of, 509 
Precipitate, White, 289 

Red, 289 
Precipitation, 520 
Pregnancy, Disorders of, 804 

Vomiting of, 885 
Preparations, 523 

Official, 523 

Pharmaceutical, 523 
Prepositions, Latin, 911 
Prescription Writing, 499 
Prescriptions, 498 

Abbreviations in, 506 

Analysis of, 498 

Blanks for, 507 

Combination, 504 

Contractions, 505 

Filling of, 513 

Latin Phrases used in, 502, 897, 911 

Metric, 505 

Renewals, 507 

Table of Doses, — See cover. 

Tonic, 570, 576 

Use of Latin, 502 
Prickly Heat, — See Miliaria, 743 
Prince's Pine, 208 
Principles in Drugs, 5 

Bitter, 8 

Neutral, 8 
Proctitis, — See Rectum, 816 
Proferrin, 269 
Prolapsus Ani, 805 

Uteri, 805 
Pronunciation, 910 
Propaesin, 232 
Propyl Oxide, 328 
Propylamine, 151 
Prosopalgia, — See Neuralgia, Odontalgia, 

Tic Douloureux. 
Prostate, Hypertrophied, 806 
Prostatitis, 807 
Prostatorrhea, 807 
Protargol, 145 
Protectives, 39 
Proteid, Coagulated, n 
Protein, 89 

Bodies, n 
Protonuclein, 132 
Protopine, 208, 343, 416 
Protoveratridine, 483 
Protoveratrine, 483 
Prune, 390 
Prunum, 390 
Prunus Amygdalus, 114 

domestica, 390 

Laurocerasus, 68 

Serotina, 390 

Virginiana, 390 
Prurigo, 807 
Pruritus, 807, 808 
Pseudaconitine, 77 
Pseudococcus cacti, 238 
Pseudo-hyoscyamine, 167 
Pseudo-jervine, 483 



952 



INDEX. 



Pseudo-morphine, 343 
Psilosis, — See Sprue, 836 
Psoriasis, 809 
Psyckrotrine, 308 
Pterocarpus Marsupium, 313 

santalinus, 417 
Pterygium, 811 
Ptomaines, 801 
Ptyalism, 810 
Puerperal Convulsions, 811 

Disorders, 812 

Fever, 813 

Mania, 813 

Melancholia, 813 
Puff-ball, 315 
Pulmonary Sedatives, 39 
Pulsatilla, 291 

Antidotes and Antagonists, 801 
Pulse, 814 

and Temperature, 847 
Pulveres, 546 
Pulverization, 522 
Purvis Doveri, 308, 343 

Purgans, 311 
Pumpkin-seed, 356 
Punica Granatum, 383 
Punicine, 383 
Purgatives, 26 
Purpura, 814 

Pus in Urine, Test for, 873 
Pustule, Malignant, — See Anthrax, 579 
Pustules, — See Anthrax, Ecthyma, Erup- 
tions, Impetigo, Variola. 
Pustulants, 37 
Pyelitis, 815 
Pyemia, 829 
Pyoderma, 815 
Pyoktanin, 327 
Pyramidon, 135 
Pyrethrine, 393 
Pyrethrum, 393 
Pyretine, 56 
Pyridine, 471 
Pyrocatechin, 398 
Pyrogallol, 64 
Pyrosis, 815 
Pyroxylin, 119, 282 

Quaker Button, 335 

Quantities, Prescription, — See Cover. 

Quassia, 393 

Quassin, 393 

Queen's Delight, 459 

Quercin, 64 

Quercus, 63 

Quicksilver, 288 

Quillaja, 394 

Quinalgen, 56, 209 

Quince-seed, 252 

Quinetum, 225 

Quinicine, 224 

Quinidine, 224 

Quinine, 224, 225 

Antidotes and Antagonists, 801 

Carbonic Ester, 225 



Quinine, Carbonic Ether, 225 

Hypodermically, 230 

Mixtures, 540, 712 

Solutions, 538 
Quinoidin, 226 
Quinoline, 208 
Quinquinina, 226 
Quinsy, — See Tonsillitis, 852 

Rabies, 449, — See Hydrophobia, 705 

Antitoxin, 449 

Toxin, 449 
Rachitis, 816 
Radium, 394 

Raspail's Eau Sedative, 112, 193 
Raspberry, 406 

Rat-pastes, Antidotes, etc., 801 
Ratsbane, 801 
Rectum, Absorption by, 48 

Diseases of, 816 

Prolapse of, 805 

Ulceration of, 816 
Red-Gum, — See Strophulus, 840 
References and Bibliography, 565 
Refrigerants, 40 
Reinsch's Test, 153 
Relapsing Fever, 817 
Renal Depressants, 31 

Disease, Diagnosis, 912 

Stimulants, 43 
Renewals of Prescriptions, 507 
Resin, 9, 475 
Resina, 474 
Resinae, 549 
Resinol, 475 
Resins, 9, 548 

Pharmaceutical, 9 

True, 9 
Resorcinol, 398 

Antidotes and Antagonists, 801 
Respiration, — See Bronchitis, Croup, Dysp- 
nea, Emphysema, Pneumoma. 

Agents affecting, 33, 40 

Artificial, 585 
Respiratory Depressants, 40 

Stimulants, 40, 43 
Respiratory Tract, Absorption by, 48 
Restoratives, 40 
Retina, Affections of, 817 
Retinol, 475 
Rhamnoxanthin, 276 
Rhamnus Frangula, 276 

Purshiana, 400 
Rhatanine, 313 
Rhatany, 64, 313 
Rhein, 401 
Rheum, 400 
Rheumatism, Acute, 818 

Gonorrheal, 820 

Muscular, 820 
Rheumatoid Arthritis, 583 
Rhinitis, — See Catarrh Acute Nasal, In- 
fluenza, Nasal Affections. 
Rhceadine, 343 
Rhubarb, 400 



INDEX. 



953 



Rhus, 402 

Antidotes and Antagonists, 801 
Rice, 118, 120 
Ricin, 404, 428 
Ricinine, 404 
Ricinolein, 404 
Ricinus communis, 404 
Rickets,— See Rachitis, 816 
Ring- worm, — See Dhobie Itch, 637; Tinea, 

821 
Risus sardonicus, 337 
Roasting, 521 
Rochelle Salt, 386 
Rosa, 64, 405 
Rose, 64, 405 

Attar of, 405 

Honey of, 405 
Rosemary, 64, 406 
Roseola, 822 
Rosin, 474, 477 

Cerate, 475 

Plaster, 475 
Rosmarinus, 406 
Rottlera, 313 
Rottlerin, 313 
Rubber, 259 

Plaster, 260 
Rubefacients, 37 
Rubeola, — See Measles, 736 
Rubijervine, 495 
Rubini's Tincture, 193 
Rubus, 64, 406 
Rue, 406 
Rules for Incompatibility, 511 

for Pharmaceutists, 515 
Rum, 99 

Bay, 331 
Rumex, 74, 406 
Rumicin, 406 

Rupia, — See Pemphigus, 767 
Ruta, 406 
Rutin, 180 
Rye, 120, 260 

Sabadine, 483 
Sabadinine, 483 
Sabal, 407 
Sabina, 407 

Antidotes and Antagonists, 802 
Sabromin, 176 
Saccharin, 408, 410 
Saccharum, 408 

Lactis, 408 
Sacred Bark, 400 
SafHower, 248 
Saffron, 248 

Meadow, 239 
Saffron-tea, 248 
Safrol, 193, 420 
Sage, 415 
Sago, 120 

Sal Alembroth, 295 
Sal-ammoniac, 112 
Salbromalide, 55 
Salfene, 56 



Salicin, 423 

Salicylate, Acetylparaninophenyl, 411 

Physostigmine, 372 
Salicylates, 410 
Salicyl-bromalide, 53 
Saline Mineral Waters, 140 

Purgatives, 26 
Salipyrin, 135, 411, 415 
Saliva, Agents affecting, 42 
Salivation, 42, 292, 810 
Salix, 410 
Salochinin, 411 
Salol, 411, 413 
Salophen, 411, 415 
Saloquinin, 226, 411 
Salt, common, 456 

as an Antidote, 791 

Carlsbad, 140, 701 

Epsom, 320 

Glauber's, 456 

MonsePs, 268 

Rochelle, 386 

Solution, Normal, 457, 458 
Saltpetre, 386 

Antidotes and Antagonists, 801 

Chili, 456 
Salt-rheum, — See Eczema, 653 
Salts, 41 

Deliquescent, List of, 545 

Efflorescent, List of, 545 

Insoluble, 509 

of Lemon, 790 

Metallic, Antidotes, etc., 798 

of Sorrel, 790 
Salvarsan, 153, 159 
Salve, Red Lip, 477 
Salvia, 415 
Salviol, 415 
Sambucus, 416 
Sandal- wood, 417 
Sanguinaria, 416 
Sanguinarine, 208, 416 
Sanitas, 475 
Sanose, 92 
Santalum Album, 417 

Citrinum, 417 

Rubrum, 417 
Santonica, 418 
Santonin, 418 
Sapo, 418 
Saponification, 419 
Saponin, 207, 394, 420 
Sarcinae, 822 

Sarcocele, — See under Cancer, Testicles. 
Sarcoma, 442 
Sarsaparilla, 419 
Sarsaponin, 420 
Sassafras, 420 
Sassy Bark, 255 
Saunders, Red, 417 
Savin, 407 

Antidotes and Antagonists, 802 
Saw Palmetto, 407 
Sayre's Method for Chloroform, 219 
Scabies, 822 



954 



INDEX. 



Scald-head, — See Eczema, Tinea. 
Scalds, 599 
Scammonium, 421 
Scammony, 421 
Scarlet Fever, 823 

Diagnosis of, 915 

Temperature in, 847 
Scheele's Acid, 68 

Green, 153 
Schleich's Method of Anesthesia, 86 

Narcotic Mixture, 215 

Solutions, 83, 231 
Sciatica, 825 
Scilla, 421 
Scillin, 421 
Scillipicrin, 421 
Scillitin, 421 
Scillitoxin, 421 
Scirrhus, — See Cancer, 601 

Spinal, 835 
Scoparin, 422 
Scoparius, 422 
Scopola, 298 
Scopolamine, 297 
Scorbutus, — See Scurvy, 827 
Screaming,' — See Nightmare, 753 
Scrofulosis, 826 
Scudamore's Mixture, 684 
Scurvy, 827 
Scutellaria, 423 
Scutellarin, 423 
Sea-sickness, 827 
Seborrhea, 828 
Secacornin, 261 
Secale cereale, 260 
Sedative, Battley's, 344 
Sedatives, 41 

Cardiac, 24 

Gastric, 32, 548 

General, 32 

Pulmonary, 39 

Urinary, 45 

Uterine, 45 

Vascular, 46 

Vesical, 46 
Seidlitz Powder, 386 
Senega, 423 
Senegin, 423 
Sennacrol, 424 
Sennapicrin, 424 
Separation, 520 
Septicemia, 829 
Sera, 425 
Serpentaria, 452 

Serpent-venom, 451, Antidotes, etc., 802 
Serenoa serrulata, 407 

Anti-diphtheric, 435 

Anti-pneumococcus, 445 

Anti-streptococcus, 444 

Antitoxic, 428 

Anti-tuberculous, 441 

Artificial, 751 

Cholera, 448 

Meningococcus, 446 

Normal, 451 



Serenoa serrulata, Plague, 449 
Rabies, 449 
Serpent Venom, 451 
Syphilis, 450 
Tetanus, 436 
Typhoid, 447 
Vaccinia, 446 

Serums and Vaccines, 425 

Serumtherapy, 425 

Sevum, 81 

Sheep, 81 

Shells, 185 

Sherry Wine, 99 

Shingles, — See Herpes Zoster, 703 

Shock, 830 

Sialogogues, 42 

Sickness at Stomach, — See Nausea, Sea- 
sickness, Vomiting. 

Sick-room, 831 

Siddhi, 196 

Silicates, 456 

Silicious Mineral Waters, 141 

Silicon, 452 

Silver, 144 

Antidotes and Antagonists, 803 
Compounds, 144 

Sinalbin, 453 

Sinapis, 453 

Sinapism, 525 

Singultus, — See Hiccough, 704 

Sinigrin, 454 

Sinistrin, 421 

Siriasis, — See Insolation, 710 

Skin Diseases, — See Acne, Anthrax, Bed- 
sores, Boils, Burns, Carbuncle, Chapped 
Hands and Lips, Chilblains, Condylo- 
mata, Dhobie Itch, Ecchymosis, Ecthy- 
ma, Eczema, Eruptions, Erysipelas, Ery- 
thema, Freckles, Herpes, Herpes Zoster, 
Ichthyosis, Impetigo, Intertrigo, Keloid, 
Leprosy, Lichen, Lupus, Miliaria, Nevus, 
Onychia, Pemphigus, Perspiration, Phleg- 
mon, Pityriasis, Prurigo, Pruritus, Psori- 
asis, Roseola, Scabies, Scleroderma, Seb- 
orrhea, Strophulus, Sycosis, Syphilis, 
Tinea, Ulcers, Urticaria, Warts, Wen. 

Skull-cap, 423 

Sleep, Abnormal, — See Delirium, Insomnia, 
Nightmare, Somnambulism. 

Sleeping-sickness, — See Worms, 887 

Slippery Elm Bark, 480 

Smallpox, — See Variola, 881 
Diagnosis of, 915 

Smart- weed, 384 

Smell, Agents affecting, 42 

Smilax, 419 

Snake-root, 452, 503 

Sneezing, 831 

Agents producing, 33, — See also Ca- 
tarrh, Hay Fever, Influenza. 

Soaloin, 108 

Soamin, 153 

Soap, 418 

as an Antidote, 787 
Bark, 394 



INDEX. 



955 



Soda, 455 

Antidotes and Antagonists, 803 

Caustic, 456 

Chlorinated, 220 

Mint, 327 

Water, 201, 204 
Sodium, 455 

Arsenate, 152 

Benzoate, 171 

Bisulphite, 75 

Cacodylate, 153 

Chloride, as an Antidote, 788 
in Urine, Test for, 871 

Cinnamate, 171 

Cyanide, 69 

Ethylate, 456 

Hydroxide, 455 

Hyposulphite, 75 

Nitrite, 116 

Nucleinate, 132 

Phenolsulphonate, 363 

Phosphate, 372 

Silicate, 453 

Sulphite, 75 

Taurocholate, 266 

Thiosulphate, 75 

as an Antidote, 788 
Sodiumichthyol, 467 
Solanine, 259 
Solanum Dulcamara, 259 
Solid Preparations, 523 
Soloid, 551 

Soluble Substances, 537 
Solution, 520 

Aids to, 538 

Alkaline Cupric Tartrate, 249 

Antiseptic, 62 

Circulatory, 521 

Clemens', 153 

Creuse's, 267 

Dakin's, 23 

Dobell's, 534 

Donovan's, 153 

Fehling's, 249 

Fowler's, 152 

Glass, 152 

Hypophysis, 130 

Labarraque's, 22, 220, 796 

Loeffler's, 644 

Lugol's, 302 

Magendie's, 344 

Monsel's, 268 

Normal Salt, 457, 458 

Pearson's, 152 

Quinine, 538 

Sal Alembroth, 295 

Salt, Normal, 457, 458 

Saturated, 520 
Solutions (Liquores), 535 

Hypodermic, 48, 911 

Percentage, 920 

Precipitant, Table of, 509 

Schleich's, 83, 231 

Stock, 509 
Solvents, 521 



Somatose, 92 
Somnal, 210 
Somnambulism, 232 
Somnoform, 215 
Sorbefacients, 29 
Sores, 861 

Bed, 589 
Sorghum, 408 
Sorrel, 74, 406, 790 
Spanish Flies, 197 
Sparteine, 422 
Spasmodic Affections, 832 
Spearmint, 327 
Specific Gravity, 498 
Specific Volume, 498 
Specifics, 42 
Spermaceti, 81 
Spermatorrhea, 833 
Sphacelo toxin, 260 
Spigelia, 459 
Spina Bifida, 833 
Spinal Concussion, 834 

Congestion, 834 

Inflammation, — See Meningitis, Mye- 
litis, etc. 

Irritation, 834 

Paralysis, 834 

Sclerosis, 835 
Spirit of Mindererus, in 

Methylated, 98 

Perfumed, 99 

Potato, 98 

Proof, 98 

Rectified, 99 

Wood, 98 
Spirits (Spiritus), 548 
Spirosal, 411 
Splenic Affections, 836 

Extract, 124 
Spongio-piline, 535 

Spotted Fever, — See Typhus Fever, Men- 
ingitis Cerebro-spinal. 
Sprains,- 836 
Spruces, 379 
Sprue, 836 
Spunk, 88 

Squamae, — See Ichthyosis, Pityriasis, Pso- 
riasis, Skin Diseases, etc. 
Squaw-root, 207 
Squibb' s Mixture, 344 
Squill, 421 

St. Ignatius' Bean, 335 
St. Jacob's Oil, 77 
St. Mary's Thistle, 204 
St. Vitus' Dance, — See Chorea, 615 
Stains, 837 
Stammering, 837 
Staphisagria, 459 
Starch, 118 

as an Antidote, 788 
Star Anise, 302 
Star-wort, 108, 503 
Statice, 64 
Stavesacre, 459 
Steapsin, 359 



956 



INDEX. 



Stearin, So 
Sterculia, 182 
Sterility, 837 
Sternutatories, 33 
Stillingia, 459 
Stimulants, 42 

Cardiac, 25 

Diffusible, 43 

Hepatic, 35 

Local, 43 

Pancreatic, 39 

Respiratory, 40 
Stimulants, Spinal, 43 

Vascular, 45 
Stings and Bites, 838 
Stock Solutions, 514 
Stokes' Liniment, 535 
Stomach, Absorption by, 47 

Diseases, — See Dyspepsia, Gastralgia, 
Gastric Ulcer, Gastritis, etc. 
Stomach-pump, 788 
Stomachics, 43 
Stomatitis, 839 
Stone, — See Calculi, 600, 672 
Storax, 643 
Stovaine, 233 
Strabismus, 840 
Straining, 516 
Stramonium, 298 

Antidotes and Antagonists, 803 
Strangury, — See Cystitis, Dysuria. 
Streptococcus Infections, 444 
Stricture, — See Rectum, 816 

Urethral, 865 
Strontium, 460 
Strophanthin, 460 
Strophanthus, 461 
Strophulus, 840 
Strychnine, 287, 335, 336 

Antidotes and Antagonists, 798 
Strychnos Ignatia, 335 

Gautheriana, 287 

Nux Vomica, 335 
Styptic Collodion, 64, 282 
Stypticin, 344 
Styptics, 44, 698 
Styracin, 463 
Styracol, 774 
Styrax, 463 

Benzoin, 171 
Styrol, 463 
Sublamin, 289 
Sublimation, 521 
Substances, Amyloid, 5, n 

best given alone, 512 

difficult to combine in pill, 544 

Ovarian, 130 

suitable for mixtures, 537 

suitable for pills, 543 

suitable for powders, 547 

unsuited to pill-form, 543 
Succi (Juices), 549 
Succinum, 463 
Succus Alterans, 459 
Sudorifics, 29 



Suet, 81 
Sugar, 408 

Fruit, 408 

of Lead, 381 

of Milk, 408 

in Urine, — See Diabetes Mellitus, 637 
Tests for, 872 
Sulphates, — See the titles of their basic con- 
stituents. 

as Antidotes, 788 
Sulphides, 467, 803 
Sulphites, 75 

Sulpho-carbolates, 363, 368 
Sulpho-cyanate, Acrinyl, 453 
Sulpho-cyanide, Allyl, 453 
Sulpho-ichthyolate, 467 
Sulphonal, 463 

Antidotes, etc., 803 
Sulphonethylmethane, 463 
Sulphonmethane, 463 
Sulphur, 466 

Antidotes and Antagonists, 803 

Iodide, 467 
Sulphuretted Hydrogen, 467 
Sulphurous Mineral Waters, 140 
Sumach, 402 
Sumbul, 470 
Sun Burn, 636 
Sun-dew, 259 

Sunstroke, — See Insolation, 710 
Suppositoria, 549 
Suppositories, Formulae, 550 

Official in Br. Phar., 549 
Suppuration, 840 
Suprarenals, 126 
Suprarenin, 125 
Surgeon's Agaric, 88 
Sus scrofa, 80, 357 
Svapnia, 343 
Swallowing, — See Dysphagia, Esophageal 

Affections. 
Sweet Flag, 188 

Gum, 463 
Swertia Chirayita, 209 
Sycosis Vulgaris, 841 
Syncope, 841 
Synergitis, 44 
Synovitis, 842 
Syntonin, 93 
Syphilis, 450, 842 

Diagnosis, — See Chancre, 913 
Syrup, 409 

Mrs. Winslow's Soothing, 344 
Syrupi (Syrups), 550 

Tabacum, 471, 803 

Tabellse, 551 

Tabes, — See Locomotor Ataxia, 726 
Mesenterica, 844 

Table of Antagonistic Drugs, 19 

Drops in a Drachm, etc., 497, 918 
Latin Words, Phrases, etc., 897 
Metric Conversion, 919 and cover. 
Percentage Solutions, 920 
Precipitant Solutions, 912 



INDEX. 



957 



Table, Prescription Doses and Quantities, — 

See inside of cover. 
Tables of Differential Diagnosis, 912 

of Weights and Measures, 494, 918 
Tablets, 551 

Bacillary, 71 

Compressed, 50, 548 

Hypodermic, List of, 551 

Lactic, 71 

of Nitroglycerin, 116 

Thyroid, 125 
Tabloid, 551 
Taka-diastase, 359 
Talc, 453 
Tamarind, 473 
Tamar-Indien, 424 ' 
Tamarindus, 473 
Tanacetin, 473 
Tanacetum, 473 
Tannalbin, 64 
Tannate, Bismuth, 64 
Tannigen, 64 
Tannin, 63 

as an Antidote, 788 
Tannocol, 64 
Tannoform, 64 
Tannopin, 64 
Tansy, 473 

Tapeworms, 20, 283, 887 
Tapioca, 120 
Tar, 370 

Tar-camphor, 333 
Tar-water, 380 
Taraxacerin, 473 
Taraxacin, 473 
Taraxacum, 473 
Tartar, Cream of, 386 

Crude, 385 

Emetic, 133 

Antidotes and Antagonists, 792 
Tartrate, Antimony and Potassium, 133 

Potassium and Sodium, 386 
Tartrates, 76 
Taste, Agents affecting, 44 

Disordered, 844 
Taurocholate of Sodium, 266 
Tea, 185 

Boneset, 266 

Flaxseed, 316 

German Breast, 109 

Linseed, 316 

Saffron, 248 

Tansy, 473 

Worm, 459 
Teeth, 845 

Agents affecting, 28 
Teething,- — See Dentition, 634 
Temperature in Disease, 845 

Drugs affecting, 21 

and Pulse, 847 
Tenesmus, — See Dysentery, 646 
Teniae, 20, 283, 887 
Teniafuges, 283 
Terebene, 474 
Terebinthene, 474 



Terebinthina, 474 

Terpenes, 474 

Terpin Hydrate, 474 

Terpinol, 475 

Terraline, 360 

Testa Praeparata, 189 

Testicles, 849; See also Orchitis, 757 

Testicular Juice, 127 

Testing, 521 

Tests for Arsenic, 153 

Brucine, 336 

Morphine, 345 

Strychnine, 336 

Urine, 869 
Tetanus, 436, 847 
Tetra-iodol-phenol-phthalein, 303 
Tetranitrin, 116 
Tetronal, 464, 465 

Tetter, — See Herpes, Pityriasis, Psoriasis. 
Thea sinensis, 182, 185 
Thebaine, 342, 348 
Theine, 182 
Theism, 185 

Theobroma Cacao, 182, 477 
Theobromine, 183, 187, 477 
Theocin, 182, 187 
Theophylline, 183 
Therapeutical Incompatibility, 551 
Therapeutics, 1 

Applied, 2, 566 

Empirical, 2 

Natural, 1 

Rational, 2 

Special, 565 
Theriaca, 408 
Thermodin, 56, 59 
Thermometer, Clinical, 845 
Thigenol, 467, 470 

Thimble-berry, 406 > 

Thiocol, 248 
Thiol, 467, 470 
Thiosinamin, 454 
Thirst, 849 

Agents allaying, 42 
Thistle, Blessed, 204 

St. Mary's, 204 
Thompson's Tincture, 369 
Thorn-apple, 298 
Thorough-wort, 266 

Throat, — See Aphonia, Croup, Diphtheria, 
Laryngitis, Pharyngitis, Scarlet 
Fever, Tonsillitis, etc. 

Sore, 849 
Thrush, — See Aphthae, 580 
Thuja, 477 
Thujetin, 477 
Thujin, 477 
Thus Americanum, 474 
Thyme, Garden, 478 
Thymene, 478 
Thymol, 490 

Carbonate, 478 

Iodide, 303, 308 
Thymotal, 478 
Thymus (gland) Extract, 129 



958 



INDEX. 



Thymus vulgaris, 478 
Thyroid Extract, 125 

Glands, 123, 125 
Thyroiodin, 125 
Tic Douloureux, 850 
Tiglii Oleum, 479 

Tin, Antidotes and Antagonists, 803 
Tinctura Antiperiodica, 225 

Pyrexialis, 225 
Tincturae (Tinctures), 552 
Tincture, Churchill's, 302 

Fleming's, 77 

Hager's, 225 

Huxham's, 225 

Norwood's, 483 

Planat's, 374 

Rubini's, 193 

Thompson's, 369 

Warburg's, 225 
Tinea Circinata, 851 

Favosa, 851 

Trycophitina, 821 
Tinnitus Aurium, — See Ear, 652 
Tobacco, 471 

Antidotes and Antagonists, 803 

Indian, 318 

Symptoms, — See Amaurosis, Nervous- 
ness. 
Toe-nails, — See Nails, Ingrowing. 
Tolene, 165 
Toluifera Balsamum, 165 

Pereirae, 164 
Tongue, 852 

Absorption by, 47 
Tonics, 41 

Cardiac, 25 

Gastric, 43 

Hair, 573 

Nerve, 747, 751 

Pill for Women, 546 

Prescriptions, 570, 576, 747, 751 

Vascular, 45 

Vesical, 49 
Tonsillitis, 852 
Tonsils, Enlarged, 853 

Ulcerated, 854 
Toothache, — See Odontalgia- 754 
Toothrash, — See Strophulus, 840 
Torref action, 521 
Torticollis, 854 
Torulae, — See Sarcinae, 822 
Toxemia, 854 

Toxicological Antagonism, 18 
Toxicology, 1, 17, 784 
Toxin, Cholera, 448 

Erysipelas, 442 

Prodigiosus, 442 

Rabies, 449 

Streptococcus, 444 

Tuberculosis, 438 
Toxins, 426 
Toxophore, 428 
Tracheitis, — See Croup, 628 
Trachoma, — See Conjunctivitis Granular, 
625; Ophthalmia, 620 



Tragacantha, 480 

Transfusion, 48 

Traumatic Fever, — See Surgical Fever. 

Treacle, 408 

Tree of Heaven, 89 

Tremor, 855 

Tri-bromo-methane, 176 

Trichiniasis, 855 

Trichloraldehyde, 209 

Trichloro-methane, 214 

Tricophytosis, — See Tinea, 85 1 

Triferrin, 269 

Trihydroxy-benzene, 64 

Triiodo-me thane, 302 

Trikresol, 364 

Trimethylamine, 151, 152, 260, 287 

-xanthin, 181 
Trinitrate of Glyceryl, 116 
Trinitrin, 116 
Trional,. 463, 803 
Triphenin, 59 
Trismus, 856 
Triticin, 480 
Triticum, 118, 480 
Tritopine, 343 
Trituration, 521 
Triturationes, 553 
Triturations, their advantages, 553 

of Elaterin, 260 

Formulae, 554 

of Mercury, 553 
Troches, 64, 554 
Trochisci, 554 
Tropacocaine, 232 
Tropical Fruit Laxative, 424 
Tropine, 166 

Trypanosomiasis, — See Worms, 887 
Trypsin, 358 
Tuberculin, 438 
Tuberculin-R, 438 

Tuberculosis, 856, — See also Tuberculous. 
Affections, etc.; also Lupus, Phthisis, 
Scrofulosis. 

Acute, 856 

Antitoxin, 441 
Tuberculous Affections, 856 

Laryngitis, 721 

Meningitis, 740 

Peritonitis, 769 
Tumenol, 467, 470 
Tumors, 856 

Uterine, 878 
Turnera aphrodisiaca, 252 
Turpentine, 473 

as an Antidote, 788 

Antidotes and Antagonists, 803 
Tympanites, 857 
Typhoid Fever, 447, 858 

Diagnosis of, 916 

Temperature in, 847 
Typho-malarial Fever, — See Typhoid, 858 
Typhus Fever, 860 

Diagnosis of, 916 
Tyramine, 261 
Tyrotoxicon, Antidotes, etc., 803 



INDEX. 



959 



Ulcers and Sores, 86 1 

of Rectum, 816 

of Stomach, 875 

of Tonsils, 850 

of Uterus, 878 
Ulmus, 480 
Umbelliferon, 276 
Uncinariasis, — See Worms, 887 , 
Unguenta, 554 
Unguentum, 207, 554 

Crede, 146 
Unna's Ointment, 724 

Paint, 280 

Paste, 280 
Urates, Test for, 873 
Urea, Agents affecting, 35 

in Urine, Test for, 873 
Uremia, 864 
Urethane, 464, 466 
Urethral Stricture, 865 

Injections, 534, 682, 866 
Urethritis, 865 
Urginea maritima, 421 
Uric Acid Diathesis, — See Lithemia, 725 

Test for, 874 
Urinary Acidifiers, 44 

Alkalinizers, 44 

Astringents, 45 

Depressants, 45 

Disorders, 867 

Sedatives, 45 
Urine, Articles coloring,' 86 9 

Color of, 869 

Composition of, 868 

Deposits in, 874 

Examination of, 867 
Uro tropin, 274 
Ursone, 481 
Urticaria, 875 
Uterine Affections, 876 

Cancer, 876 

Congestion, 877 

Depressants, 45 

Displacements, 878 
Uterine Hypertrophy, 877 

Prolapse, 805 

Stimulants, 45 

Tumors, 878 

Ulceration, 878 
Uva Ursi, 481 , 
Uvula, 879 



Vaccination, 879 
Vaccines, 425 
Vaginismus, 879 
Vaginitis, 880 
Valerene, 481 
Valerian, 252, 481 
Valerates, 481 
Valerol, 287, 481 
Validol, 482 
Vallet's Mass, 278 
Valyl, 482 
Vanilla, 483 



Vanillin, 483 

Vao, 250 

Vapores (Vapors), 533, 796 

Vaporization, 522 

Varicella, 880 

Diagnosis of, 917 
Varicocele, 881 
Varicosis, 881 
Variola, 881 

Diagnosis of, 916 
Varioloid, Diagnosis, 917 
Vascular Contractors, 45 

Dilators, 45 

Sedatives, 46 

Stimulants, 43, 45 

Tonics, 46 
Vaseline, 360 

Vegetable Drugs, their Constituents, 4 
Veins, — See Phlebitis, Phlegmasia, Varicosis 

Transfusion by, 48 
Vellarine, 297 
Venice Turpentine, 474 
Venom, Insect, Antidotes, 792 

Serpent, Antidotes, etc., 802 
Venous Medication, 48 
Vera trine, 483, 484 
Veratrum, 483 

Antidotes and Antagonists, 804 
Verbascum, 486 
Verbs, Latin, 910 
Verdigris, 250 
Vermicides, 19 
Vermifuges, 19 
Veroform, 274 
Veronal, 464, 465, 804 
Veronica Virginica, 314 
Verruca, — See Warts, 887 
Vertigo, 883 
Vesical Tonics, 46 

Sedatives, 46 
Vesicants, 37 
Viburnin, 486 
Viburnum, 486 
Vienna Mixture, 83 
Vienna Paste, 385 
Vina (Wines), 99, 556 
Vinegar, 60 
Vinegars (Aceta), 523 
Vinum, 99 
Vioform, 303 

Tricolor, 486 
Violet, 486 
Violine, 486 
Viscum, 486 
Vision, 46 
Vitellin, 91 
Vitellus, 91 
Vitiligo, 883 
Vitriol, Elixir of, 75 

Oil of, 74 
Volatile or Essential Oils, 10 
Volkmann's Antiseptic Fluid, 478 
Vomiting, 884 

of Pregnancy, 885 
Vouacapoua x\raroba, 222 



960 



INDEX. 



Vulva. 886 
Vulvitis, SS6 

Wade's Bougies, 550 
Wafers, 547 
Wakoo, 266 
Walnut, White, 312 
Warburg's Tincture, 225 
Warts, 887 
Wash, 535 

Black, 289 

Hair, 574 

Lead and Opium, 535 

Mouth, 685 

Nasal, 534, 607 

Yellow, 289 
Washing, 522 

Waste, Agents promoting, 29 
Wasting, — See Atrophy, Emaciation. 
Water, 139, 353 

Carbonated, 201 

Carlsbad, 140 

Cherry-laurel, 68, 70 

Chlorine, 220 

Cologne, 99 

of Crystallization, 516 

Distilled, 139 

Hunyadi, 623 

Javelle, Antidotes, etc., 796 

Lavender, 314 

Lead, 382 

Lime, 188 

Oxygenated, 353 

Peppermint, 326 

Phenol, 362 

Sedative, 112, 193 

Soda, 201 

Sterilized, 139 

Tar, 380 

Vals, 140 

Vichy, 140 
Water-brash, — See Pyrosis, 815 

-pepper, 384 
Water (Aquae), 523 

Mineral, 139 
Wax, 207 

Myrtle, 64, 207 
Waxes, 10 

Weakness, — See Adynamia, Exhaustion. 
Weight of a Drachm in Grains, 918 
Weights and Measures, 494, 918 

Apothecaries', 595, 918 

British Pharmacopceial, 495 

Metric, 496, 918 

Table for Converting, 919 
Wen, 887 



Wheat, 118, 120 

Whisky, 99 

White-leg, — See Phlegmasia, 773 

White-swelling, — See Joints, Synovitis. 

Whitlow, — See Onychia, 755 

Whooping-cough, — See Pertussis-, 769 

Willow, 410 

Wine, 99 

Wines (Vina), 99, 556 

Winslow's (Mrs.) Soothing Syrup, 344 

Wintergreen, 411, 503 

Witch-hazel, 64, 285 

Wolf's-bane, 76 

Wolff's Formula, 92 

Wood Oil, 285 

Spirit, 98 
Wool-fat, 81 
Woorara, 251 

Words and Phrases, Latin, 897, 911 
Worm-grass, 459 
Worms, 887 
Wormseed, 208 

Levant, 418 
Worm Tea, 459 
Wormwood, 53 
Wounds, 889 

Poisoned, Antidotes, etc., 804 
Writers' Cramp, — See Spasmodic Affections, 

832 
Wry-neck, — See Torticollis, 854 

Xanthine, 182 

Xanthoma Palpebrarum, 895 

Xanthopuccine, 295 

Xanthoxyline, 487 

Xanthoxylum, 487 

Xeroderma, — See Ichthyosis, 708 

Xeroform, 173 

Yam, Wild, 259 
Yellow Fever, 894 

Diagnosis of, 917 
Yerba Santa, 264 
Yolk of Egg, 91, 96 
Yohimbine, 487 
Yvon's Hypnotic Elixir, 712 

Zea, 487 

Mays, 118, 408, 487 
Zinc, 486 

Salts, Antidotes, etc., 804 
Zincite, 488 
Zincum, 488 
Zingiber, 491 
Zinol, 488 
Zona, — See Herpes Zoster, 703 • 



A TABLE OF PRESCRIPTION DOSES AND QUANTITIES. 





Designed and Calculated by 


Dr. Sam'l 0. L 


Potter, M.R.C.P. Lond. 








Grains in each 5 dose 


in a mixture of 




Grains in each 5 dose in a mixture 


of 


Grains 


! 








Grains 








in Entire 


















in Entire 


















Mixture 


§1 


iv 


§HJ 


Siv 


3vi 


Svnj 


3*IJ 


^XVI 


Mixture 


Si 


iu 


§iij 


3 iv 


3v. 


Svnj 


^XIJ 


I XVI 


A 


A 


Ths 


2¥o 


2 T 20 










XXXI 


31 


iff 


if 


17 
12 


TT 


A 


5 

T2 


1 


l 

8 


A 


1 

T22 


1 

T22 


Jh 


1?¥ 








XXXIJ 


4 


2 


«* 


I 


I 


\ 


1 
2 


1 


1 


i 

T2 


A 


TT? 


T22 


1 

222 


?!? 






XXXIIJ 


4i 


*A 


if 


iA 


tt 


1 

2 


f 


T»T 


1 
T 


1 


A 


A 


T22 


T22 


i 

222 






XXXIV 


4i 


4 


if 


*A 


7 
T2 


TT 


TT 


A 


1 
3 


A 


i 

T2 


A 


1 
22 


1 

TTT 


T22 


282 




XXXV 


4f 


*A 


if 


iA 


t 


5 
2 


TT 


f 


\ 


i 

T2 


1 

32 


i 

4? 


A 


A 


1 
T22 


T22 




XXXVI 


42 


4 


12 


H 


f 


A 


f 


2 

7 


2 
3 


1 

1 2 


1 
2T 


1 
35" 


A 


i 

72 


A 


xll 


i 

T22 


XXXVI I J 


4| 


2f 


«♦ 


iA 


t 


I 


2 
2 


A 


I 


A 


A 


1 
32" 


A 


A 


i 
22 


T22 


Th 


XXXIX 


41 


*A 


if 


if 


TT 


f 


I 


A 


I 


i 
2 


i 

T2 


A 


A 


i 

T2 


A 


1 
22 


T22 


XL 


5 


22 


if 


it 


f 


5 
2 


A 


A' 


ISS 


2 

TT 


A 


A 


22 


A 


i 

?3" 


A 


A 


XLI 


5i 


2 T2 


ItV 


if 


7 


TT 


f 


f 


IJ 


1 
T 


i 

8 


A 


A 


A 


A 


i 

?2 


A 


XLIJ 


5* 


2 2 


If 


iA 


1 


2 

2 


7 
T2 


1 
2 


IJSS 


1 
2 


* 


t 


i 

T2 


A 


A 


1 
4"0 


i 

T2 


XLIIJ 


51 


2 H 


H 


if 


8 

2 


2 
2 


f 


1 
2 


"J 


f 


1 

s 


i 

2 


1 

TT 


i 

T2 


A 


1 
22 


1 

40 


XLIV 


51 


2| 


If 


i| 


tt 


11 

T6 


A 


A 


IIJSS 


t 


2 
f 


1 
7 


1 
2 


1 

TT 


A 


1 
22 


1 
26 


XLV 


51 


2| 


If 


if 


Tl 


tV 


7 
T2 


A 


IV 


1 
2 


i 


1 
2 


1 


A 


• i 

T2 


A 


1 

32 


XLVIJ 


51 


*A 


lA 


IfT 


H 


7 


A 


A 


IVSS 


f 


2 

7 


2 

TT 


1 

7 


i 

TT 


A 


i 

22 


A 


XLIX 


61 


3 


2 


I| 


1 


7 
2 


1 
2 


f 


V 


5 

8 


A 


I 


f 


1 

T2 


i 

T2 


1 

20 


i 

24" 


L 


H 


32 


2 


If 


1 


f 


t 


f 


VI 


I 


1 


1 
T 


1 
2 


1 
2 


A 


1 

T2 


A 


LIJ 


6f 


3t 


2i 


If 


iA 


5 

6 


f 


1 


vi J 


1 7 

j 2 


3 

7 


2 


2 


l 
7 


i 

2 


A 


1 

T2 


LIV 


6f 


3f 


«i 


l T5 


if 


7 


7 


7 


VI I J 


j I 


1 


1 
2 


\ 


1 


i 
2 


A 


A 


LVI 


7 


32 


2| 


If 


if 


7 
2 


A 


1 


IX 


H 


4 

7 


t 


7 


2 
TT 


i 

7 


i 

TT 


i 

TT 


LVIIJ 


7i 


3f 


2f 


If 


if 


H 


f 


A 


X 


\*i 


1 


1 


A 


1 


1 
6 


A 


1 
T2 


lx (3j) 


72 


3* 


22 


If 


if 


if 


2 


A 


XI 


if 


it 


4 
2 


4 

TT 


2 


2 

TT 


i 

2 


TT 


3 ISS 


"f 


5f 


31 


2 T \ 


-if 


if 


1 5 

T2 


A 


XIJ 


"I 




\ 


3 

2 


1 


1 




1 
2 


A. 


IJ 


15 


7-2 


5 


3f 


2f 


if 


If 


if 


XI I J 


if 


4 




6 

TT 


2 

2 


3 

TT 


1 
5 


1 
2 


i 

To 


IJSS 


i8f 


9f 


6i- 


4A 


31 


2f 


If 


if 


XIV 


x f 


i 


4 


3 


f 


2 
2 


7 


1 

2 


IIJ 


22 £ 


"1 


72 


51 


31 


2f 


If 


if 


XV 


i| 


15 
16 


5 
8 


TT 


A 


2 

2 


7 


1 
2 


IIJSS 


26I 


i3l 


H 


6f 


4| 


37 


2f 


if 


XVI 


2 


I 


2 
2 


l 

2 


i 


1 

4" 


1 

6 


1 
2 


IV 


30 


15 


10 


7i 


5 


3| 


2f 


if 


XVIJ 


2-i 


*A 


7 
10 


TT 


A 


3 

TT 


1 


8 


V 


372 


i8f 


I2i 


9f 


H 


4f 


3f 


2f 


XVI I J 


»1 


If 


3 

T 


A 


3 

2 


2 
7 


A 


1 
7 


VI 


45 


22^ 


15 


»i 


7f 


51 


3| 


2f 


XIX 


*t 


I T 3 6" 


1 


2 


2 

5 


3 

TO 


i 

2 


7 


VIJ 


5*2 


26J 


172 


I3f 


8| 


6f 


4f 


3? 


XX 


«1 


*i 


5 

6 


5 

2 


A 


Iff 


* 


1 
2 


VII J (3 1 ) 


60 


30 


20 


15 


10 


7f 


5 


3f 


XXI 


«t 


*A 


6 

7 


f 


3 

7 


1 • 

2 


1 
2 


1 
2 


VIIJSS 


6 3 | 


3 I 2 


2IJ 


16 


iof 


8 


51 


4 


XXIJ 


2| 


if 


if 


11 
T2 


2 


1 ' 
2 


t 


1 


IX 


*7i 


33f 


22l 


i6f 


nf 


8 T r 2 


51 


4| 


XXIV 


3 


H 


I 


3 


1 
2 


3 

8 


¥ 


1 


X 


75 


371 


25 


i8f 


I2f 


9f 


6i 


4ff 


XXVI 


3l 


If 


'A 


9 

TT 


TT 


2 

9 


A 


1 
2 


XI 


to* 


41* 


272 


20f 


I3f 


IO T 3 2 


61 


51 


XXVIIJ 


3* 


If 


if 


7 
2 


4 

7 


3 

7 


2 

7 


t 


XIJ (giss) 


90 


45 


30 


22| 


15 


Ilf 


71 


51 


XXIX 


3f" 


I-?- 


if 


11 
T2 


f 


1 


A 


2 

2 


XIV 


105 


52| 


35 


261 


i7f 


i3f 


8| 


6f 


xxx(sss) 


3f 


jl 


if 


15 

T2 


5 
8 


_5_ 
1 1 


A 


1 
T 


XVI (glj) 


120 


60 


40 


30 


20 


15 


10 


71 



Explanation. — In Writing a Prescription look for the dose of the ingredient (say gr. ^) in 
the column headed by the size of your mixture ( ^ vi) ; then on that line in the left marginal column is 
the quantity (gr. Ijss) you must put into the entire mixture to get your dose in each drachm thereof. 
In Reading a Prescription find the quantity of any ingredient called for in the left marginal column 
(say gr. 3^),. and on the same line in the column headed by the number of ounces in the mixture (311J) 
you will find the quantity ( gr. 3^) in each drachm dose. Of course when the dose is more or less than 
5 1 the result must be proportionately multiplied or divided accordingly. 

Copyrighted, 1894, by P. Blakiston, Son & Co. 



